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Ellenbogen MI, Feldman LS, Prichett L, Zhou J, Brotman DJ. Development of a disease-based hospital-level diagnostic intensity index. Diagnosis (Berl) 2024; 0:dx-2023-0184. [PMID: 38643385 DOI: 10.1515/dx-2023-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES Low-value care is associated with increased healthcare costs and direct harm to patients. We sought to develop and validate a simple diagnostic intensity index (DII) to quantify hospital-level diagnostic intensity, defined by the prevalence of advanced imaging among patients with selected clinical diagnoses that may not require imaging, and to describe hospital characteristics associated with high diagnostic intensity. METHODS We utilized State Inpatient Database data for inpatient hospitalizations with one or more pre-defined discharge diagnoses at acute care hospitals. We measured receipt of advanced imaging for an associated diagnosis. Candidate metrics were defined by the proportion of inpatients at a hospital with a given diagnosis who underwent associated imaging. Candidate metrics exhibiting temporal stability and internal consistency were included in the final DII. Hospitals were stratified according to the DII, and the relationship between hospital characteristics and DII score was described. Multilevel regression was used to externally validate the index using pre-specified Medicare county-level cost measures, a Dartmouth Atlas measure, and a previously developed hospital-level utilization index. RESULTS This novel DII, comprised of eight metrics, correlated in a dose-dependent fashion with four of these five measures. The strongest relationship was with imaging costs (odds ratio of 3.41 of being in a higher DII tertile when comparing tertiles three and one of imaging costs (95 % CI 2.02-5.75)). CONCLUSIONS A small set of medical conditions and related imaging can be used to draw meaningful inferences more broadly on hospital diagnostic intensity. This could be used to better understand hospital characteristics associated with low-value care.
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Affiliation(s)
- Michael I Ellenbogen
- Department of Medicine, 1500 Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Leonard S Feldman
- Departments of Medicine and Pediatrics, 1500 Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Laura Prichett
- Biostatistics, Epidemiology, and Data Management (BEAD) Core, 1500 Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Junyi Zhou
- Biostatistics, Epidemiology, and Data Management (BEAD) Core, 1500 Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Daniel J Brotman
- Department of Medicine, 1500 Johns Hopkins School of Medicine , Baltimore, MD, USA
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Moreyra AE, Mehta C, Cosgrove NM, Zinonos S, Sargsyan D, Gold A, Trivedi M, Kostis JB, Cabrera J, Kostis WJ. Factors influencing the indication of coronary angiography in patients presenting with chest pain unspecified: an analysis of two decades (1994-2014). Int J Qual Health Care 2024; 36:mzae012. [PMID: 38408270 DOI: 10.1093/intqhc/mzae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024] Open
Abstract
Guidelines for cardiac catheterization in patients with non-specific chest pain (NSCP) provide significant room for provider discretion, which has resulted in variability in the utilization of invasive coronary angiograms (CAs) and a high rate of normal angiograms. The overutilization of CAs in patients with NSCP and discharged without a diagnosis of coronary artery disease is an important issue in medical care quality. As a result, we sought to identify patient demographic, socioeconomic, and geographic factors that influenced the performance of a CA in patients with NSCP who were discharged without a diagnosis of coronary artery disease. We intended to establish reference data points for gauging the success of new initiatives for the evaluation of this patient population. In this 20-year retrospective cohort study (1994-2014), we examined 107 796 patients with NSCP from the Myocardial Infarction Data Acquisition System, a large statewide validated database that contains discharge data for all patients with cardiovascular disease admitted to every non-federal hospital in NJ. Patients were partitioned into two groups: those offered a CA (CA group; n = 12 541) and those that were not (No-CA group; n = 95 255). Geographic, demographic, and socioeconomic variables were compared between the two groups using multivariable logistic regression, which determined the predictive value of each categorical variable on the odds of receiving a CA. Whites were more likely than Blacks and other racial counterparts (19.7% vs. 5.6% and 16.5%, respectively; P < .001) to receive a CA. Geographically, patients who received a CA were more likely admitted to a large hospital compared to small- or medium-sized ones (12.5% vs. 8.9% and 9.7%, respectively; P < .05), a primary teaching institution rather than a teaching affiliate or community center (16.1 % vs. 14.3% and 9.1%, respectively; P < .001), and at a non-rural facility compared to a rural one (12.1% vs. 6.5%; P < .001). Lastly from a socioeconomic standpoint, patients with commercial insurance more often received a CA compared to those having Medicare or Medicaid/self-pay (13.7% vs. 9.5% and 6.0%, respectively; P < .001). The utilization of CA in patients with NSCP discharged without a diagnosis of coronary artery disease in NJ during the study period may be explained by differences in geographic, demographic, and socioeconomic factors. Patients with NSCP should be well scrutinized for CA eligibility, and reliable strategies are needed to reduce discretionary medical decisions and improve quality of care.
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Affiliation(s)
- Abel E Moreyra
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Chirag Mehta
- Department of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street Providence, Providence, RI 02903, United States
| | - Nora M Cosgrove
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Stavros Zinonos
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Davit Sargsyan
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Alex Gold
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Mihir Trivedi
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Javier Cabrera
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, United States
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Palmowski L, von Busch A, Unterberg M, Bergmann L, Schmitz S, Schlüter A, Peters J, Adamzik M, Rahmel T. Timely Cessation of Proton Pump Inhibitors in Critically Ill Patients Impacts Morbidity and Mortality: A Propensity Score-Matched Cohort Study. Crit Care Med 2024; 52:190-199. [PMID: 38240505 PMCID: PMC10793775 DOI: 10.1097/ccm.0000000000006104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Proton pump inhibitors (PPIs) are among the drugs most commonly used in critically ill patients. Although mainly applied temporarily for stress ulcer prophylaxis, their application is frequently not terminated. Potential adverse effects of PPI treatment could impact the outcome in case of unnecessary and, therefore, avoidable long-term continuation. We tested the hypotheses that nonindicated PPI therapy continued beyond hospital discharge is associated with increased morbidity, rehospitalization rate, and mortality. DESIGN Nationwide retrospective cohort study considering critically ill patients treated on German ICUs between January, 2017, and December, 2018 with a 2-year follow-up. SETTING A total of 591,207 patient datasets of a German healthcare insurer were screened. PATIENTS We identified 11,576 ICU patients who received PPI therapy for the first time during their index ICU stay without having an indication for its continuation. INTERVENTIONS The cohort was stratified into two groups: 1) patients without further PPI therapy and 2) patients with continuation of PPI therapy beyond 8 weeks after hospital discharge. MEASUREMENTS AND MAIN RESULTS Frequency of predescribed adverse events associated with PPI therapy, 1-year rehospitalization rate, and 2-year mortality were determined. The proportion of patients with continued PPI therapy without an objectifiable indication was 41.7% (4,825 of 11,576 patients). These patients had a 27% greater risk of pneumonia (odds ratio [OR] 1.27; 95% CI, 1.15-1.39; p < 0.001) and a 17% greater risk of cardiovascular events (OR 1.17; 95% CI, 1.08-1.26; p < 0.001). Continued PPI therapy was associated with a 34% greater risk of rehospitalization (OR 1.34; 95% CI, 1.23-1.47) and a nearly 20% greater 2-year mortality risk (hazard ratio 1.17; 95% CI, 1.08-1.27; p = 0.006). CONCLUSIONS These data demonstrate that an unnecessary continuation of PPI therapy after hospital discharge may significantly impact morbidity and mortality. To avoid potentially harmful overuse of a PPIs, intensivists should ensure timely cessation of a temporarily indicated PPI therapy.
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Affiliation(s)
- Lars Palmowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Alexander von Busch
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Matthias Unterberg
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Lars Bergmann
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Stefanie Schmitz
- Abteilung I - Kranken und Pflegeversicherung, Knappschaft, Bochum, Germany
| | - Andreas Schlüter
- Hauptverwaltung, Knappschaft Kliniken GmbH, Recklinghausen, Germany
| | | | - Michael Adamzik
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Tim Rahmel
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
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Shin D, Cho HJ, Tsega S, Alaiev D, Talledo J, Chandra K, Manchego PA, Zaurova M, Garcia M, Jacobson J, Krouss M. Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System. J Gen Intern Med 2024; 39:13-18. [PMID: 37429975 PMCID: PMC10817880 DOI: 10.1007/s11606-023-08300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3 days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm. OBJECTIVE To reduce inappropriate duplicate T&S testing across a large, multihospital setting. SETTING The largest urban safety net health system in the USA, with 11 acute care hospitals. INTERVENTIONS Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S. MAIN MEASURES The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days. KEY RESULTS Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05). CONCLUSIONS Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.
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Affiliation(s)
- Dawi Shin
- Icahn School of Medicine, New York, NY, USA
| | - Hyung J Cho
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, USA
| | - Surafel Tsega
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
- Department of Medicine, NYC Health + Hospitals/Kings County, New York, NY, USA
| | - Daniel Alaiev
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Joseph Talledo
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Komal Chandra
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | - Peter Alarcon Manchego
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
- Department of Pediatrics, NYC Health + Hospitals/Kings County, New York, NY, USA
| | - Milana Zaurova
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine, New York, NY, USA
| | - Mariely Garcia
- Icahn School of Medicine, New York, NY, USA
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA
| | | | - Mona Krouss
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, USA.
- Department of Medicine, Icahn School of Medicine, New York, NY, USA.
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Domroes T, Weidlich K, Bohm S, Mersmann F, Arampatzis A. Personalized tendon loading reduces muscle-tendon imbalances in male adolescent elite athletes. Scand J Med Sci Sports 2024; 34:e14555. [PMID: 38268075 DOI: 10.1111/sms.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
An imbalanced adaptation of muscle strength and tendon stiffness in response to training may increase tendon strain (i.e., the mechanical demand on the tendon) and consequently tendon injury risk. This study investigated if personalized tendon loading inducing tendon strain within the effective range for adaptation (4.5%-6.5%) can reduce musculotendinous imbalances in male adolescent handball athletes (15-16 years). At four measurement time points during a competitive season, we assessed knee extensor muscle strength and patellar tendon mechanical properties using dynamometry and ultrasonography and estimated the tendon's structural integrity with a peak spatial frequency (PSF) analysis of proximal tendon ultrasound scans. A control group (n = 13) followed their usual training routine, an intervention group (n = 13) integrated tendon exercises into their training (3x/week for ~31 weeks) with a personalized intensity corresponding to an average of ~6.2% tendon strain. We found a significant time by group interaction (p < 0.005) for knee extensor muscle strength and normalized patellar tendon stiffness with significant increases over time only in the intervention group (p < 0.001). There were no group differences or time-dependent changes in patellar tendon strain during maximum voluntary contractions or PSF. At the individual level, the intervention group demonstrated lower fluctuations of maximum patellar tendon strain during the season (p = 0.005) and a descriptively lower frequency of athletes with high-level tendon strain (≥9%). The findings suggest that the personalized tendon loading program reduced muscle-tendon imbalances in male adolescent athletes, which may provide new opportunities for tendon injury prevention.
