scholarly journals Defensive medicine in neurosurgery: the Canadian experience

2016 ◽  
Vol 124 (5) ◽  
pp. 1524-1530 ◽  
Author(s):  
Timothy R. Smith ◽  
M. Maher Hulou ◽  
Sandra C. Yan ◽  
David J. Cote ◽  
Brian V. Nahed ◽  
...  
Keyword(s):  
Online Survey ◽  
Insurance Coverage ◽  
Patient Characteristics ◽  
Defensive Medicine ◽  
Published Data ◽  
Risk Environment ◽  
Malpractice Insurance ◽  
The Us ◽  
Survey Responses ◽  
The Impact

OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian neurosurgeons and used to measure Canadian neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosurgeons felt confident with their insurance coverage, and 60% reported that they rarely felt the need to practice defensive medicine. The majority of the respondents reported that the perceived medicolegal risk environment has no bearing on their preferred practice location. Only 1 in 5 respondent Canadian neurosurgeons (21.8%) reported viewing patients as a potential lawsuit. Only 4.9% of respondents would have selected a different career based on current medicolegal risk factors, and only 4.1% view the cost of annual malpractice insurance as a major burden. CONCLUSIONS Canadian neurosurgeons perceive their medicolegal risk environment as more favorable and their patients as less likely to sue than their counterparts in the US do. Overall, Canadian neurosurgeons engage in fewer defensive medical behaviors than previously reported in the US.

scholarly journals 469. The Mental Health Implications of Job Loss for Never-married Women During the COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S337-S337
Author(s):  
Katherine Kricorian
Keyword(s):  
Mental Health ◽  
Job Loss ◽  
Online Survey ◽  
Community Support ◽  
Adult Women ◽  
Never Married ◽  
The Us ◽  
Mental Health Programs ◽  
Us Census ◽  
The Impact

Abstract Background The COVID-19 pandemic was associated with an array of social and economic events, influencing how the pandemic affected people of all genders. In particular, job losses surged during the COVID-19 pandemic, especially among women. We analyzed how the pandemic and rising job losses affected the mental health of unmarried women with and without children in order to identify possible health disparities, potential causal factors and opportunities for interventions. Methods Data were collected from Wave 3 (January 6-February 15, 2021) of the US Census COVID-19 Household Pulse online survey designed to measure the impact of COVID-19. Microdata files were downloaded from the Census website and included N=13,940 never-married female respondents aged 25-54 years old. Data were analyzed using χ2 tests, with z-tests for more granular between-group comparisons. Results When asked if they had felt anxiety in the past week, 31% of respondents without children in the household and 28% of those with children reported feeling anxiety nearly every day (p< .05). Among those who did not lose work during the pandemic, 24% of those without children felt anxiety nearly every day vs. 20% of those with children (p< .05). Among those who did experience pandemic-related job loss, 33% of those with children and 42% of those without children reported daily anxiety (p< .05). Conclusion Overall, COVID-19 job loss was associated with higher levels of anxiety for never-married adult women. Notably, respondents without children expressed significantly higher levels of anxiety than respondents with children, and this difference was even greater when comparing those who had lost jobs during the pandemic. Reasons are being further researched but may be related to mothers’ greater opportunities for social and community support, particularly when encountering difficult circumstances. These results have implications for the development of mental health programs serving women experiencing environmental stressors such as job loss, especially women without children who may not have the same mental health and community support. Disclosures All Authors: No reported disclosures

scholarly journals Perceived impact of meteorological conditions on the use of public space in winter settlements

2020 ◽  
Vol 64 (4) ◽  
pp. 631-642
Author(s):  
Agneta Larsson ◽  
David Chapman
Keyword(s):  
Public Space ◽  
Online Survey ◽  
Ground Surface ◽  
Weather Conditions ◽  
Public Spaces ◽  
Meteorological Conditions ◽  
Ambient Conditions ◽  
Cross Sectional ◽  
Survey Responses ◽  
The Impact

