Single Visit Evaluation and Tympanostomy Tube Placement for the Treatment of Acute Otitis Media in Children.

OBJECTIVE: To review our experiences with development of a single visit surgery (SVS) program for children with recurrent acute otitis media (AOM) undergoing tympanostomy tube (TT) placement the same day as their otolaryngology surgical consultation. STUDY DESIGN: Retrospective cohort analysis. METHODS: Retrospective series of patients participating in SVS from inception March 1, 2014 to April 30, 2020 were analyzed, with attention to factors associated with increasing interest and participation in SVS and parent experiences/satisfaction. RESULTS: A total of 224 children had TT placed through SVS for AOM management. The average age of patients was 18.1 months (standard deviation 7.8 months), and 130 (58.0%) were male. The median interval between initial contact to schedule SVS, and the SVS date was 15 days (interquartile range 9-23 days). When analyzing year-over-year volumes from inception of SVS, notable increases were seen in 2016 and 2017 after a radio advertisement was played locally. A marked increase in volume was noted after implementation of a Decision Tree Scheduling (DTS) algorithm for children with recurrent AOM. Sixty-six (28.8%) procedures were performed after institution of DTS. A parent survey demonstrated high levels of satisfaction with the SVS experience. Estimations of savings to families in terms of time away from work demonstrated potential for indirect healthcare benefits. CONCLUSIONS: SVS for TT placement was a successful, alternative model of care for management of children with AOM. Marketing strategies regarding SVS, and the inclusion of SVS pathway in DTS platforms increased rates of interest and choice of this option. Parents of children undergoing TT through SVS were satisfied with the overall experience. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2823-2829, 2021.

Los seniors en la publicidad española: tensiones entre la investigación, planificación y la representación de los mayores en los anuncios / Senior citizens in Spanish advertising: tensions between research, planning and representation of the elderly in advertisements / Idosos na publicidade espanhola: tensões entre pesquisa, planejamento e representação dos mais velhos nos anúncios

El presente artículo analiza las continuidades y discontinuidades que se producen entre la investigación, la planificación de medios y la construcción de las representaciones sobre los mayores en la publicidad española. El estudio, centrado en los anuncios sobre envejecimiento, mayores y salud, se ha implementado desde una triangulación metodológica que incluye técnicas como el análisis del discurso, la encuesta y la revisión de literatura sobre segmentación publicitaria. Las conclusiones apuntan a una restricción de las representaciones puestas en juego en los anuncios respecto a la diversidad planteada por los profesionales y en la literatura científica. Se plantea el reto de superar las visiones excesivamente individualistas del mayor y de la gestión de su salud, al tiempo que emerge como alternativa la concepción de la salud como un espacio simbólico de conflicto y negociación.(AU)

The article analyzes the continuities and descontinuities that occur between research, media planning and the construction of representations of senior citizens in Spanish advertising. The study, centered on advertisements about aging, senior citizens and health, employed a methodological triangulation that included techniques like discourse analysis, research, and a literature review on segmentation in advertising. The conclusions point to a limitation of the representations called into play in advertisements regarding the diversity established by professionals and in the scientific literature. It is necessary to face the challenge of overcoming the excessively individualistic views of the elderly and of the management of their health. At the same time, the conception of health as a symbolic space of conflict and negotiation emerges as an alternative..(AU)

O presente artigo analisa as continuidades e descontinuidades que ocorrem entre a pesquisa, o planejamento de mídia e a construção das representações dos idosos na publicidade espanhola. O estudo, centrado nos anúncios sobre envelhecimento, idosos e saúde, foi implementado a partir de uma triangulação metodológica que incluiu técnicas como a análise do discurso, a pesquisa e a revisão de literatura sobre segmentação publicitária. As conclusões apontam para uma limitação das representações postas em jogo nos anúncios a respeito da diversidade estabelecida pelos profissionais e na literatura científica. Constitui-se o desafio de superar as visões excessivamente individualistas sobre o idoso e da gestão de sua saúde, ao tempo que emerge como alternativa a concepção da saúde como um espaço simbólico de conflito e negociação..(AU)

Preferred Single-Vendor Program for Total Joint Arthroplasty Implants: Surgeon Adoption, Outcomes, and Cost Savings.