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Affiliation(s)
- Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kolja Weidlich
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Cho HJ, Talledo J, Alaiev D, Israilov S, Chandra K, Tsega S, Garcia M, Shin DW, Zaurova M, Alarcon Manchego P, Krouss M. Choosing Wisely and reducing the simultaneous ordering of erythrocyte sedimentation rate and C-reactive protein testing in a large safety net system. Am J Clin Pathol 2023; 160:585-592. [PMID: 37549105 DOI: 10.1093/ajcp/aqad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/03/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are commonly used inflammatory markers. C-reactive protein is more sensitive and specific for monitoring acute inflammation. However, it is commonly co-ordered with ESR despite recommendations against this. Our objective was to reduce unnecessary ESR orders and ESR/CRP co-ordering rates across a large safety net health system. METHODS This was a quality improvement project that used a quasi-experimental pre- and postintervention interrupted time-series regression analysis. Patients with a positive COVID-19 test were excluded. We designed a nonintrusive, normative nudge within the ESR order that recommended against co-ordering ESR and CRP. In addition, a best practice advisory triggered when ESR and CRP were simultaneously ordered. The outcome measures were ESR order rates per 1000 patient days in the inpatient setting and per 1000 patient encounters in the outpatient setting, as well as ESR/CRP co-ordering rates. RESULTS Inpatient ESR orders decreased from 12.02 preintervention to 5.61 per 1000 patient days (-53.3%, P < .001). Outpatient ESR orders decreased from 6.09 to 4.07 per 1000 patient encounters (-33.2%, P < .001). Relative co-ordering rates decreased by 50%. CONCLUSIONS This electronic health record initiative successfully reduced ESR testing across 11 hospitals and 70 ambulatory centers in a safety net setting.
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Affiliation(s)
- Hyung J Cho
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, US
| | - Joseph Talledo
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
| | - Daniel Alaiev
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
| | - Sigal Israilov
- Department of Anesthesia, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Komal Chandra
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
| | - Surafel Tsega
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
- Department of Medicine, NYC Health + Hospitals, New York, NY, US
| | - Mariely Garcia
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
| | - Da Wi Shin
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
| | - Milana Zaurova
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Peter Alarcon Manchego
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
- Pediatrics, NYC Health + Hospitals, New York, NY, US
| | - Mona Krouss
- Department of Quality and Safety, NYC Health + Hospitals, New York, NY, US
- Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, US
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Domroes T, Weidlich K, Bohm S, Arampatzis A, Mersmann F. Effect of sex on muscle-tendon imbalances and tendon micromorphology in adolescent athletes-A longitudinal consideration. Scand J Med Sci Sports 2023; 33:2561-2572. [PMID: 37697699 DOI: 10.1111/sms.14483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
Imbalances between muscle strength and tendon stiffness may cause high-level tendon strain during maximum effort muscle contractions and lead to tendon structural impairments and an increased risk for tendinopathy in adolescent athletes. However, it remains unclear whether the development of musculotendinous imbalances is influenced by sex. At four measurement time points during a competitive season, we measured quadriceps femoris muscle strength and patellar tendon mechanical properties in 15 female (14.3 ± 0.7 years) and 13 male (16.0 ± 0.6 years) elite handball players of similar maturity using dynamometry and ultrasonography. To estimate the tendon's structural integrity, the peak spatial frequency (PSF) of proximal tendon ultrasound scans was determined. Females demonstrated significantly lower muscle strength (p < 0.001) and patellar tendon stiffness (p < 0.001) than males with no significant changes over time (p > 0.05). Tendon strain during isometric maximum voluntary contractions and PSF neither differed between sexes nor changed significantly over time (p > 0.05). We found lower fluctuations in muscle strength (p < 0.001) in females during the season but no differences in the fluctuations of tendon strain, stiffness, and PSF (p > 0.05). Descriptively, there was a similar frequency (~40%) of athletes with high-level tendon strain (>9%) in both sexes. These findings suggest that the lower strength capacity of female athletes is paralleled by lower tendon stiffness. Thereby, muscle-tendon imbalances occur to a similar extent in both sexes leading to increased strain levels during the season, which indicates the need for specific tendon training.
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Affiliation(s)
- Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kolja Weidlich
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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8
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Calissendorff J. The dangerous trend of levothyroxine medicalization. Trends Endocrinol Metab 2023; 34:783-785. [PMID: 37714811 DOI: 10.1016/j.tem.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
Thyroid hormone replacement is paramount in overt hypothyroidism; recently, however, thyroid hormone substitution is increasingly prescribed to patients with normal thyroid hormone levels. This forum article discusses the complex causes and the possible negative effects of overusing thyroid hormone replacement drugs.
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Affiliation(s)
- Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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9
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Stojanović E, Faude O, Scanlan AT, Jakovljević V, Ćosić M, Kocić M, Radovanović D. Injury incidence among adolescent and senior basketball players: a prospective study in 19 teams across an entire season. PHYSICIAN SPORTSMED 2023:1-9. [PMID: 37965758 DOI: 10.1080/00913847.2023.2284133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/13/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To quantify and compare injury incidence between national-level, adolescent and regional-level, senior, male basketball players competing in Serbia overall and according to injury mechanism (contact, non-contact, or overuse), exposure setting (training or games), and history (new or recurrent). METHODS A total of 218 male basketball players from 19 teams (106 senior and 112 adolescent players) volunteered to participate in the study. Descriptive data regarding game and training injury incidence were gathered across all players and reported per 10,000 athlete-exposures (AE) with 95% confidence intervals. RESULTS Overall, 26 injuries were reported across 52,509 AE. Ankle (n = 10, incidence rate [IR] = 1.90 [0.97, 3.40]) and knee injuries (n = 8, IR = 1.52 [0.71, 2.89]) accounted for 69% of all reported injuries, with only 1-2 injuries documented for other body regions. Ankle injuries were attributed to contact (60%, IR = 1.14 [0.46, 2.38]) or non-contact mechanisms (40%, IR = 0.76 [0.24, 1.84]). Most knee injuries occurred due to overuse (50%, IR = 0.76 [0.24, 1.84]) or non-contact mechanisms (38%, IR = 0.57 [0.15, 1.56]). Comparisons according to exposure setting revealed significantly higher knee (incidence rate ratio [IRR] = 9.95 [1.85, 53.41], p = 0.004) and ankle (IRR = 39.79 [7.94, 384.67], p < 0.001) injuries per 10,000 AE during games compared to training. Recurrent injuries were most prominent in the ankle (30% of all ankle injuries, p = 0.11). Total contact (p = 0.04), non-contact (p = 0.04), and recurrent IR (p = 0.005) were significantly higher in senior than adolescent players. CONCLUSION The players examined were most susceptible to ankle and knee injuries, particularly during games compared to training. Ankle injuries were mostly attributed to player contact, while knee injuries were mostly attributed to overuse and non-contact mechanisms. Senior players were at a greater risk of sustaining contact, non-contact and recurrent injuries than adolescent players.
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Affiliation(s)
- Emilija Stojanović
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Aaron T Scanlan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Vladimir Jakovljević
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, State Medical University IM Sechenov, Moscow, Russian Federation
| | - Marko Ćosić
- Faculty of Sport and Physical Education, University of Belgrade, Belgrade, Serbia
| | - Miodrag Kocić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
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Hadjispyrou S, Hadjimichael AC, Kaspiris A, Leptos P, Georgoulis JD. Treatment and Rehabilitation Approaches for Stress Fractures in Long-Distance Runners: A Literature Review. Cureus 2023; 15:e49397. [PMID: 38146574 PMCID: PMC10749698 DOI: 10.7759/cureus.49397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Stress fractures (SFs) result from repetitive mechanical stress on bones, leading to an imbalance in osseous tissue adaptation and resulting in cortical fractures. The majority of SFs occur in the lower limb due to excessive mechanical loads. Long-distance runners are highly susceptible to SFs, especially when there is a significant increase in the load or intensity of their activity. Various intrinsic and extrinsic factors contribute to the development of SFs. Common SF locations in long-distance runners include the tibial shaft, femur, metatarsal, and pelvic region. Diagnosis may be delayed due to mild symptoms and unremarkable imaging tests. However, the chronicity and recurrence of misdiagnosed SFs may lead to debilitating complete fractures that are even more challenging to treat. In this review, we present data revealed from published case reports and case series studies obtained through PubMed and Embase databases focusing on the management of SFs in long-distance runners and correlate treatment outcomes with rehabilitation and return to high-level athletic performance.
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Affiliation(s)
| | | | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Patras, Patras, GRC
| | - Petros Leptos
- Orthopaedic Department, Saint Mary's and John's Polyclinic, Nicosia, CYP
- Medical School, University of Nicosia, Nicosia, CYP
| | - Jim D Georgoulis
- First Department of Orthopaedics, Attikon University General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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11
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Acosta GJ, Ospina NS, Brito JP. Overuse of thyroid ultrasound. Curr Opin Endocrinol Diabetes Obes 2023; 30:225-230. [PMID: 37288725 PMCID: PMC10527722 DOI: 10.1097/med.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW Thyroid ultrasound (TUS) is a common diagnostic test that can help guide the management of patients with thyroid conditions. Yet, inappropriate use of TUS can lead to harmful unintended consequences. This review aims to describe trends in the use and appropriateness of TUS in practice, drivers and consequences of inappropriate use, and potential solutions to decrease overuse. RECENT FINDINGS TUS use has increased in the U.S. and is associated with increased diagnosis of thyroid cancer. Between 10-50% of TUSs may be ordered outside of clinical practice recommendations. Patients who receive an inappropriate TUS and are incidentally found to have a thyroid nodule may experience unnecessary worry, diagnostic interventions, and potential overdiagnosis of thyroid cancer. The drivers of inappropriate TUS use are not yet fully understood, but it is likely that a combination of clinician, patient, and healthcare system factors contribute to this problem. SUMMARY Inappropriate TUS is a factor leading to the overdiagnosis of thyroid nodules and thyroid cancer, resulting in increased healthcare costs and potential harm to patients. To effectively address the overuse of this diagnostic test, it is necessary to gain a deeper understanding of the frequency of inappropriate TUS use in clinical practice and the factors that contribute to it. With this knowledge, interventions can be developed to reduce the inappropriate use of TUS, leading to improved patient outcomes and more efficient use of healthcare resources.
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Affiliation(s)
- Gonzalo J. Acosta
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
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12
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Kruiswijk AA, Kuhrij LS, Dorleijn DMJ, van de Sande MAJ, van Bodegom-Vos L, Marang-van de Mheen PJ. Follow-Up after Curative Surgical Treatment of Soft-Tissue Sarcoma for Early Detection of Recurrence: Which Patients Have More or Fewer Visits than Advised in Guidelines? Cancers (Basel) 2023; 15:4617. [PMID: 37760585 PMCID: PMC10527323 DOI: 10.3390/cancers15184617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Follow-up (FU) in soft-tissue sarcoma (STS) patients is designed for early detection of disease recurrence. Current guidelines are not evidenced-based and not tailored to patient or tumor characteristics, so they remain debated, particularly given concerns about cost, radiation frequency, and over-testing. This study assesses the extent to which STS patients received guideline-concordant FU and to characterize which type of patients received more or fewer visits than advised. METHODS All STS patients surgically treated at the Leiden University Medical Center between 2000-2020 were included. For each patient, along with individual characteristics, all radiological examinations from FU start up to 5 years were included and compared to guidelines. Recurrence was defined as local/regional recurrence or metastasis. RESULTS A total of 394 patients was included, of whom 250 patients had a high-grade tumor (63.5%). Only 24% of patients received the advised three FU visits in the first year. More FU visits were observed in younger patients and those diagnosed with a high-grade tumor. Among patients with a recurrence, 10% received fewer visits than advised, while 28% of patients without a recurrence received more visits than advised. CONCLUSIONS A minority of STS patients received guideline-concordant FU visits, suggesting that clinicians seem to incorporate recurrence risk in decisions on FU frequency.