AbstractThis study aimed to assess the impact of meteorological conditions on the use of public space in Scandinavia and Canada. Between September 21 and December 18, 2017, a cross-sectional online survey ‘EAMQ-Climate: space’ was distributed via web-based platforms. Survey responses were received from 361 residents (258 people from Scandinavia and 103 from Canada). The relative impact of the meteorological determinants on the use of public space was calculated, and a factor analysis was performed. Disparities between Canada and Scandinavia as well as between the climate zones represented were analysed using ANOVA. Overall results showed that the most significant meteorological enablers for the use of outdoor public spaces in winter were solar gain, snowfall and snow-covered surfaces. The main barriers were slush-covered and icy surfaces, rainfall and darkness. Wind and cold were conditions with less influence. The impact of rain and ice, however, differed between climatic zones. It was also established that, when addressing the meteorological impact on avoiding the use of public spaces in winter, it is vital to discriminate between conditions related to a) the ground surface and b) ambient conditions, as well as the particular significance of c) snow and sun, and d) darkness. For the design of public space in winter cities, we conclude that designers need to focus on a wider range of weather conditions than sun, wind and cold, and include snow, rainfall, slushy and icy ground and poor visibility. The study suggests that winter public space has a higher climatic design requirement to be successful than streets and pathways that are mainly used for soft mobility.

Cost Impact of Switching Histamine2-Receptor Antagonists to Nonprescription Status

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1135-1141 ◽  
Author(s):  
Michelle D Furler ◽  
Mark S Rolnick ◽  
Kathleen S Lawday ◽  
Miranda W Mak ◽  
Thomas R Einarson
Keyword(s):  
Market Share ◽  
Insurance Coverage ◽  
Consumer Price Index ◽  
Population Data ◽  
Status Change ◽  
Prescribing Practices ◽  
Receptor Antagonists ◽  
The Us ◽  
The Uk ◽  
The Impact

BACKGROUND: There is a recent trend to switching medications from prescription to nonprescription status. Often, such switches are accompanied by dramatic changes in utilization due to increased availability or decreased insurance coverage. The histamine2-receptor antagonists (H2RAs) underwent such status change in the UK in 1994, the US in 1995, and Canada in 1996. OBJECTIVE: To examine the impact of the status change for H2RAs on the market for gastrointestinal (GI) agents in the US, UK, and Canada. METHODS: IMS market sales data from 1992 to 1997 were procured. All costs were converted to 1997 US dollars using the consumer price index. Per capita sales figures were determined using population data from the US Census Bureau's International Database. RESULTS: Overall spending on GI remedies increased in all 3 markets between 1992 and 1997; however, the contribution of prescription sales and number of prescriptions varied across the 3 countries. An increased market share for nonprescription H2RAs occurred in the US, correlating with a decline in prescription numbers for GI remedies. The opposing trend occurred in the UK, where market share of nonprescription H2RAs was minimal and use of prescription H2RAs increased. Prescription and nonprescription H2RA sales could not be differentiated for Canada. CONCLUSIONS: The impact of the H2RA status change varied across countries. Differences in utilization may be attributed to many factors such as differing healthcare systems, patient convenience, and physician prescribing practices. Further research is required to identify the reasons for differences in utilization and to quantify the potential clinical impact.

scholarly journals Wellbeing during the COVID-19 pandemic in the UK: a secondary data analysis

2021 ◽  
Author(s):  
Jen Murphy ◽  
Mark Elliot
Keyword(s):  
Mental Health ◽  
Online Survey ◽  
National Level ◽  
Secondary Data ◽  
Well Being ◽  
Ordinary Least Squares ◽  
Least Squares Regression ◽  
The Uk ◽  
Survey Responses ◽  
The Impact