BACKGROUND: In total joint arthroplasty, variation in implant use can be driven by vendor relationships, surgeon preference, and technological advancements. Our institution developed a preferred single-vendor program for primary hip and knee arthroplasty. We hypothesized that this initiative would decrease implant costs without compromising performance on quality metrics. METHODS: The utilization of implants from the preferred vendor was evaluated for the first 12 months of the contract (September 1, 2017, to August 31, 2018; n = 4,246 cases) compared with the prior year (September 1, 2016, to August 31, 2017; n = 3,586 cases). Per-case implant costs were compared using means and independent-samples t tests. Performance on quality metrics, including 30-day readmission, 30-day surgical site infection (SSI), and length of stay (LOS), was compared using multivariable-adjusted regression models. RESULTS: The utilization of implants from the preferred vendor increased from 50% to 69% (p < 0.001), with greater use of knee implants than hip implants from the preferred vendor, although significant growth was seen for both (from 62% to 81% for knee, p < 0.001; and from 38% to 58% for hip, p < 0.001). Adoption of the preferred-vendor initiative was greatest among low-volume surgeons (from 22% to 87%; p < 0.001) and lowest among very high-volume surgeons (from 61% to 62%; p = 0.573). For cases in which implants from the preferred vendor were utilized, the mean cost per case decreased by 23% in the program's first year (p < 0.001), with an associated 11% decrease in the standard deviation. Among all cases, there were no significant changes with respect to 30-day readmission (p = 0.449) or SSI (p = 0.059), while mean LOS decreased in the program's first year (p < 0.001). CONCLUSIONS: The creation of a preferred single-vendor model for hip and knee arthroplasty implants led to significant cost savings and decreased cost variability within the program's first year. Higher-volume surgeons were less likely to modify their implant choice than were lower-volume surgeons. Despite the potential learning curve associated with changes in surgical implants, there was no difference in short-term quality metrics. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Three Pink Decades: Breast Cancer Coverage in Magazine Advertisements.

Breast cancer advocacy has experienced tremendous success since the 1980s. Yet, the quality and authenticity of breast cancer information in the media are sometimes questionable. Using a content analysis, we examined the informative (donation information, breast cancer advocacy content, etc.) and persuasive (appeals used, cues to action, etc.) contents of magazine advertisements relevant to breast cancer. While ads offered minimal informative content about the disease or about ways by which sales will contribute to the breast cancer cause, they integrated "breast cancer appeals," such as the color pink, the pink ribbon, and mostly positive depictions of survivorship and hope, into the ads. Breast cancer thus took center stage in the persuasive content of the ads, but a back seat when it came to their informative content. We discuss the implications of those findings in light of the meanings and purposes of cause-related marketing campaigns.

Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

From waste to (fool's) gold: promissory and profit values of cord blood.

According to biomedical discourse, cord blood has been transformed from 'waste' to 'clinical gold' because of its potential for use in treatments. Private cord blood banks deploy clinical discourse to market their services to prospective parents, encouraging them to pay to bank cord blood as a form of 'biological insurance' to ensure their child's future health. Social scientists have examined new forms of (bio)value produced in biological materials emergent with contemporary biotechnologies. This paper contributes to this literature by examining the social and technical production of value in cord blood units collected for private banking. Value, in this paper is defined as a socio-cultural concept in which an object is made meaningful, or valuable, through its relations with social actors and within specific regimes of value. I draw on in-depth interviews with women who banked cord blood and key informants in private banks in Canada, to analyze how social actors produced cord blood as a valuable biological object. I show that a cord blood unit holds promissory value for women who bank and profit value for private banks and that these values are folded into each other and the biological material itself. Analyzing how specific cord blood units are made valuable provides insight into the multiple and possibly competing values of biological materials and the tensions that may arise between social actors and forms of knowledge during the valuing process.