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Affiliation(s)
- Anouk A. Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Laurien S. Kuhrij
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
| | - Desiree M. J. Dorleijn
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | | | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
| | - Perla J. Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands (P.J.M.-v.d.M.)
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13
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Heus P, van Dulmen SA, Weenink JW, Naaktgeboren CA, Takada T, Verkerk EW, Kamm I, van der Laan MJ, Hooft L, Kool RB. What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies. J Healthc Qual 2023; 45:261-271. [PMID: 37428942 PMCID: PMC10461725 DOI: 10.1097/jhq.0000000000000392] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Low-value care is healthcare leading to no or little clinical benefit for the patient. The best (combinations of) interventions to reduce low-value care are unclear. PURPOSE To provide an overview of randomized controlled trials (RCTs) evaluating deimplementation strategies, to quantify the effectiveness and describe different combinations of strategies. METHODS Analysis of 121 RCTs (1990-2019) evaluating a strategy to reduce low-value care, identified by a systematic review. Deimplementation strategies were described and associations between strategy characteristics and effectiveness explored. RESULTS Of 109 trials comparing deimplementation to usual care, 75 (69%) reported a significant reduction of low-value healthcare practices. Seventy-three trials included in a quantitative analysis showed a median relative reduction of 17% (IQR 7%-42%). The effectiveness of deimplementation strategies was not associated with the number and types of interventions applied. CONCLUSIONS AND IMPLICATIONS Most deimplementation strategies achieved a considerable reduction of low-value care. We found no signs that a particular type or number of interventions works best for deimplementation. Future deimplementation studies should map relevant contextual factors, such as the workplace culture or economic factors. Interventions should be tailored to these factors and provide details regarding sustainability of the effect.
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14
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Tokuda N, Watanabe D, Naito A, Yamauchi N, Ashida Y, Cheng AJ, Yamada T. Intrinsic contractile dysfunction due to impaired sarcoplasmic reticulum Ca 2+ release in compensatory hypertrophied muscle fibers following synergist ablation. Am J Physiol Cell Physiol 2023; 325:C599-C612. [PMID: 37486068 DOI: 10.1152/ajpcell.00127.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Synergist ablation (SA) is an experimental procedure for the induction of hypertrophy. However, SA causes a decrease in specific force (i.e., force per cross-sectional area), likely due to excessive muscle use. Here, we investigated the mechanisms behind the SA-induced intrinsic contractile dysfunction, especially focusing on the excitation-contraction (EC) coupling. Male Wistar rats had unilateral surgical ablation of gastrocnemius and soleus muscles to induce compensatory hypertrophy in the plantaris muscles. Two weeks after SA, plantaris muscle was dissected from each animal and used for later analyses. SA significantly increased the mean fiber cross-sectional area (+18%). On the other hand, the ratio of depolarization-induced force to the maximum Ca2+-activated specific force, an indicator of sarcoplasmic reticulum (SR) Ca2+ release, was markedly reduced in mechanically skinned fibers from the SA group (-51%). These functional defects were accompanied by an extensive fragmentation of the SR Ca2+ release channel, the ryanodine receptor 1 (RyR1), and a decrease in the amount of other triad proteins (i.e., DHPR, STAC3, and junctophilin1). SA treatment also caused activation of calpain-1 and increased the amount of NADPH oxidase 2, endoplasmic reticulum (ER) stress proteins (i.e., Grp78, Grp94, PDI, and Ero1), and lipid peroxidation [i.e., 4-hydroxynonenal (4-HNE)] in SA-treated muscles. Our findings show that SA causes skeletal muscle weakness due to impaired EC coupling. This is likely to be induced by Ca2+-dependent degradation of triad proteins, which may result from Ca2+ leak from fragmented RyR1 triggered by increased oxidative stress.NEW & NOTEWORTHY Synergist ablation (SA) has widely been used to understand the mechanisms behind skeletal muscle hypertrophy. However, compensatory hypertrophied muscles display intrinsic contractile dysfunction, i.e., a hallmark of overuse. Here, we demonstrate that SA-induced compensatory hypertrophy is accompanied by muscle weakness due to impaired sarcoplasmic reticulum Ca2+ release. This dysfunction may be caused by the degradation of triad proteins due to the reciprocal amplification of reactive oxygen species and Ca2+ signaling at the junctional space microdomain.
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Affiliation(s)
- Nao Tokuda
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Daiki Watanabe
- Graduate School of Sport and Health Sciences, Osaka University of Health and Sport Sciences, Osaka, Japan
| | - Azuma Naito
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Nao Yamauchi
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Yuki Ashida
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
- The Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Arthur J Cheng
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Takashi Yamada
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
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Bloom ET, Lin LM, Locke RC, Giordani A, Krassan E, Peloquin JM, Silbernagel KG, Parreno J, Santare MH, Killian ML, Elliott DM. Overload in a Rat In Vivo Model of Synergist Ablation Induces Tendon Multiscale Structural and Functional Degeneration. J Biomech Eng 2023; 145:081003. [PMID: 37184932 PMCID: PMC10782872 DOI: 10.1115/1.4062523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
Tendon degeneration is typically described as an overuse injury with little distinction made between magnitude of load (overload) and number of cycles (overuse). Further, in vivo, animal models of tendon degeneration are mostly overuse models, where tendon damage is caused by a high number of load cycles. As a result, there is a lack of knowledge of how isolated overload leads to degeneration in tendons. A surgical model of synergist ablation (SynAb) overloads the target tendon, plantaris, by ablating its synergist tendon, Achilles. The objective of this study was to evaluate the structural and functional changes that occur following overload of plantaris tendon in a rat SynAb model. Tendon cross-sectional area (CSA) and shape changes were evaluated by longitudinal MR imaging up to 8 weeks postsurgery. Tissue-scale structural changes were evaluated by semiquantified histology and second harmonic generation microscopy. Fibril level changes were evaluated with serial block face scanning electron microscopy (SBF-SEM). Functional changes were evaluated using tension tests at the tissue and microscale using a custom testing system allowing both video and microscopy imaging. At 8 weeks, overloaded plantaris tendons exhibited degenerative changes including increases in CSA, cell density, collagen damage area fraction (DAF), and fibril diameter, and decreases in collagen alignment, modulus, and yield stress. To interpret the differences between overload and overuse in tendon, we introduce a new framework for tendon remodeling and degeneration that differentiates between the inputs of overload and overuse. In summary, isolated overload induces multiscale degenerative structural and functional changes in plantaris tendon.
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Affiliation(s)
- Ellen T Bloom
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Lily M Lin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Ryan C Locke
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104; Translational Musculoskeletal Research Center, CMCVAMC, Philadelphia, PA 19104
| | - Alyssa Giordani
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Erin Krassan
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - John M Peloquin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Justin Parreno
- Department of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Michael H Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716
| | - Megan L Killian
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48104
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
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16
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Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance. Orthop J Sports Med 2023; 11:23259671231186820. [PMID: 37655246 PMCID: PMC10467408 DOI: 10.1177/23259671231186820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Background The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design Case series; Level of evidence, 4. Methods This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.
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Affiliation(s)
- Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey
| | | | - Gian Mario Micheloni
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Andrea Giorgini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
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17
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Hanlon SL, Scattone Silva R, Honick BJ, Silbernagel KG. Effect of Symptom Duration on Injury Severity and Recovery in Patients With Achilles Tendinopathy. Orthop J Sports Med 2023; 11:23259671231164956. [PMID: 37250747 PMCID: PMC10214069 DOI: 10.1177/23259671231164956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Achilles tendinopathy is a common overuse condition. Distinguishing between early- and late-stage tendinopathy may have implications on treatment decisions and recovery expectations. Purpose To compare the effects of time and baseline measures of tendon health on outcomes among patients with varying symptom durations after 16 weeks of comprehensive exercise treatment. Study Design Cohort study; Level of evidence, 3. Methods Participants (N = 127) were categorized into 4 groups based on the number of months since symptom onset: ≤3 months (n = 24); between >3 and ≤6 months (n = 25); between >6 and ≤12 months (n = 18); or >12 months (n = 60). All participants received 16 weeks of standardized exercise therapy and pain-guided activity modification. Outcomes representing symptoms, lower extremity function, tendon structure, mechanical properties, psychological factors, and patient-related factors were assessed at baseline and at 8 and 16 weeks after the initiation of exercise therapy. Chi-square tests and 1-way analysis of variance were used to compare baseline measures between groups.Time, group, and interaction effects were evaluated using linear mixed models. Results The mean age of the participants was 47.8 ± 12.6 years, 62 participants were women, and symptoms ranged from 2 weeks to 274 months. No significant differences were found among symptom duration groups at baseline for any measure of tendon health. At 16 weeks, all groups demonstrated improvements in symptoms, psychological factors, lower extremity function, and tendon structure, with no significant differences among the groups (P > .05). Conclusion Symptom duration did not influence baseline measures of tendon health. Additionally, no differences were observed among the different symptom duration groups in response to 16 weeks of exercise therapy and pain-guided activity modification.
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Affiliation(s)
- Shawn L. Hanlon
- Department of Physical Therapy,
University of Delaware, Newark, Delaware, USA
| | - Rodrigo Scattone Silva
- Department of Physical Therapy,
University of Delaware, Newark, Delaware, USA
- Brazilian Tendinopathy and Sports
Injuries Research Group, Postgraduate Program in Rehabilitation Sciences, Federal
University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Brian J. Honick
- Department of Physical Therapy,
University of Delaware, Newark, Delaware, USA
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18
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Cuker A, Tkacz J, Manjelievskaia J, Haenig J, Maier J, Bussel JB. Overuse of corticosteroids in patients with immune thrombocytopenia (ITP) between 2011 and 2017 in the United States. EJHaem 2023; 4:350-357. [PMID: 37206283 PMCID: PMC10188501 DOI: 10.1002/jha2.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/17/2023] [Indexed: 05/21/2023]
Abstract
Corticosteroids (CSs) are standard first-line therapy for immune thrombocytopenia (ITP). Prolonged exposure is associated with substantial toxicity; thus guidelines recommend avoidance of prolonged CS treatment and early use of second-line therapies. However, real-world evidence on ITP treatment patterns remains limited. We aimed to assess real-world treatment patterns in patients with newly-diagnosed ITP, using two large US healthcare databases (Explorys and MarketScan) between January 1, 2011 and July 31, 2017. Adults with ITP, ≥12 months of database registration prior to diagnosis, ≥1 ITP treatment, and ≥1 month enrollment following initiation of first ITP treatment were included (n = 4066 Explorys; n = 7837 MarketScan). Information on lines of treatment (LoTs) was collected. As expected, CSs were the most common first-line treatment (Explorys, 87.9%; MarketScan, 84.5%). However, CSs remained by far the most common treatment (Explorys ≥77%; MarketScan ≥85%) across all subsequent LoTs. Second-line treatments such as rituximab (12.0% Explorys; 24.5% MarketScan), thrombopoietin receptor agonists (11.3% Explorys; 15.6% MarketScan), and splenectomy (2.5% Explorys; 8.1% MarketScan) were used much less frequently. CS use is widespread in the US in patients with ITP across all LoTs. Quality improvement initiatives are needed to reduce CS exposure and bolster use of second-line treatments.