Introduction: In March 2020 in response to the COVID pandemic the UK government declared a national lockdown where citizens were required to stay at home. The impact of this lockdown on levels of well-being has been a source of concern for citizens and mental health professionals.Objectives: We investigated the trajectory of well-being over the course of the ?first wave and sought to determine whether the change in well-being is distributed equally across the population. Speci?fically we investigated pre-existing medical conditions, social isolation, ?financial stress and deprivation as a predictor for well-being and whether there were community level characteristics which protect against poorer well-being.Methods: Using online survey responses from the COVID19 modules of Understanding society, we linked 8,379 English cases across ?five waves of data collection to location based deprivation statistics. We used ordinary least squares regression to estimate the association between deprivation, pre-existing conditions and socio-demographic factors and the change in well-being scores over time, as measured by the GHQ-12 questionnaire.Results: A decline in well-being was observed at the beginning of the fi?rst lock down period at the beginning of March 2020. This was matched with a corresponding recovery between April and July as restrictions were gradually lifted. There was no association between the decline and deprivation, nor between deprivation and recovery. The strongest predictor of well-being during the lockdown, was the baseline score, with the counterintuitive finding that for those will pre-existing poor well-being, the impact of pandemic restrictions on mental health were minimal, but for those who had previously felt well, the restrictions and the impact of the pandemic on well-being were much greater.Conclusion: These data show no evidence of a social gradient in well-being related to the pandemic. In fact, wellbeing was shown to be highly elastic in this period indicating a national level of resilience which cut across the usually observed health inequalities.

Anticoagulation after Iliofemoral Vein Stenting - Old Versus New

2019 ◽  
Vol 24 (38) ◽  
pp. 4525-4533 ◽  
Author(s):  
Anja B. Drebes ◽  
Neil H. Davies
Keyword(s):  
Thrombus Formation ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Published Data ◽  
Antithrombotic Treatment ◽  
Related Factors ◽  
Stent Patency ◽  
Venous Outflow Obstruction ◽  
The Impact

In recent years, there has been an increasing interest in endovascular iliofemoral vein stenting to prevent/ alleviate symptoms related to proximal venous outflow obstruction. Maintaining long-term stent patency is one of the main challenges, and risk factors for the development of re-thrombosis are not well understood. Published data on the safety and efficacy of the procedure predominantly come from cohort studies mainly focusing on mechanical aspects relating to stent placement and flow. Aetiology of thrombus formation and thrombotic tendencies of patients due to underlying medical conditions are not captured well or linked to clinical outcomes, and the impact of choice and length of antithrombotic therapy have not been specifically investigated. Here, we review different procedure-related factors and patient characteristics that might increase the risk of re-thrombosis and the utility of antithrombotic treatment options currently available.

Significance of Prior HSCT on the Outcome of Salvage Therapy with CPX-351 or Conventional Chemotherapy Among First Relapse AML Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2619-2619
Author(s):  
Jorge E. Cortes ◽  
Eric J Feldman ◽  
Stuart L. Goldberg ◽  
David A. Rizzieri ◽  
Arthur C. Louie ◽  
...  
Keyword(s):  
Phase 1 ◽  
Prognostic Index ◽  
Patient Characteristics ◽  
Molar Ratio ◽  
Advisory Committees ◽  
Salvage Regimen ◽  
Patient Response ◽  
The Us ◽  
Ecog Ps ◽  
The Impact

