Doctors hospital corridor with nurses and female patient

Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy

Pelvic floor muscle exercises are a mainstay in the treatment of pelvic floor disorders such as urinary incontinence, overactive bladder, pelvic organ prolapse, and fecal incontinence. Women are more likely to report improvement in incontinence symptoms when they participate in directly supervised pelvic floor physical therapy (PFPT) as opposed to performing recommended exercises without supervision. However, < 50% of women referred for PFPT complete their prescribed program. HIP Investigator, Dr. Heidi Brown et al. sought to determine whether consultation with PFPT at the time of initial urogynecologic evaluation increases adherence to PFPT and to identify factors associated with PFPT attendance and completion.

The authors were also interested in exploring the relationship between the rate of surgical management of patients seen in multidisciplinary clinic versus those seen in a traditional clinic and those who attended PFPT versus those who did not. They hypothesized that rates of PFPT adherence would be higher when the patient met with a physical therapist at her initial urogynecology consultation as opposed to meeting with the urogynecologist alone.

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Patient and nurse at skilled nursing facility

30-day readmission & mortality among Medicare beneficiaries discharged to SNFs after vascular surgery

30-day readmission & mortality among Medicare beneficiaries discharged to SNFs after vascular surgery

Using HIP Chronic Conditions Warehouse data, authors looked at readmissions among vascular surgery patients discharged to skilled nursing facilities (SNFs). They found 36% were readmitted or had died at 30 days. Predictors of readmission or death at 30 days included SNF for-profit status, number of hospitalizations in the previous year, comorbidities, emergency procedures, and complications.

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Ultrasound machine

Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma

Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma

In this study, Dr. Ryan Schmocker et al. examined patterns of preoperative endoscopic ultrasound (EUS) for pancreatic adenocarcinoma and the impact on downstream treatment. The investigators used the SEER-Medicare database to conduct the study and found the factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and an NCI or academic hospital. EUS was associated with a longer time to surgery and higher number of staging tests.

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Doctor and female patient talking

Variation in the types of providers participating in breast cancer follow-up care

Variation in the types of providers participating in breast cancer follow-up care

Dr. Heather Neuman et al. aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors. Using the SEER-Medicare database, investigators found 80% of follow-up care was with a medical oncologist, 46% with a surgeon, and 39% with a radiation oncologist after radiation treatment. Patients with larger tumor size, positive axillary nodes, estrogen receptor-positive status, and chemotherapy treatment were more llikely to have medical oncology follow-up.

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Surgeons operating on patient

Endovascular vs. open revascularization for peripheral arterial disease

Endovascular vs. open revascularization for peripheral arterial disease

The aim of this study by Dr. Jason Wiseman et al. was to determine whether endovascular or open revascularization provides an advantageous long-term approach to symptomatic peripheral artery disease. The authors used Chronic Conditions Warehouse Medicare data and found that an endovascular approach is associated with improved amputation-free survival over the long term with only a modest relative increased risk of subsequent intervention.

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Using a microscope

The role of intraoperative assessment in the surgical management of ductal carcinoma in situ

The role of intraoperative assessment in the surgical management of ductal carcinoma in situ

This study by Dr. Marquita Decker et al. examined the relationship between intraoperative pathologic assessment and subsequent operations in patients with a diagnosis of ductal carcinoma in situ (DCIS). Using SEER-Medicare data, investigators found that the use of intraoperative frozen section or touch preparation during partial mastectomy did not result in a reduction in subsequent breast operations in women with DCIS.

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Mechanical ventilator

Trajectories and prognosis of patients who have prolonged mechanical ventilation after high-risk surgery

Trajectories and prognosis of patients who have prolonged mechanical ventilation after high-risk surgery

This retrospective cohort study of Medicare beneficiaries by Dr. Michael Nabozny et al. examined patterns of mortality and hospitalization for patients 66 and older who have major surgery with and without prolonged mechanical ventilation. The authors found those who received prolonged mechanical ventilation had higher 1-year mortality than those who did not. Patients who did not receive mechanical ventilation were more likely to be discharged home. 

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Man showing doctor stomach pain

The diagnosis of diverticulitis in outpatients: On what evidence?

The diagnosis of diverticulitis in outpatients: On what evidence?

Investigators used electronic health record data to examine the clinical assessment generating the diagnostic label of diverticulitis in outpatients. They found that diverticulitis in the outpatient setting is often characterized by infrequent use of CT scans, lack of leukocytosis, and rare need for urgent surgery or early admission. Further study is needed as this diagnostic label seems to be commonly applied without objective evidence.

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