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Affiliation(s)
- Adam Cuker
- Department of Medicine and Department of Pathology and Laboratory MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - James B Bussel
- Pediatric Hematology/OncologyWeill Cornell MedicineNew YorkNew YorkUSA
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19
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Leonard LD, Beaty L, Thomas M, Quinn C, Colborn KL, de Araujo TB, Torphy RJ, Assumpção LR, Olino K, Studts CR, Rodriguez Franco S, McCarter M, Stewart C, Gleisner AL. Unmeasured factors are associated with the use of completion lymph node dissection (CLND) in melanoma. J Surg Oncol 2023; 127:716-726. [PMID: 36453464 DOI: 10.1002/jso.27153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Completion lymph node dissection (CLND) was the standard treatment for patients with melanoma with positive sentinel lymph nodes (SLN) until 2017 when data from the DeCOG-SLT and MLST-2 randomized trials challenged the survival benefit of this procedure. We assessed the contribution of patient, tumor and facility factors on the use of CLND in patients with surgically resected Stage III melanoma. METHODS Using the National Cancer Database, patients who underwent surgical excision and were found to have a positive SLN from 2012 to 2017 were included. A multivariable mixed-effects logistic regression model with a random intercept for the facility was used to determine the effect of patient, tumor, and facility variables on the risk of CLND. Reference effect measures (REMs) were used to compare the contribution of contextual effects (unknown facility variables) versus measured variables on the variation in CLND use. RESULTS From 2012 to 2017, the overall use of CLND decreased from 59.9% to 26.5% (p < 0.0001). Overall, older patients and patients with government-based insurance were less likely to undergo CLND. Tumor factors associated with a decreased rate of CLND included primary tumor location on the lower limb, decreasing depth, and mitotic rate <1. However, the contribution of contextual effects to the variation in CLND use exceeded that of the measured facility, tumor, time, and patient variables. CONCLUSIONS There was a decrease in CLND use during the study period. However, there is still high variability in CLND use, mainly driven by unmeasured contextual effects.
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Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laurel Beaty
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Madeline Thomas
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher Quinn
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathryn L Colborn
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Thiago B de Araujo
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert J Torphy
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lia R Assumpção
- Department of Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Kelly Olino
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christina R Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Salvador Rodriguez Franco
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.,The Heart Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Martin McCarter
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Camille Stewart
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ana L Gleisner
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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20
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Najjar S, Sultan HO, Falana HH, Ata RO, Manasrah MA, Dreidi M, Abukhalil AD, Naseef H. Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study. Germs 2023; 13:32-39. [PMID: 38023957 PMCID: PMC10659749 DOI: 10.18683/germs.2023.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 12/01/2023]
Abstract
Introduction One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.
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Affiliation(s)
- Shahenaz Najjar
- PhD, Assistant Professor, Dean Faculty of Graduate Studies, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine and Leuven Institute for Healthcare Policy, Pillar Quality and Safety, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Haya O Sultan
- MA, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Hiba H Falana
- MA, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Razan O Ata
- MA, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine
| | - Maryam A Manasrah
- MA, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine
| | - Mutaz Dreidi
- PhD, Assistant Professor, Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Abdallah D. Abukhalil
- PhD, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Hani Naseef
- PhD, Associate Professor, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
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21
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Winkelmann MT, Achenbach L, Zeman F, Laver L, Walter SS. The throwing shoulder in youth elite handball: adaptions of inferior but not anterior capsule thickness differ between the two sexes. Res Sports Med 2023; 31:112-124. [PMID: 34176387 DOI: 10.1080/15438627.2021.1943391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim was to investigate side-to-side and sex differences of anterior and inferior capsule thickness (ACT, ICT) between the throwing and non-throwing shoulder (TS, NTS) in youth elite handball players. 125 youth female and male elite handball players (14.1±0.7yo) were assessed for ACT and ICT by ultrasound . ACT measurement was performed from anterior (3 o'clock) in upright position and for ICT from inferior (6 o'clock) in supine position. Measurements of ICT in the TS of all athletes (1.4±0.2 mm) differed significantly but marginally to those in the NTS (1.3±0.2 mm) (p = 0.001). Female (1.2±0.2 mm vs. 1.3±0.2 mm; p = 0.007) but not male youth players (1.4±0.2 mm vs. 1.4±0.2 mm, p = n.s.) demonstrated slight differences in ICT in the TS compared with the NTS. Although significant, the thickness in the TS compared to the NTS was within the measurement accuracy of the ultrasonic assessment. No difference in ACT was observed in the TS (1.4±0.3 mm) compared to the NTS (1.4±0.3 mm) for both sexes (n.s.).In conclusion, the anterior and inferior capsule thickness in youth elite handball athletes is not or only marginally different between throwing and non-throwing shoulders.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Leonard Achenbach
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Lior Laver
- Department of Orthopaedics, Sports Medicine Unit, Hillel Yaffe Medical Center (HYMC), Hadera, Israel.,Rappaport Faculty of Medicine, Technion (Israel Institute of Technology), Halifax, Israel
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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22
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Grouse CK, Waung MW, Holmgren AJ, Mongan J, Neinstein A, Josephson SA, Khanna RR. Behavioral "nudges" in the electronic health record to reduce waste and misuse: 3 interventions. J Am Med Inform Assoc 2023; 30:545-550. [PMID: 36519951 PMCID: PMC9933068 DOI: 10.1093/jamia/ocac238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Electronic health records (EHRs) offer decision support in the form of alerts, which are often though not always interruptive. These alerts, though sometimes effective, can come at the cost of high cognitive burden and workflow disruption. Less well studied is the design of the EHR itself-the ordering provider's "choice architecture"-which "nudges" users toward alternatives, sometimes unintentionally toward waste and misuse, but ideally intentionally toward better practice. We studied 3 different workflows at our institution where the existing choice architecture was potentially nudging providers toward erroneous decisions, waste, and misuse in the form of inappropriate laboratory work, incorrectly specified computerized tomographic imaging, and excessive benzodiazepine dosing for imaging-related sedation. We changed the architecture to nudge providers toward better practice and found that the 3 nudges were successful to varying degrees in reducing erroneous decision-making and mitigating waste and misuse.
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Affiliation(s)
- Carrie K Grouse
- Department of Neurology, UCSF, San Francisco, California, USA
| | - Maggie W Waung
- Department of Neurology, UCSF, San Francisco, California, USA
| | - A Jay Holmgren
- Center for Clinical Informatics and Improvement Research, UCSF, San Francisco, California, USA
| | - John Mongan
- Department of Radiology, UCSF, San Francisco, California, USA
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Aaron Neinstein
- Division of Endocrinology, Department of Medicine, UCSF, San Francisco, California, USA
- UCSF Center for Digital Health Innovation, UCSF, San Francisco, California, USA
| | | | - Raman R Khanna
- Division of Hospital Medicine, Department of Medicine, UCSF, San Francisco, California, USA
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23
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de Las Vecillas L, Quirce S. Landscape of short-acting beta-agonists (SABA) overuse in Europe. Clin Exp Allergy 2023; 53:132-144. [PMID: 36468654 DOI: 10.1111/cea.14250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 12/11/2022]
Abstract
This review article provides an overview of short-acting beta-agonist (SABA) use and prescribing trends in Europe, summarizing updated data on the results from the industry-funded SABINA program (SABA use IN asthma) and other studies on this matter. SABA use continues to increase worldwide. Overuse has been defined as ≥3 canisters/year. Almost a third of European patients with asthma, at all severity levels, overuse SABA. Guidelines recommend close monitoring of patients who overuse SABA and avoiding over-reliance on SABA monotherapy. SABA overuse is associated with increased risk of asthma exacerbations and mortality, increased use of health services and negative physical and mental health outcomes. Reliance on SABA monotherapy can be unsafe and therefore it is necessary to change asthma treatment approaches and policies. Changes in physician and patient behaviours towards SABA use are required to ensure that patients with asthma are not over-reliant on SABA monotherapy. Notwithstanding, the limitations of the studies on the use of SABA should be considered, taking into account that the prescription/purchase of medication canisters does not always represent the actual use of the medication and that associations between SABA overuse and poor asthma outcomes may not be directly causal. National health systems and asthma guidelines must align asthma management with global recommendations and adjust them to local needs.
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Affiliation(s)
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
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24
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Youens D, Doust J, Ha NT, O'Leary P, Wright C, Parizel PM, Moorin R. Computed Tomography Angiography for Detection of Pulmonary Embolism in Western Australia Shows Increasing Use with Decreasing Diagnostic Yield. J Clin Med 2023; 12. [PMID: 36769627 DOI: 10.3390/jcm12030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Background: Pulmonary embolism (PE) can be fatal. Computed tomography pulmonary angiography (CTPA) can accurately diagnose PE, but it should be used only when reasonable pre-test probability exists. Overtesting with CTPA exposes patients to excess ionizing radiation and contrast media, while PE overdiagnosis leads to the treatment of small emboli unlikely to cause harm. This study assessed trends in CTPA use and diagnostic yield. We also assessed trends in PE hospitalizations and mortality to indicate PE severity. (2) Methods: Analysis of Western Australian linked administrative data for 2003-2015 including hospitalizations, emergency department (ED) attendances, and CTPA performed at hospitals. Age-sex standardized trends were calculated for CTPA use, PE hospitalizations, and mortality (as a proxy for severity). Logistic regression assessed diagnostic yield of CTPA following unplanned ED presentations. (3) Results: CTPA use increased from 3.3 per 10,000 person-years in 2003 (95% CI 3.0-3.6) to 17.1 per 10,000 person-years (16.5-17.7) in 2015. Diagnostic yield of CTPA increased from 12.7% in 2003 to 17.4% in 2005, declining to 12.2% in 2015 (p = 0.049). PE hospitalizations increased from 3.8 per 10,000 (3.5-4.1) in 2003 to 5.2 per 10,000 (4.8-5.5) in 2015. Mortality remained constant at 0.50 per 10,000 (0.39-0.62) in 2003 and 0.42 per 10,000 (0.32-0.51) in 2015. (4) Conclusions: CTPA increased from 2003 to 2015, while diagnostic yield decreased, potentially indicating overtesting. PE mortality remained constant despite increasing hospitalizations, likely indicating a higher proportion of less severe cases. As treatment can be harmful, this could represent overdiagnosis.
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25
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Trapani S, Montemaggi A, Indolfi G. Choosing Wisely in pediatric healthcare: A narrative review. Front Pediatr 2023; 10:1071088. [PMID: 36704146 PMCID: PMC9871764 DOI: 10.3389/fped.2022.1071088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background It has been estimated that 20% of the tests and therapies currently prescribed in North America are likely unnecessary, add no value, and may even cause harm. The Choosing Wisely (CW) campaign was launched in 2012 in the US and Canada to limit the overuse of medical procedures in adult and pediatric healthcare, to avoid overdiagnosis and overtreatment. Methods In this narrative review, we describe the birth and spread of the CW campaign all over the world, with emphasis on CW in pediatric healthcare. Results To date, CW has spread to more than 25 countries and 80 organizations, with 700 recommendations published. The awareness of medication overuse also made its way into pediatrics. One year after the launch of the CW campaign, the American Academy of Pediatrics and the pediatric section of the Society of Hospital Medicine provided the first recommendations specifically aimed at pediatricians. Thereafter, many European pediatric societies also became active in the CW campaign and published specific top-5 recommendations, although there is not yet a common set of CW recommendations in Europe. Discussion We reviewed the main pediatric CW recommendations in medical and surgical fields and discussed how the recommendations have been produced, published, and disseminated. We also analyzed whether and how the CW recommendations impacted pediatric medical practice. Furthermore, we highlighted the common obstacles in applying CW recommendations, such as pressure from patients and families, diagnostic uncertainty, and worries about legal problems. Finally, we highlighted the necessity to foster the CW culture, develop an implementation plan, and measure the results in terms of overuse decline.