Abstract Abstract 2619 Background: CPX-351 is a liposomal formulation containing a 5:1 molar ratio of cytarabine (Ara-C) and daunorubicin (DNR) designed to maximize anti-tumor synergy (Mayer L, et al. Mol Can Ther, 2006;5:1854). In the Phase 1 study 18/45 AML patients were in 1st relapse with 8 patients ≤65 years of age. All 8 achieved aplasia and 4/8 achieved CR after CPX-351 treatment. (Feldman E, et al. Blood 2008;112:Abst 2984). These observations provided the rationale for a randomized Phase 2b study in 1st relapse AML patients comparing CPX-351 against investigator's choice of salvage regimen. An initial safety and efficacy summary has been submitted to this meeting. This report summarizes the impact of prior HSCT on patient response and 60 day mortality. Methods: Patients ≤65yo with AML in 1st relapse after an initial CR lasting >1 month with ECOG PS= 0–2, SCr <2.0 mg/dL, total bilirubin <2.0 mg/dL, ALT/AST <3 × ULN, and LVEF ≥50% were eligible. Patients were randomized 2:1 to receive CPX-351 (100 u/m2; D 1, 3, 5) or investigators choice of intensive salvage treatment. Up to 2 induction and 2 consolidation courses were allowed. Post remission treatment with HSCT was permitted. Patients were stratified using the European Prognostic Index (EPI) (Breems DA, et al. J Clin Oncol, 2005 Mar 20;23:1969–1978). The primary efficacy endpoint is % survival at 1 year. Results: By November 12, 2010, 126 patients were accrued at 35/46 sites in the US, Canada, France, Poland. Data for response, acute safety, and 60 day deaths are available. Patients in both arms were well balanced by Relapse Free Interval (RFI), age at 1st relapse and cytogenetics. More patients with prior HSCT were assigned to the CPX-351 arm (27% v. 18%). Table 1 shows patient characteristics organized by presence or absence of prior HSCT. Among patients with prior HSCT, the CPX-351 arm had more patients with RFI ≤6 months (36% v. 0%) and younger patients (age <45, 36% v. 13%). The group with no prior HSCT was balanced for overall risk by EPI, RFI, age at 1st relapse, and adverse cytogenetics. For the overall study, the CPX-351 arm had higher aplasia (90% v. 60%) and CR + CRi rate (51% v. 42%) and similar 60 day mortality (15% v. 16%) compared to control. Table 2 shows patient response and early mortality organized by presence or absence of prior HSCT. In the 96 patients (76%) with no prior HSCT, CPX-351 produced an increased rate of aplasia compared to control (90% v. 57%), a response rate that was greater than control (56% v. 41%), and a lower 60 day mortality rate (10% v. 16%). HSCT had little observed impact on outcomes in the control arm but appears to be associated with reduced aplasia (90% to 55%) and response (56% to 36%) and a disproportionate contribution to early deaths (6/12) in the CPX-351 arm. The higher proportion of patients with RFI ≤6 months on the CPX-351 arm (36% v. 0%) may be a contributing factor. Conclusion: Eighty six/126 (68%) patients had unfavorable risk by EPI with equal proportions randomized to each arm of the study. Prior HSCT had little impact on outcomes in the control arm but seemed to have a much larger adverse impact on the CPX-351 arm. This observation of a change in outcome associated with prior HSCT may be due to the higher proportion of patients with RFI ≤6 months on the CPX-351 arm (36% v. 0) and is being evaluated further. Additional data (EFS, % survival at 1 year) are expected later this year. Disclosures: Cortes: Celator: Membership on an entity's Board of Directors or advisory committees. Louie:Celator: Employment.

scholarly journals Management of Hepatitis B: A Longitudinal National Survey – Impact of the Canadian Hepatitis B Consensus Guidelines

2010 ◽  
Vol 24 (9) ◽  
pp. 537-542 ◽  
Author(s):  
Paul Marotta ◽  
Kurt Lucas
Keyword(s):  
Hepatitis B ◽  
Complex Disease ◽  
Insurance Coverage ◽  
Management Strategies ◽  
Daily Practice ◽  
Patient Characteristics ◽  
Drug Coverage ◽  
Consensus Guidelines ◽  
Canadian Association ◽  
The Impact

