Endoscopic procedures and diagnoses are not influenced by seasonal variations

Epidemiology of Helicobacter pylori

In many countries alike, the time trends of gastric cancer, gastric and duodenal ulcer, ulcerative colitis, Crohn's disease, and colorectal cancer are characterized by similar birth-cohort patterns. Mortality from these diagnoses rose in cohorts born during the 19th century and then fell in subsequent cohorts born during the 20th century.

December Is Coming: A Time Trend Analysis of Monthly Variation in Adult Elective Anesthesia Caseload across Florida and Texas Locations of a Large Multistate Practice

BACKGROUND

Anesthesia staffing models rely on predictable surgical case volumes. Previous studies have found no relationship between month of the year and surgical volume. However, seasonal events and greater use of high-deductible health insurance plans may cause U.S. patients to schedule elective surgery later in the calendar year. The hypothesis was that elective anesthesia caseloads would be higher in December than in other months.

METHODS

This review analyzed yearly adult case data in Florida and Texas locations of a multistate anesthesia practice from 2017 to 2019. To focus on elective caseload, the study excluded obstetric, weekend, and holiday cases. Time trend decomposition analysis was used with seasonal variation to assess differences between December and other months in daily caseload and their relationship to age and insurance subgroups.

RESULTS

A total of 3,504,394 adult cases were included in the analyses. Overall, daily caseloads increased by 2.5 ± 0.1 cases per day across the 3-yr data set. After adjusting for time trends, the average daily December caseload in 2017 was 5,039 cases (95% CI, 4,900 to 5,177), a 20% increase over the January-to-November baseline (4,196 cases; 95% CI, 4,158 to 4,235; P < 0.0001). This increase was replicated in 2018: 5,567 cases in December (95% CI, 5,434 to 5,700) versus 4,589 cases at baseline (95% CI, 4,538 to 4,641), a 21.3% increase; and in 2019: 6,103 cases in December (95% CI, 5,871 to 6,334) versus 5,045 cases at baseline (95% CI, 4,984 to 5,107), a 21% increase (both P < 0.001). The proportion of commercially insured patients and those aged 18 to 64 yr was also higher in December than in other months.

CONCLUSIONS

In this 3-yr retrospective analysis, it was observed that, after accounting for time trends, elective anesthesia caseloads were higher in December than in other months of the year. Proportions of commercially insured and younger patients were also higher in December. When compared to previous studies finding no increase, this pattern suggests a recent shift in elective surgical scheduling behavior.

EDITOR’S PERSPECTIVE

Definition, Pathogenesis, and Management of That Cursed Dyspepsia

Dyspepsia is an umbrella term used to encompass a number of symptoms thought to originate from the upper gastrointestinal tract. These symptoms are relatively nonspecific; not surprisingly, therefore, a myriad of conditions may present with any one or a combination of these symptoms. Therein lays the clinician's first challenge: detecting the minority who may have a potentially life-threatening disorder, such as gastric cancer, from a population whose symptoms are, for the most part, considered functional in origin. The second challenge lies in the definition and management of those individuals with functional dyspepsia (FD); the major focus of this review. The Rome process has addressed the issue of FD definition and a look back at the evolution of Rome criteria for this disorder illustrates the complexities that have so frustrated us. There has been no shortage of hypotheses to explain symptom pathogenesis in FD; initially focused on gastric sensorimotor dysfunction, these have now strayed well into the duodenum and have come to entertain such factors as immune responses and the microbiome. FD has proven to be an equally challenging area for therapeutics; while the staple approaches of acid suppression and eradication of Helicobacter pylori have some limited efficacy in select populations, strategies to ameliorate symptoms in the majority of sufferers based on presumed pathophysiology have largely foundered. Lacking a validated biomarker(s) FD continues to be an elusive target and is likely to remain so until we can better define the various phenotypes that it must surely contain.

Importance of gender, socioeconomic status, and history of abuse on patient preference for endoscopist

OBJECTIVES

Patients have previously expressed preference for the gender of their endoscopist. Most of these patients were Caucasian women of predominantly high socioeconomic status. No study has evaluated the gender preferences of both women and men from a diverse but predominantly low socioeconomic background. The aim of this study was to evaluate gender preferences for endoscopists within an inner-city, tertiary care population.

METHODS

Consecutive patients scheduled for elective outpatient upper or lower endoscopy were prospectively asked to complete a questionnaire. Data included patient demographics, income level, education level, medical history, social history, abuse history, and gender preferences toward various health-care professionals.

RESULTS

A total of 500 patients completed the study (286 women, 214 men). Overall, 33% of patients surveyed had a preference for the gender of their endoscopist (165/500; CI: 29-37%). Women were significantly more likely to have a gender preference vs. men (42.3 vs. 21%; P<0.001). Female gender, lower income level, and history of physical/emotional abuse were significant factors for gender preference, as shown by multivariate analysis. Of our patients, 88 (18%) reported a history of abuse. A history of abuse significantly increased the percentage of patients with a gender preference for endoscopist (P<0.001).

CONCLUSIONS

Women in our inner-city tertiary care center expressed gender preference for their endoscopist at rates similar to those seen in previous studies. A higher percentage of men had a gender preference than previously reported. Both men and women with a history of abuse are significantly more likely to prefer a woman endoscopist. Physicians should be aware of these high preference rates to increase compliance and optimize patient care.