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Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department NEUROFARBA, University of Florence, Florence, Italy
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26
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Pastor T, Schweizer A, Andronic O, Dietrich LG, Berk T, Gueorguiev B, Pastor T. A Life Dedicated to Climbing and Its Sequelae in the Fingers-A Review of the Literature. Int J Environ Res Public Health 2022; 19:17050. [PMID: 36554928 PMCID: PMC9778768 DOI: 10.3390/ijerph192417050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.
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Affiliation(s)
- Tatjana Pastor
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Andreas Schweizer
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
| | - Octavian Andronic
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
| | - Léna G. Dietrich
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3012 Bern, Switzerland
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Torsten Pastor
- Division of Hand Surgery, Department of Orthopaedics and Trauma Surgery, Balgrist University Hospital, University of Zurich, 8006 Zurich, Switzerland
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6002 Lucerne, Switzerland
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27
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Kakatkar S, Narayan A, Balkrishnan R. Prescription analgesic overuse in older adults: Can we mitigate this growing problem? Aging Med (Milton) 2022; 5:294-296. [PMID: 36606265 PMCID: PMC9805287 DOI: 10.1002/agm2.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
With older adults already on numerous prescription medications to manage their chronic conditions, the addition of pain medications could impose an even greater burden due to dependency issues. We need to understand the use of chronic pain medication, especially opioids, discuss current strategies and gaps, and offer potential solutions to mitigate overuse among older adults.
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Affiliation(s)
- Sara Kakatkar
- Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Aditya Narayan
- Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Rajesh Balkrishnan
- Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
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28
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Yoshida K, Nyland J, Krupp R. History of Ulnar Collateral Ligament Injury and College Pitcher Fastball Profiles: A Retrospective, Observational, Live Pitching Analysis. J Hand Surg Am 2022:S0363-5023(22)00536-6. [PMID: 36280555 DOI: 10.1016/j.jhsa.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/02/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to retrospectively compare the fastball profiles of pitchers who had previously sustained grade I or II ulnar collateral ligament (UCL) injuries, were rehabilitated, and released back for competition with those of pitchers with no history of elbow injury. METHODS Eighteen pitchers from the pitching staff of 1 National Collegiate Athletic Association Division III team participated in this study. Group 1 had a history of grade I or II UCL injury (n = 8), and group 2 (n = 10) did not. A computerized pitch tracking device was used to analyze ball movement and pitching mechanics. The hypothesis was that the pitchers with a history of injury (group 1) would display differing fastball velocity-ball movement relationships compared to those without (group 2). RESULTS The groups had similar heights, weights, pitching experiences, and arm slot positions at ball release. The pitching coach-determined preinjury arm slot position and the postinjury computerized pitch tracking device measurements after return to competition displayed strong agreement (r = 0.83), suggesting comparable pre and postinjury pitching techniques. The groups had comparable glenohumeral joint range of motion and fastball profiles, except that group 1 released the ball at a 2.5 times lesser horizontal distance away from the pitching rubber center. Group 2 also displayed consistently more robust and more frequent fastball movement relationships with velocity, horizontal break, and vertical break than group 1. CONCLUSIONS Reduced horizontal ball release distances at comparable vertical ball release heights without changes in the arm slot position suggest that pitchers with a history of grade I or II UCL injury have greater contralateral trunk tilt and elbow flexion at ball release. Increased contralateral trunk tilt may occur to increase pitch velocity at the expense of ball movement while placing the pitching elbow in a potentially injurious position. Computerized fastball profile analysis using a computerized pitch tracking device, in conjunction with coach pitching technique observation, and team medical staff clinical examination may help better identify pitchers with an increased risk of UCL injury. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Kei Yoshida
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY
| | - John Nyland
- Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY.
| | - Ryan Krupp
- Norton Sports Performance, Louisville, KY
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Muramoto Y, Kuruma H. The Effectiveness of Trunk and Balance Warm-up Exercises in Prevention, Severity, and Length of Limitation From Overuse and Acute Lower Limb Injuries in Male Volleyball Players. Int J Sports Phys Ther 2022; 17:1026-1032. [PMID: 36237657 PMCID: PMC9528693 DOI: 10.26603/001c.38019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Injuries in volleyball players are most common in the ankles and knees. Many volleyball players suffer from overuse injuries because of the strain placed on the lower extremities from repeated jumping. A characteristic of players who are most at risk for lower extremity injuries is the tendency to display trunk instability during landing, such as lateral flexion and rotation. Research has shown the effectiveness of exercise-based warm-up interventions for acute volleyball injuries. However, comprehensive analyses on the use of lower extremity, trunk, and balance programs to prevent overuse injuries are lacking. Purpose To examine the effects of trunk and balance warm-up exercises on the prevention, severity, and length of limitation of overuse and acute lower limb injuries in male volleyball players. Study Design Prospective, single-cohort study. Methods This study involved the 2019 (control group) and 2021 (intervention group) male volleyball teams. The control and intervention groups were on the same team; however, seven players joined in 2021 through a sports referral program through which different players are recruited. Measurements included injury incidence rate, injury severity, and injury burden. The intervention involved the addition of trunk and balance exercises during the 2021 season. Results There was no significant difference in injury incidence rates between groups. Injury severity decreased by 3.7 days for overuse injuries (p=0.04). Injury burden decreased by 11.8 (days/1000 player hours) overall and by 7.1 (days/1000 player hours) for overuse injuries. Conclusion The results show that an exercise-based warm-up aimed at improving trunk posture during landing did not reduce the incidence rate of injury in men's volleyball. However, the addition of this warm-up did significantly reduce the severity of overuse injury. Level of Evidence Level 3B.
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Affiliation(s)
- Yuki Muramoto
- Insutitute for Integrated Sports Medicine, Keio University
| | - Hironobu Kuruma
- Department of Physical Therapy Science, Tokyo Metropolitan University Graduate School of Human Health Sciences
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30
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Cheng H, Zhang Y, Sun J, Liu Y. How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis. Int J Environ Res Public Health 2022; 19:12226. [PMID: 36231527 PMCID: PMC9566082 DOI: 10.3390/ijerph191912226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/17/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017. OBJECTIVE This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives. METHODS This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective. RESULTS The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04). DISCUSSION The policy might reduce overprescription in public hospitals from the patient's perspective. The patient's attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.
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Affiliation(s)
- Hanchao Cheng
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Yuou Zhang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing 100730, China
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Lyamouri M, Mårild K, Gaardskaer Nielsen R, Størdal K. Proton pump inhibitors for infants in three Scandinavian countries increased from 2007-2020 despite international recommendations. Acta Paediatr 2022; 111:2222-2228. [PMID: 35860963 DOI: 10.1111/apa.16491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022]
Abstract
AIM There is weak evidence that proton pump inhibitors (PPIs) alleviate non-specific complaints often attributed to gastroesophageal reflux in infancy and international guidelines do not recommend their use. We studied PPIs dispensed for infants in three Nordic countries. METHODS This was an observational population-based study of infants living in Norway, Sweden and Denmark in 2007-2020. We used nationwide pharmaceutical registers to study dispensed PPIs. The data provided a total of 3.3 million observed years on about 240,000 annual births. RESULTS The overall use of PPIs in infancy showed a marked increase in all three countries from 2007-2020. In 2020, PPI dispensing was 46.4, 23.4 and 18.9 per 1000 per year in infants aged 0-11 months in Denmark, Norway and Sweden. These were increases of 357%, 585% and 556% respectively. Although the rate was highest in Denmark, it had decreased by 42% in the last three years of the study. CONCLUSION Despite international recommendations against routine PPI prescribing in infancy, dispensed PPIs increased more than four-fold on average in three Nordic countries from 2007-2020. The reason for this notable increase could not be established from the data, but the large variations over time, and between the countries, probably indicated unwarranted use.
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Affiliation(s)
| | - Karl Mårild
- Department of pediatrics, Sahlgrenska academy, Gothenburg University, Gothenburg, Sweden; Department of pediatric gastroenterology, Queen Silvia Children's hospital, Gothenburg, Sweden
| | | | - Ketil Størdal
- Department of pediatric research, University of Oslo, Oslo, Norway.,Division of pediatric and adolescent medicine, Oslo University Hospital, Oslo, Norway
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Mair H, Kenney NA, Uhl TL, Ullery LR, Hosey RG. Effect of Pitching Restrictions and Mound Distance on Youth Baseball Pitch Counts. Orthop J Sports Med 2022; 10:23259671221110547. [PMID: 35859649 PMCID: PMC9289911 DOI: 10.1177/23259671221110547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies have shown that higher pitch counts are directly related to a greater
incidence of elbow and shoulder pain among youth baseball pitchers. Purpose/Hypothesis: The purpose of this study was to examine the effect of different pitching
restriction rules on the number of pitches thrown in youth baseball leagues.
We hypothesized that more pitches would be thrown in leagues with inning
restrictions versus leagues with pitch count restrictions as well as in
leagues with a longer mound distance (from pitching mound to home
plate). Study Design: Cohort study; Level of evidence, 2. Methods: Pitch count data were collected for 2 consecutive years over a 10-week season
from 3 different leagues of 9- to 12-year-old baseball players in a single
city. The Eastern league had a pitch count restriction and 46-ft (14.02-m)
mound distance. The Southeastern and South leagues’ pitching restrictions
were based on innings per week. The Southeastern league had a 50-ft
(15.24-m) mound distance, while the South league had a 46-ft mound distance.
Comparisons of total seasonal pitches thrown were made of the 3
highest-volume pitchers on each team. League averages for each value were
then compared utilizing analysis of variance with Bonferroni post hoc
analysis. The number of pitchers in each league who threw >600 pitches
per season was compared using the chi-square test. Results: No significant difference in seasonal pitch counts or innings pitched was
noted between the Eastern and South leagues, which differed only in their
pitching restrictions. The Southeastern league, with a longer mound
distance, was found to have higher seasonal pitch counts per thrower (598 ±
195 pitches) than the South league (463 ± 198 pitches) for the 3
highest-volume throwers for each team (P = .004). The
Southeastern league also had a significantly larger number of pitchers who
threw >600 pitches per season (33 vs 20 for Eastern and 13 for South;
P = .009). Conclusion: There was no significant difference in seasonal pitch counts when the leagues
in this study differed based on pitching restrictions. However, the league
with a greater mound distance (Southeastern) had higher seasonal pitch
counts for the highest-volume throwers. Pitching restrictions based on pitch
counts, as opposed to innings, may be advisable.