BACKGROUND: The Canadian Association for the Study of the Liver, and The Association of Medical Microbiology and Infectious Diseases Canada, jointly developed the Canadian Chronic Hepatitis B (HBV) Consensus Guidelines to assist practitioners involved in the management of this complex disease. These guidelines were published inThe Canadian Journal of Gastroenterologyin June 2007 and distributed to all Canadian gastroenterologists and hepatologists.OBJECTIVE: To assess the degree to which Canadian specialist physicians were able to incorporate the recommendations from the Canadian HBV Consensus Guidelines into their daily practice.METHODS: A 30 min telephone survey probing the management strategies of 80 key HBV specialists was completed on three occasions, eight months apart, to longitudinally assess the impact of the Canadian HBV Consensus Guidelines on the management of HBV. The questionnaire detailed HBV practice patterns, the impact of the Canadian HBV Consensus Guidelines on clinical practice and HBV management.RESULTS: The majority of specialists incorporated many of the published recommendations outlined in the Canadian HBV Consensus Guidelines into their daily practice for patients with HBV. However, because public drug coverage is a major hurdle in the management of HBV, patients are provided markedly different HBV treatments depending on whether they have public or private drug insurance coverage.CONCLUSIONS: The management of HBV is growing in complexity and continues to evolve rapidly. The Canadian HBV Consensus Guidelines have served as a valuable tool for many physicians in the management of HBV. However, effective treatment algorithms continue to be rendered irrelevant by restrictive drug coverage issues. Coverage for effective therapies and, therefore, management of HBV, differs widely across Canada depending on therapy reimbursement criteria rather than patient characteristics.

scholarly journals Individual Differences in Responsiveness to Acupuncture: An Exploratory Survey of Practitioner Opinion

Medicines ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 85 ◽  
Author(s):  
David Mayor ◽  
Lara McClure ◽  
J. Clayton McClure
Keyword(s):  
Online Survey ◽  
Survey Methods ◽  
Patient Characteristics ◽  
Situational Factors ◽  
Free Text ◽  
Practitioner Survey ◽  
Specific Factors ◽  
Treatment Responses ◽  
The Impact ◽  
Depth Response

Background: Previous research has considered the impact of personal and situational factors on treatment responses. This article documents the first phase of a four-stage project on patient characteristics that may influence responsiveness to acupuncture treatment, reporting results from an exploratory practitioner survey. Methods: Acupuncture practitioners from various medical professions were recruited through professional organisations to complete an online survey about their demographics and attitudes as well as 60 questions on specific factors that might influence treatment. They gave categorical (“Yes”, “No”, and “Don’t know”) and free-text responses. Quantitative and qualitative (thematic) analyses were then conducted. Results: There were more affirmative than negative or uncertain responses overall. Certain characteristics, including ability to relax, exercise and diet, were most often considered relevant. Younger and male practitioners were more likely to respond negatively. Limited support was found for groupings between characteristics. Qualitative data provide explanatory depth. Response fatigue was evident over the course of the survey. Conclusions: Targeting and reminders may benefit uptake when conducting survey research. Practitioner characteristics influence their appreciation of patient characteristics. Factors consistently viewed as important included ability to relax, exercise and diet. Acupuncture practitioners may benefit from additional training in certain areas. Surveys may produce more informative results if reduced in length and complexity.

scholarly journals The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare

2008 ◽  
Vol 98 (5) ◽  
pp. 2242-2258 ◽  
Author(s):  
David Card ◽  
Carlos Dobkin ◽  
Nicole Maestas
Keyword(s):  
Bypass Surgery ◽  
Hospital Admissions ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Care Utilization ◽  
Socioeconomic Groups ◽  
Doctor Visits ◽  
The Us ◽  
Use Of Medical Services ◽  
The Impact

The onset of Medicare eligibility at age 65 leads to sharp changes in the health insurance coverage of the US population. These changes lead to increases in the use of medical services, with a pattern of gains across socioeconomic groups that varies by type of service. While routine doctor visits increase more for groups that previously lacked insurance, hospital admissions for relatively expensive procedures like bypass surgery and joint replacement increase more for previously insured groups that are more likely to have supplementary coverage after 65, reflecting the relative generosity of their combined insurance package under Medicare. (JEL I11, I18)

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