Associations of sociodemographic and clinical factors with gastrointestinal cancer risk assessment appointment completion.

Cancer risk assessment services are important for patient care; effective use requires appropriate provider referral, accurate scheduling processes, and completed attendance at booked appointments. Sociodemographic and clinical factors associated with gastrointestinal cancer (GIC)-specific risk assessment appointments remain unstudied; therefore, we aimed to identify factors associated with appointment completion in a GIC risk assessment program at a tertiary academic center. Retrospective chart review was conducted on all patients scheduled for an appointment in the Gastrointestinal Cancer Risk Evaluation Program (GI-CREP) between January 2016 and December 2017. Data collected included demographic and clinical factors. Chi-square and Wilcoxon's rank-sum tests compared variables among patients based on the study outcome of whether a GI-CREP appointment was completed; marginal standardization was used to predict the standardized percentage of patients that had appointment completion. A total of 676 patients had a scheduled GI-CREP appointment; 32 individuals were excluded due to incomplete information or scheduling error, resulting in 644 patients available for final analysis. Our study population was predominantly female (61%), White (77%), and married (64%), had private healthcare insurance (76%), and lacked a personal history of cancer (60%). Referrals internal to the healthcare system were most common (77%), with gastroenterologists as the most frequent referring provider (42%). Seventy-five percent of scheduled individuals had appointment completion, while 25% of individuals did not. Independent predictors for an incomplete GI-CREP appointment included Medicaid insurance (OR 2.45, 95% CI 1.21-4.28, p = .01), self-identified Black race (OR 1.97, 95% CI: 1.20-3.25, p = .008), and personal history of cancer (OR 1.60, 95% CI 1.11-2.31, p = .01). These data highlight existing disparities in GIC risk assessment appointment completion associated with race, health insurance coverage, and medical status. Further studies of these areas are necessary to ensure equitable access to important GIC risk assessment services.

Effect of Playing and Training at Altitude on Concussion Incidence in Professional Football.

BACKGROUND: Despite the increased attention to sports-related concussion, the literature lacks information about the environmental factors that contribute to concussion incidence. Previous investigators have noted a decreased rate of concussion in football games played at higher altitude. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate whether the protective effects of altitude on concussion rate, as described by previous investigators, were due to acute effects of altitude exposure or chronic adaptations to training at altitude. Our hypothesis was that these protective effects are not attributable to relative cerebral edema that occurs in conditions of altitude-associated hypobaric hypoxia, known as the "slosh effect," but rather result from long-term adaptations to training at altitude. STUDY DESIGN: Descriptive epidemiology study. METHODS: Athletes from the 2012, 2013, 2014, and 2015 National Football League (NFL) seasons were included in this analysis of publicly available data. Concussion rates were subdivided into 4 groups: (1) low-altitude teams playing below 644 feet (low-low), (2) low-altitude teams playing above 644 feet (low-high), (3) high-altitude teams playing below 644 feet (high-low), and (4) high-altitude teams playing above 644 feet (high-high). RESULTS: Away teams had a significantly higher rate of concussion (0.32 concussions per exposure) compared with their home team counterparts (0.27 concussions per exposure; P = .03). Teams training and playing at high altitude had a 28% decreased concussion rate, which was significantly lower compared with concussion incidence rates for overall, low-low, and high-low groups (P < .05). In comparison, teams that trained at altitude but played below 644 feet had the highest rate of concussion, at 0.36 concussions per exposure (P < .05). CONCLUSION: These data indicate that living and training at altitude may have a protective effect on concussion rate, as evidenced by the significant reduction in the high-high group and the lack of an effect in the low-high group. However, teams from low altitude playing at high altitude did not have a statistically significant reduction in concussion rate. These results show that the slosh theory does not completely explain the effects of altitude on concussion incidence rate in the NFL. Further analyses are needed to investigate the true cause of altitude-induced protection in the NFL.

Reduced Surgical Site Infection Rates Following Spine Surgery Using an Enhanced Prophylaxis Protocol.

BACKGROUND: Postoperative surgical site infection (SSI) is a common complication after spine surgery. Reduction of SSI has many benefits including, but not limited to, the reduced length of stay, readmission rates, and morbidity and mortality. OBJECTIVE: To determine whether an enhanced antibiotic prophylaxis reduced the rate of surgical site infections in spine surgery. METHODS: This is a retrospective observation study which analyzed the incidence of postoperative SSI following a consecutive series of 1,486 cervical, thoracic and lumbar spine operations performed at a single institution by the senior author between the dates of October 2001 to March 2014. Patients with surgeries between October 2001 and November 2005 received a standard institutional antibiotic prophylaxis. Patients between December 2005 and March 2014 underwent an enhanced antibiotic protocol. RESULTS: A total of nine cases met the criteria for SSI. All nine cases were recorded during the initial time period when the standard institutional prophylaxis was used. Further, these cases were only observed under posterior operative approaches. No further cases of SSI were observed after the institution of the enhanced antibiotic prophylaxis (p < 0.0001). This was statistically significant in the cervical and lumbar regions (p < 0.0042 and p < 0.0119, respectively). CONCLUSIONS: Although difficult to predict the incidence of SSI, this study found that the use of an enhanced antibiotic prophylaxis protocol significantly reduced one surgeon's overall rates of surgical site infections after spine surgery.

Concussion Incidence in Professional Football: Position-Specific Analysis With Use of a Novel Metric.

BACKGROUND: In the United States alone, millions of athletes participate in sports with potential for head injury each year. Although poorly understood, possible long-term neurological consequences of repetitive sports-related concussions have received increased recognition and attention in recent years. A better understanding of the risk factors for concussion remains a public health priority. Despite the attention focused on mild traumatic brain injury (mTBI) in football, gaps remain in the understanding of the optimal methodology to determine concussion incidence and position-specific risk factors. PURPOSE: To calculate the rates of concussion in professional football players using established and novel metrics on a group and position-specific basis. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Athletes from the 2012-2013 and 2013-2014 National Football League (NFL) seasons were included in this analysis of publicly available data. Concussion incidence rates were analyzed using established (athlete exposure [AE], game position [GP]) and novel (position play [PP]) metrics cumulatively, by game unit and position type (offensive skill players and linemen, defensive skill players and linemen), and by position. RESULTS: In 480 games, there were 292 concussions, resulting in 0.61 concussions per game (95% CI, 0.54-0.68), 6.61 concussions per 1000 AEs (95% CI, 5.85-7.37), 1.38 concussions per 100 GPs (95% CI, 1.22-1.54), and 0.17 concussions per 1000 PPs (95% CI, 0.15-0.19). Depending on the method of calculation, the relative order of at-risk positions changed. In addition, using the PP metric, offensive skill players had a significantly greater rate of concussion than offensive linemen, defensive skill players, and defensive linemen (P < .05). CONCLUSION: For this study period, concussion incidence by position and unit varied depending on which metric was used. Compared with AE and GP, the PP metric found that the relative risk of concussion for offensive skill players was significantly greater than other position types. The strengths and limitations of various concussion incidence metrics need further evaluation. CLINICAL RELEVANCE: A better understanding of the relative risks of the different positions/units is needed to help athletes, team personnel, and medical staff make optimal player safety decisions and enhance rules and equipment.