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Affiliation(s)
- Hailey Mair
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | - Timothy L Uhl
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - L Robert Ullery
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Robert G Hosey
- University of Kentucky Medical Center, Lexington, Kentucky, USA
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Kwiatkowski LR, Jolles DR, Edwards C. Overuse, underuse, and misuse: Improving effective primary care at a Federally Qualified Health Center. Nurs Forum 2022; 57:703-709. [PMID: 35258107 DOI: 10.1111/nuf.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND U.S. healthcare costs have increased exponentially to almost $4 trillion. Despite increased costs, patient outcomes remain suboptimal. It is imperative that primary care providers are intentional with testing and medical technology to improve effective care. LOCAL PROBLEM Preintervention chart audits showed average overspending of $79.41 per provider per day. Despite overspending, outcomes are not optimal. Only 48% of persons with hypertension and 38% of persons with diabetes at Orange Blossom Family Health (OBFH) are controlled. The aim of this 8-week quality improvement (QI) project was to decrease lab spending by 20% for adult primary care patients at OBFH. METHODS A rapid cycle QI initiative of four Plan-Do-Study-Act cycles, 2 weeks each, was completed to implement four interventions concurrently. The data was assessed every 2 weeks with iterative tests of change as indicated. INTERVENTIONS The primary care quality metrics chart audit and preclinical care coordination tools were developed, and the My Life, My Healthcare tool and medical assistant (MA)-provider huddles were initiated with the focus on effective patient care. RESULTS A savings of $3406.43 on overordering of labs by one provider in 8 weeks was identified. The average provider compliance to national guidelines was found to be 54.1%. There was a 19.3% increase in referrals. MA-provider huddles were balanced for this initiative. CONCLUSIONS The initiative addressed effective care through awareness of resource allocation, patient engagement, and team communication. Continued application of these core interventions will ensure consistent and quality healthcare.
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Affiliation(s)
| | - Diana R Jolles
- Department of Medical, Frontier Nursing University, Versailles, Kentucky, USA
| | - Colin Edwards
- Department of Medical, Frontier Nursing University, Versailles, Kentucky, USA
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Fraiman J, Brownlee S, Stoto MA, Lin KW, Huffstetler AN. An Estimate of the US Rate of Overuse of Screening Colonoscopy: a Systematic Review. J Gen Intern Med 2022; 37:1754-1762. [PMID: 35212879 PMCID: PMC8877747 DOI: 10.1007/s11606-021-07263-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aims to assess the rate at which screening colonoscopy is performed on patients younger or older than the age range specified in national guidelines, or at shorter intervals than recommended. Such non-indicated use of the procedure is considered low-value care, or overuse. This study is the first systematic review of the rate of non-indicated completed screening colonoscopy in the USA. METHODS PubMed and Embase were queried for relevant studies on overuse of screening colonoscopy published from January 1, 2002, until January 23, 2019. English-language studies that were conducted for screening colonoscopy after 2001 for average-risk patients were included. Studies must have followed national guidelines for detecting rates of overuse. We followed methods outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the reporting recommendations of the Meta-analysis of Observational Studies in Epidemiology group (MOOSE). RESULTS A total of 772 papers were reviewed for inclusion; 42 were reviewed in full text. Of those reviewed, six studies met eligibility criteria, including a total of 459,503 colonoscopies of which 242,756 were screening colonoscopies. The rate of overuse ranged credibly from 17 to 25.7%. DISCUSSION This study demonstrates that screening colonoscopy is regularly performed in the USA more often, and in populations older or younger, than recommended by national guidelines. Such overuse wastes resources and places patients at unnecessary risk of harm. Efforts to reduce non-indicated screening colonoscopy are needed.
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Affiliation(s)
- Joseph Fraiman
- Department of Emergency Medicine, Thibodaux Regional Medical Center, Thibodaux, LA, USA. .,, New Orleans, USA.
| | | | - Michael A Stoto
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Kenneth W Lin
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
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Bézie A, Morisseau V, Rolland R, Guillemassé A, Brouard B, Chaix B. Using a Chatbot to Study Medication Overuse Among Patients Suffering From Headaches. Front Digit Health 2022; 4:801782. [PMID: 35373183 PMCID: PMC8968024 DOI: 10.3389/fdgth.2022.801782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
According to the World Health Organization, half the adult population around the world suffers from headaches. Even though this condition remains in most cases innocuous, it can have a major impact on the patient's quality of life but also on public health expenditure. Moreover, most patients manage their headaches on their own, without consulting a doctor. Therefore, self-medication can eventually lead to drug overuse, and consequently the emergence of a secondary disease called medication-overuse headache (MOH). The detection and follow-up of these unconventional patients represent a major challenge. Some of the latest technology advancements seem to be tailored and fitting for this context. The goal of this study is to investigate medication overuse in French patients suffering from headaches using the chatbot Vik Migraine. Data collection and analysis were assembled from answers to a questionnaire of 28 questions divided into three parts: socio-demographic profile, drug consumption, and medical follow-up. The study showed that medication overuse was often linked to increased headache frequency. Prescription drugs like triptans and opioids, were the most overused drugs among the cohort. This suggests that healthcare professionals could play a critical role in targeting these drugs in prevention of overuse.
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Affiliation(s)
- Arthur Bézie
- Wefight, Brain and Spine Institute, Paris, France
| | | | | | | | | | - Benjamin Chaix
- Wefight, Brain and Spine Institute, Paris, France.,Hospital Gui de Chauliac, Montpellier, France.,University of Montpellier, Montpellier, France
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Caverly TJ, Skurla SE, Klamerus ML, Sparks JB, Kerr EA, Hofer TP, Reed D, Damschroder LJ. Applying User-Centered Design to Develop Practical Strategies that Address Overuse in Primary Care. J Gen Intern Med 2022; 37:57-63. [PMID: 34535845 DOI: 10.1007/s11606-021-07124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Engaging patients and frontline clinicians in re-designing clinical care is essential for improving care delivery in a complex clinical environment. This study sought to assess an innovative user-centered design approach to improving clinical care quality, focusing on the use cases of de-intensifying non-beneficial care within the following areas: (1) de-intensifying diabetes treatment in high-risk patients; (2) stopping screening for carotid artery stenosis in asymptomatic patients; and (3) stopping colorectal cancer screening in average-risk, older adults. METHODS The user-centered design approach, consisting of patient and patient-clinician charrettes (defined as intensive workshops where key stakeholders collaborate to develop creative solutions to a specific problem) and participant surveys, has been described previously. Following the charrettes, we used inductive coding to identify and categorize themes emerging from the de-intensification ideas prioritized by participants as well as facilitator notes and audio recordings from the charrettes. RESULTS Thirty-five patients participated in the patient design charrettes, generating 134 unique de-intensification ideas and prioritizing 32, which were then distilled into six patient-generated principles of de-intensification by the study team. These principles provided a starting point for a subsequent patient-clinician charrette. In this follow-up charrette, 9 patients who had participated in an earlier patient design charrette collaborated with 7 clinicians to generate 63 potential de-intensification solutions. Six of these potential solutions were developed into multi-faceted, fully operationalized de-intensification strategies. DISCUSSION The de-intensification strategies that patients and clinicians prioritized and operationalized during the co-design charrette process were detailed and multi-faceted. Each component of a strategy had a rationale based on feasibility, practical considerations, and ways of overcoming barriers. The charrette-based process may be a useful way to engage clinicians and patients in developing the complex and multi-faceted strategies needed to improve care delivery.
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Achenbach L, Huppertz G, Zeman F, Weber J, Luig P, Rudert M, Krutsch W. Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes. BMJ Open Sport Exerc Med 2022; 8:e001270. [PMID: 35342642 PMCID: PMC8919472 DOI: 10.1136/bmjsem-2021-001270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Handball is associated with a high risk of overuse shoulder injury. This study investigated if an injury prevention programme effectively reduces overuse injury to the throwing shoulder of handball athletes. Methods 61 men’s and women’s handball teams (u-19 and senior athletes) were cluster-randomised into an intervention and a control group in the 2019–2020 season. Players of the intervention group regularly carried out an injury prevention programme. Both groups documented overuse shoulder injuries via an online questionnaire every second week. The primary endpoint was the prevalence of overuse injury to the throwing shoulder. Secondary endpoints were the influence of compliance on the primary endpoint and intensity of overuse shoulder symptoms measured by a shortened, handball-specific Western Ontario Shoulder Index (WOSI). Results 31 teams (295 players) in the intervention group and 30 teams (284 players) in the control group were included for analyses. The overall questionnaire response rate was 61%. The average prevalence of overuse shoulder injury did not significantly differ between the intervention group (n=109, 38.4% (95% CI 32.9% to 44.2%)) and the control group (n=106, 35.9% (95% CI 30.7% to 41.6%), p=0.542). Compliance with the intervention programme did not significantly affect overuse shoulder injury (p=0.893). Using generalised estimating equations for WOSI, the estimated mean for the intervention group was 44.6 points (95% CI 42.0 to 47.1) and 47.6 points for the control group (95% CI 44.9 to 50.3, p=0.111). Conclusions A multicomponent exercise programme using rubber bands and stretching did not significantly reduce the prevalence or symptoms of overuse throwing shoulder injury in handball athletes of both sexes. Randomised controlled study; level of evidence I. Trial registration number ISRCTN99023492.
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Affiliation(s)
- Leonard Achenbach
- Department of Orthopedics, König-Ludwig-Haus, Julius Maximilians University Würzburg, Würzburg, Germany.,Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Medical Center, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center, Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Maximilian Rudert
- Department of Orthopedics, König-Ludwig-Haus, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Roggio F, Trovato B, Ledda C, Rapisarda V, Musumeci G. Kinesiological Treatment of Early Spine Osteoarthritis in a Motorcyclist. Int J Environ Res Public Health 2022; 19:ijerph19020961. [PMID: 35055784 PMCID: PMC8776179 DOI: 10.3390/ijerph19020961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/26/2021] [Accepted: 01/11/2022] [Indexed: 12/10/2022]
Abstract
This case report speculates that the prolonged vibrations from enduro off-road sports are deleterious to the spine. The results of this case report may also aid sports physicians in better understanding this complex and relatively unknown phenomenon. No published data are present in the current literature that demonstrate the correlation between early spine osteoarthritis from enduro motorcycle overuse and the long-term management effects of a non-invasive kinesiological approach to reduce pain and inflammation and improve spine mobility and muscle strength.
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Affiliation(s)
- Federico Roggio
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli 6, 90144 Palermo, Italy
| | - Bruno Trovato
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (C.L.); (V.R.)
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (C.L.); (V.R.)
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (F.R.); (B.T.)
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123 Catania, Italy
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
- Correspondence: ; Tel.: +39-095-378-2043
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Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
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40
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Bao W, Zhang Y, Hang J, Guo Y, Tang W, Yun C, Deng J, Jin M, Lai K, Yu H, Beekman M, Zhou X, Zhang M. Short-acting beta-2 agonist prescription patterns and clinical outcomes in Chinese patients with asthma: an observational study in mainland China for the SABINA programme. Ther Adv Respir Dis 2022; 16:17534666221115054. [PMID: 36065527 PMCID: PMC9449520 DOI: 10.1177/17534666221115054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: The SABINA CHINA study aimed to determine prescription data for asthma
medication with a focus on SABA and ICS in a representative population of
patients with asthma in China. Methods: SABINA China was a multicentre, observational, cross-sectional study with
data collected retrospectively from a convenience sample of 25 tertiary
centres across China. Patients (age ⩾ 12 years) with ⩾3 consultations/year
were enrolled. Data were collected on clinical characteristics, asthma
severity, and symptom control (as per GINA 2017), treatment and history of
severe exacerbations over the past year. SABA over-prescription was defined
as ⩾3 SABA canisters/year. Descriptive statistics are presented. Results: Between March and August 2020, 498 patients were included in the outcome
analysis. Mean (SD) age was 48.7 (15.0) years, 57.9% were female and 91% had
moderate-to-severe asthma (n = 453). Overall, 12.5%
(n = 62) and 26.4% (n = 131) of
patients had uncontrolled and partly controlled asthma, respectively. SABA
add-on was prescribed to 20.3% (n = 101) of patients; one
patient with moderate-to-severe asthma was prescribed SABA-alone. SABA
over-prescription in the overall population was 4.0%
(n = 20; all with moderate-to-severe asthma) and 19.8%
(20/101) among those prescribed SABA add-on. In the mild asthma group, 50%
(n = 22) were prescribed ICS/LABA and 43.2%
(n = 19) were prescribed LTRA. Among those with
moderate-to-severe asthma, 97.4% (n = 441) were prescribed
ICS/LABA and 55.0% (n = 249) were prescribed LTRA.
Approximately 30% of patients (n = 149) experienced ⩾1% and
6.6% (n = 33) ⩾3 severe exacerbations in the preceding
year; mean annual number of severe exacerbation/patient was 0.6 (1.2). Among
those prescribed SABA add-on, ICS/LABA and LTRA (non-mutually exclusive
groups due to overlapping prescriptions), 54.5%, 29.9%, and 35.3% had ⩾1
severe exacerbations, respectively. Conclusion: Among patients with predominantly moderate-to-severe asthma managed in
tertiary care and were prescribed SABA, 1 in 5 received ⩾3 canisters/year.
Fewer patients who received ICS/LABA prescriptions experienced annual
exacerbations than those prescribed SABA add-on.
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Affiliation(s)
- Wuping Bao
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingqing Hang
- Department of Pulmonary and Critical Care Medicine, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Yubiao Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunmei Yun
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Jingmin Deng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meiling Jin
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huapeng Yu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Maarten Beekman
- International Medical Respiratory & Immunology, AstraZeneca Netherlands, The Hague, The Netherlands
| | - Xin Zhou
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai 200080, China
| | - Min Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai 200080, China
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Mo M, Hirokawa M, Satokawa H, Yasugi T, Yamaki T, Ito T, Onozawa S, Kobata T, Shirasugi N, Shokoku S, Sugano N, Sugiyama S, Hoshina K, On Behalf Of Guideline Committee Japanese Society Of Phlebology, Ogawa T, On Behalf Of Japanese Commitee Of Endovenous Treatment For Varicose Veins. Supplement of Clinical Practice Guidelines for Endovenous Thermal Ablation for Varicose Veins: Overuse for the Inappropriate Indication. Ann Vasc Dis 2021; 14:323-327. [PMID: 35082936 PMCID: PMC8752913 DOI: 10.3400/avd.ra.21-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
While endovenous thermal ablation (ETA) become first choice of treatment for varicose veins, overuse of ETA for the inappropriate indication is growing problem. ETA is performed not only on varicose cases without symptom but also non diseased cases with segmental reflux of saphenous veins or no reflux. Indications of ETA was demonstrated in “the Clinical Practice Guidelines for ETA for Varicose Veins 2019” by Japanese Society of Phlebology. Purpose of this supplement is description of basics of correct indication for ETA. We also demonstrate the typical case of overuse of ETA for wrong indication. (This is a translation of Jpn J Phlebol 2020; 31: 39–43.)
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Affiliation(s)
- Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan
| | | | - Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan
| | - Takumi Yasugi
- Department of Cardiovascular Surgery, Ehime University, Toon, Ehime, Japan
| | - Takashi Yamaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Nisinomiya, Hyogo, Japan
| | - Shiro Onozawa
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Takashi Kobata
- Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, Japan
| | - Nozomu Shirasugi
- Department of Vascular Surgery, Yokohama Asahi Chuo General Hospital, Yokohama, Kanagawa, Japan
| | | | - Norihide Sugano
- Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
| | - Satoru Sugiyama
- Department of Surgery, Hiroshima Teishin Hospital, Hiroshima, Hiroshima, Japan
| | | | - On Behalf Of Guideline Committee Japanese Society Of Phlebology
- Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan.,Ochanomizu Vascular and Vein Clinic, Tokyo, Japan.,Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.,Department of Cardiovascular Surgery, Ehime University, Toon, Ehime, Japan.,Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Department of Dermatology, Hyogo College of Medicine, Nisinomiya, Hyogo, Japan.,Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan.,Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, Japan.,Department of Vascular Surgery, Yokohama Asahi Chuo General Hospital, Yokohama, Kanagawa, Japan.,Shokoku Shintaro Clinic, Okayama, Okayama, Japan.,Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.,Department of Surgery, Hiroshima Teishin Hospital, Hiroshima, Hiroshima, Japan.,Department of Vascular Surgery, Tokyo University, Tokyo, Japan.,Department of Cardiovascular Surgery, Fukushima Dai-Ichi Hospital, Fukushima, Fukushima, Japan
| | - Tomohiro Ogawa
- Department of Cardiovascular Surgery, Fukushima Dai-Ichi Hospital, Fukushima, Fukushima, Japan
| | - On Behalf Of Japanese Commitee Of Endovenous Treatment For Varicose Veins
- Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan.,Ochanomizu Vascular and Vein Clinic, Tokyo, Japan.,Department of Cardiovascular Surgery, Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.,Department of Cardiovascular Surgery, Ehime University, Toon, Ehime, Japan.,Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Department of Dermatology, Hyogo College of Medicine, Nisinomiya, Hyogo, Japan.,Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan.,Department of Cardiovascular Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama, Japan.,Department of Vascular Surgery, Yokohama Asahi Chuo General Hospital, Yokohama, Kanagawa, Japan.,Shokoku Shintaro Clinic, Okayama, Okayama, Japan.,Department of Surgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.,Department of Surgery, Hiroshima Teishin Hospital, Hiroshima, Hiroshima, Japan.,Department of Vascular Surgery, Tokyo University, Tokyo, Japan.,Department of Cardiovascular Surgery, Fukushima Dai-Ichi Hospital, Fukushima, Fukushima, Japan
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Hofmann B, Andersen ER, Kjelle E. Visualizing the Invisible: Invisible Waste in Diagnostic Imaging. Healthcare (Basel) 2021; 9:1693. [PMID: 34946419 PMCID: PMC8702028 DOI: 10.3390/healthcare9121693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
There is extensive waste in diagnostic imaging, at the same time as there are long waiting lists. While the problem of waste in diagnostics has been known for a long time, the problem persists. Accordingly, the objective of this study is to investigate various types of waste in imaging and why they are so pervasive and persistent in today's health services. After a short overview of different conceptions and types of waste in diagnostic imaging (in radiology), we identify two reasons why these types of waste are so difficult to address: (1) they are invisible in the healthcare system and (2) wasteful imaging is driven by strong external forces and internal drivers. Lastly, we present specific measures to address wasteful imaging. Visualizing and identifying the waste in diagnostic imaging and its ingrained drivers is one important way to improve the quality and efficiency of healthcare services.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. Box 191, N-2802 Gjøvik, Norway; (E.R.A.); (E.K.)
- Centre for Medical Ethics, Institute for Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1130, N-0318 Oslo, Norway
| | - Eivind Richter Andersen
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. Box 191, N-2802 Gjøvik, Norway; (E.R.A.); (E.K.)
| | - Elin Kjelle
- Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. Box 191, N-2802 Gjøvik, Norway; (E.R.A.); (E.K.)
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Giroux A, Prudent C, Jouanny P, Muller G, Devilliers H, Vadot L. Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments. J Clin Med 2021; 10:5343. [PMID: 34830625 DOI: 10.3390/jcm10225343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.
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Ma T, Semsarian CR, Barratt A, Parker L, Kumarasinghe MP, Bell KJL, Nickel B. Rethinking Low-Risk Papillary Thyroid Cancers < 1cm (Papillary Microcarcinomas): An Evidence Review for Recalibrating Diagnostic Thresholds and/or Alternative Labels. Thyroid 2021; 31:1626-1638. [PMID: 34470465 DOI: 10.1089/thy.2021.0274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Recalibrating diagnostic thresholds or using alternative labels may mitigate overdiagnosis and overtreatment of papillary microcarcinoma (mPTC). We aimed at identifying and collating relevant epidemiological evidence on mPTC, to assess the case for recalibration and/or new labels. Methods: We searched EMBASE and PubMed databases from inception to December 2020 for natural history, autopsy, diagnostic drift, and diagnostic reproducibility studies. Where a relevant systematic review was pre-identified, only new articles were additionally included. Non-English articles were excluded. One author screened titles and abstracts. Two authors screened full text articles, performed quality assessments, and extracted data. We undertook narrative synthesis of included evidence (pooled estimates from systematic reviews and single estimates from primary studies). Results: One systematic review of patients undergoing active surveillance found that after 5 years of follow-up, 5.3% (95% confidence interval [CI 4.4-6.4%]) of the mPTC lesions had increased in size by ≥3 mm, and 1.6% [CI 1.1-2.4%] of patients had lymph node metastases. Among 7 new primary studies (including 3 updates on 2 studies included in the systematic review), 1-5% of patients undergoing active surveillance had lymph node metastases after a median follow-up of 1-10 years. One systematic review found that subclinical thyroid cancer incidentally discovered at autopsy is relatively common, with a pooled prevalence of 11.2% [CI 6.7-16.1%] among studies that examined the whole thyroid. Four diagnostic drift studies evaluated the new classification of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Three studies of cases previously diagnosed as papillary thyroid cancer found 1.3-2.3% were reclassified as NIFTP (reclassifications were from follicular variation of papillary thyroid cancer [FVPTC]). One study of 48 cases previously diagnosed as mPTC found that 23.5% were reclassified as NIFTP. Thirteen reproducibility studies of papillary thyroid lesions found substantial variation in the histopathological diagnosis of thyroid lesions, including FVPTC and NIFTP classifications (no study evaluated mPTC). Conclusions: This review supports consideration of recalibrating diagnostic thresholds and/or alternative labels for low-risk mPTC.
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Affiliation(s)
- Tara Ma
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin R Semsarian
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marian Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Discipline of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sugimoto D, Lambrinakos-Raymond K, Kobelski GP, Geminiani ET, Stracciolini A, Meehan WP. Sport specialization of female figure skaters: cumulative effects on low back injuries. PHYSICIAN SPORTSMED 2021; 49:463-468. [PMID: 33337938 DOI: 10.1080/00913847.2020.1855483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specialized female figure skaters, and 3) to identify an independent risk factor(s) for low back injuries in female figure skaters.Methods: A cross-sectional questionnaire study was used. Young female figure skaters were asked questions related to sport specialization and any history of low back injuries. The primary outcome variables were status of sport specialization, weekly training hours, and low back injury. Descriptive statistics, t-test, chi-square analyses, and binary logistic regressions were used.Results: Responses from 132 female figure skaters (mean age: 16.3 ± 2.7 years, age range: 8-22 years) were analyzed. Sixty-two percent (82/132) of figure skaters were specialized. Specialized female figure skaters spent more time in training (11.3 ± 6.5 hours/week) than non-specialized skaters (7.6 ± 4.9 hours/week, p = 0.001). No statistical differences were found in proportion of low back injury history between specialized (25.6%) and non-specialized female figure skaters (24.0%, p = 0.836). Chronological age was also identified as an independent risk factor for low back injuries in female figure skaters (aOR: 1.24, 95%CI: 1.00, 1.54, p = 0.048).Conclusions: The majority of female figure skaters in this cohort were specialized. An association between chronological age and low back injuries, found in the current study, may be a result of cumulative effects of participating in figure skating over time.
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Affiliation(s)
- Dai Sugimoto
- School of Sport Sciences, Waseda University, Tokyo, Japan.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | | | - Greggory P Kobelski
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Ellen T Geminiani
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
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Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
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Merrer J, Le Ray C, Bonnet C, Coulm B, Blondel B. Overuse of antenatal visits and ultrasounds in low-risk women: A national population-based study. Paediatr Perinat Epidemiol 2021; 35:674-685. [PMID: 34160099 DOI: 10.1111/ppe.12782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A better understanding of the overuse of antenatal care is needed to improve its organisation to deal with limited medical resources and doctor shortages. OBJECTIVES To assess the proportion of women who overuse antenatal care and the associations of overuse with maternal characteristics and the qualifications of healthcare providers. METHODS We used the 2016 National Perinatal Survey, a cross-sectional population-based survey, performed in all maternity units in France, including 13,132 women. Based on the French national guidelines, 6-8 antenatal visits were defined as adequate, 9-11 as high use, and ≥12 as overuse, while 3 ultrasounds were considered adequate, 4-5 as high use, and ≥6 as overuse. We performed binary modified Poisson regressions-with adequate care as the reference-including maternal social and medical characteristics and the healthcare professionals' qualifications. RESULTS After women with inadequate care were excluded, 19.2% of low-risk women had at least 12 visits and 30.5% at least 6 ultrasounds. Overuse of visits was associated with primiparity, average to high income, less than good psychological well-being, and care by an obstetrician. The risks of overuse of ultrasounds were higher among primiparous, women with average to high income and those receiving care from a public-sector obstetrician (adjusted relative risk 1.17, 95% CI, 1.13, 1.21) or private obstetrician (adjusted relative risk 1.12, 95% CI, 1.07, 1.16), compared with a public-sector midwife. CONCLUSIONS Antenatal care overuse is very common in France and associated with some maternal characteristics and also the qualification of care provider. Antenatal care should be customised according to women's needs, in particular for primiparae and those with poor well-being, and available medical resources.
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Affiliation(s)
- Jade Merrer
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Camille Le Ray
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France.,Port-Royal Maternity Unit, Assistance Publique-Hôpitaux de Paris - Centre, Université de Paris, Paris, France
| | - Camille Bonnet
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Bénédicte Coulm
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris/ Center of Research in Epidemiology and StatisticS(CRESS)/ Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé)/ INSERM/ INRA, Paris, France
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Dora JM, Biscolla RPM, Caldas G, Cerutti J, Graf H, Hoff AO, Mazeto GMFS, Magalhães PKR, Mesa CO, Scheffel RS, de Fatima Dos Santos Teixeira P, Vaisman F, Villagelin D, Maia AL. Choosing Wisely for Thyroid Conditions: Recommendations of the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism. Arch Endocrinol Metab 2021; 65:248-252. [PMID: 33587833 PMCID: PMC10065321 DOI: 10.20945/2359-3997000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Choosing Wisely (CW) is an initiative that aims to advance the dialogue between physicians and patients about low-value health interventions. Given that thyroid conditions are frequent in clinical practice, we aimed to develop an evidence-based list of thyroid CW recommendations. METHODS The Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) named a Task Force to conduct the initiative. The Task Force work was based on an electronic Delphi approach. The 10 recommendations that received the highest scores by the Task Force were submitted for voting by all SBEM associates. The 5 recommendations that received the highest scores by SBEM associates are presented herein. RESULTS The Task Force was composed of 14 thyroidologists from 10 tertiary-care, teaching-based Brazilian institutions. The brainstorming/ideation phase resulted in 69 recommendations. After the removal of duplicates and recommendations that did not adhere to the initiative's scope, 35 remained. Then the Task Force voted to attribute a grade (0 [lowest agreement] to 10 [highest agreement]) for each recommendation. The 10 recommendations that received the highest scores by the Task Force were submitted to all SBEM associates. A total of 683 associates voted electronically, attributing a grade (0 to 10) for each recommendation. The 5 recommendations that received the highest scores by the SBEM associates compose our final list. CONCLUSION A set of recommendations to avoid unnecessary medical tests, treatments, or procedures for thyroid conditions are offered with a transparent methodology. This initiative aims to foster productive interactions between physicians and patients, stimulating shared decision-making.
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Affiliation(s)
- Jose Miguel Dora
- Unidade de Tireoide do Hospital de Clínicas de Porto Alegre e Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil,
| | | | - Gustavo Caldas
- Faculdade de Medicina da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil
| | - Janete Cerutti
- Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Hans Graf
- Faculdade de Medicina da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Ana O Hoff
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brasil
| | - Glaucia M F S Mazeto
- Faculdade de Medicina da Universidade Estadual Paulista (Unesp), Botucatu, SP, Brasil
| | | | - Cleo Otaviano Mesa
- Faculdade de Medicina da Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
| | - Rafael Selbach Scheffel
- Unidade de Tireoide do Hospital de Clínicas de Porto Alegre e Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
| | | | | | - Danilo Villagelin
- Faculdade de Medicina da Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil
| | - Ana Luiza Maia
- Unidade de Tireoide do Hospital de Clínicas de Porto Alegre e Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil
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Gooch B, Lambert BS, Goble H, McCulloch PC, Hedt C. Relationship Between Pitch Volume and Subjective Report of Injury in High School Female Fast-Pitch Softball Pitchers. Sports Health 2021; 14:702-709. [PMID: 34672828 DOI: 10.1177/19417381211051381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The relationship between pitch volume and injury is well-represented within baseball literature. However, the impact of softball pitch volume on injury epidemiology is limited. HYPOTHESIS The purpose was to determine if increased pitch volumes in high school-aged softball pitchers are related to increased rates of subjectively reported pain/injury. We hypothesized that pitchers with increased volumes would have higher pain/injury rates. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS A total of 28 female softball pitchers (aged 14-18 years) completed an online survey of questions pertaining to pitching history, pitch volume, and subjective report of pain or injury in the back, shoulder, and elbow. An independent-samples t test was used to (1) compare pitch volumes in those who reported pain in individual body regions (shoulder, elbow, back) compared with those who did not; (2) compare pitch volumes in those who reported pain in 0 or 1 of the regions of interest compared with 2 or 3 regions; and (3) compare the reported percentage of the past year that players reported playing through pain in players who averaged >85 compared with <85 pitches per game. Chi-square analysis was used to compare those who pitched either >85 or <85 pitches per game with regard to frequency of shoulder pain, elbow pain, back pain, seeking of medical attention, and actual injury diagnosis. Type I error was set at α = 0.05. RESULTS Weekly and yearly pitch counts were higher in those reporting pain or injury (YES) than those who did not (NO) in the shoulder (pitches per week: NO = 219 ± 35; YES = 429 ± 101; P = 0.027) (pitches per year: NO = 8876 ± 946; YES = 19,195 ± 4944; P = 0.022) and back (pitches per week: NO = 188 ± 16; YES = 426 ± 90; P = 0.014) (pitches per year: NO = 8334 ± 793; YES = 18,252 ± 4340; P = 0.027). Similar results were observed for those with pain or injury reported in 2 or 3 regions compared with 0 or 1 regions (pitches per week: NO = 220 ± 38; YES = 414 ± 95; P = 0.039) (pitches per year: NO = 8765 ± 1010; YES = 18,661 ± 4623; P = 0.028). Those reporting shoulder pain or injury also reported higher pitch counts per game (NO = 71.4 ± 5.2; YES = 83 ± 4; P = 0.049), and those reporting back pain also reported playing more games per week (NO = 2.7 ± 0.2; YES = 5.2 ± 1.1; P = 0.034). Those with pitch counts of >85/game were more than twice as likely to see a physician regarding pain/injury (P = 0.027) and reported playing through pain a higher percentage of the year (>85, 49.3% ± 10%; <85, 25.2% ± 6%; P < 0.05). CONCLUSION High pitching volumes commonly prevalent in high school-aged softball pitchers may be associated with increased pain/injury and appear related to cumulative volume. CLINICAL RELEVANCE This study provides recommendations for cumulative pitch volume guidelines in softball pitchers.
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Affiliation(s)
| | | | - Haley Goble
- Orthopedics and Sports Medicine, Houston Methodist, Houston, Texas
| | | | - Corbin Hedt
- Orthopedics and Sports Medicine, Houston Methodist, Houston, Texas
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50
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Pellatt RAF, Kamona S, Chu K, Sweeny A, Kuan WS, Kinnear FB, Karamercan MA, Klim S, Wijeratne T, Graham CA, Body R, Roberts T, Horner D, Laribi S, Keijzers G, Kelly AM. The Headache in Emergency Departments study: Opioid prescribing in patients presenting with headache. A multicenter, cross-sectional, observational study. Headache 2021; 61:1387-1402. [PMID: 34632592 DOI: 10.1111/head.14217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/02/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the patterns of opioid use in patients presenting to the emergency department (ED) with nontraumatic headache by severity and geography. BACKGROUND International guidelines recognize opioids are ineffective in treating primary headache disorders. Globally, many countries are experiencing an opioid crisis. The ED can be a point of initial exposure leading to tolerance for patients. More geographically diverse data are required to inform practice. METHODS This was a planned, multicenter, cross-sectional, observational substudy of the international Headache in Emergency Departments (HEAD) study. Participants were prospectively identified throughout March 2019 from 67 hospitals in Europe, Asia, Australia, and New Zealand. Adult patients with nontraumatic headache were included as identified by the local site investigator. RESULTS Overall, 4536 patients were enrolled in the HEAD study. Opioids were administered in 1072/4536 (23.6%) patients in the ED, and 386/3792 (10.2%) of discharged patients. High opioid use occurred prehospital in Australia (190/1777, 10.7%) and New Zealand (55/593, 9.3%). Opioid use in the ED was highest in these countries (Australia: 586/1777, 33.0%; New Zealand: 221/593, 37.3%). Opioid prescription on discharge was highest in Singapore (125/442, 28.3%) and Hong Kong (12/49, 24.5%). Independent predictors of ED opioid administration included the following: severe headache (OR 4.2, 95% CI 3.1-5.5), pre-ED opioid use (OR 1.42, 95% CI 1.11-1.82), and long-term opioid use (OR 1.80, 95% CI 1.26-2.58). ED opioid administration independently predicted opioid prescription at discharge (OR 8.4, 95% CI 6.3-11.0). CONCLUSION Opioid prescription for nontraumatic headache in the ED and on discharge varies internationally. Severe headache, prehospital opioid use, and long-term opioid use predicted ED opioid administration. ED opioid administration was a strong predictor of opioid prescription at discharge. These findings support education around policy and guidelines to ensure adherence to evidence-based interventions for headache.
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Affiliation(s)
- Richard A F Pellatt
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Sinan Kamona
- Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Queensland, Australia.,Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Amy Sweeny
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Frances B Kinnear
- Faculty of Medicine, University of Queensland, Queensland, Australia.,Emergency & Children's Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mehmet A Karamercan
- Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Emergency Medicine, University of Health Sciences, Ankara, Turkey
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, St Albans, Victoria, Australia.,Public Health School, La Trobe University, Bundoora, Victoria, Australia
| | - Colin A Graham
- Emergency Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR
| | - Richard Body
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tom Roberts
- Emergency Department, North Bristol NHS Trust, Bristol, UK
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Gerben Keijzers
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine, Victoria, Australia.,Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
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