Available Tools to Facilitate Early Patient Access to Medicines in the EU and the USA: Analysis of Conditional Approvals and the Implications for Personalized Medicine.

Scientific knowledge and our understanding of the human body and diseases have limited any possible treatment tailoring to each patient. The technological advances enabling the integration of various data sets (e.g. '-omics', microbiome, epigenetics and environmental exposure) have facilitated a greater understanding of the human body, the molecular basis of disease and all the factors influencing disease onset, progression and response to treatment, thereby ushering in the era of personalized medicine. We evaluate the regulatory approaches available to facilitate early patient access to efficacious and safe compounds in the EU and the USA in order to make more informed recommendations in the future as to the gaps in regulations for early patient access. An in-depth analysis of conditional approvals (EU) and accelerated approvals (USA) is performed based on the publicly available information (European public assessment reports and a summary review of products approved under both programmes). The types of product, indications, time to approval and type of evidence submitted were analysed. Between 2007 and early 2015, 17 products were conditionally approved in the EU and 25 in the USA, most of them in the area of oncology and based on evidence from phase II clinical trial data. Early approval of promising products based on data from early phases of development is already possible in the EU and the USA. Some of the improvements could entail implementing a rolling assessment of evidence in Europe and extending the scope of early dialogues.

Challenges of stimulating a market for social innovation - provision of a national health account.

Innovation in healthcare can be associated with social innovation and the mission to contribute to a shared value that benefits not only individuals or organizations but the society as a whole. In this paper, we present the prerequisites of stimulating a market for social innovations by studying the introduction of a national health account. The results show that there is a need to clarify if a national health account should be viewed as a public good or not, to clarify the financial responsibilities of different actors, to establish clear guidelines and to develop regulations concerning price, quality and certification of actors. The ambition to stimulate the market through a national health account is a promising start. However, the challenges have to be confronted in order for public and private actors to collaborate and build a market for social innovations such as a national health account.

¿Medicina basada en el mercado o medicina basada en el paciente? / [Market-based medicine or patient-based medicine?].

The health care has evolved over the centuries from a theocentric model to a model centered on man, environment and society. The process of neoliberal globalization has changed the relationship between the components of the health system and population. The active participation of organizations such as the World Trade Organization, the International Monetary Fund and the World Bank by the techno-medical industrial complex tends to make the health care in a model focused on economy. This, impacts negatively on all components in the process of health care and have an adverse effect on the humanized care. The analysis of each sector in particular and their interactions shows the effects of this change. Alternatives are proposed for each sector to contribute to a model of care focused on the patient, their family and the social environment.

How pediatric surgeons use social media to attract new patients.

Social media has changed the landscape of online interaction for all doctors including pediatric surgeons. Of course the public including our patients and potential new patients having immediate access to these sites through mobile devices and iPads has contributed immensely to this phenomenon. Nonetheless, it seems that we are all rushing to get in front of our target audience and to engage in a relationship with them in a cost-effective fashion. This article will discuss the role of the Internet and media and how you can use this technology to attract new pediatric patients to your practice.

Korean American women's perceptions about physical examinations and cancer screening services offered in Korea: the influences of medical tourism on Korean Americans.

Cancer is the leading cause of death for Korean-Americans (KAs), while cancer screening rates among KAs have been consistently low. Seven semi-structured focus group interviews with 34 KA women aged 40 or older in the Washington, DC metropolitan area were conducted to explore the perceptions of KA women about seeking physical examinations and cancer screening services in Korea. Data were analyzed using a framework approach. Informants positively perceived the use of health screening services in Korea in comparison to seeking such services in the US. Decision-making factors included cost benefits, high quality services, and more convenient screening procedures in Korea. These benefits outweighed the risks of delaying health care and travelling a vast distance with incurring additional travel costs. Motivations to seek these services in Korea included opportunities to visit their homeland and to enjoy comfortable communication with their native language. The increase of available information about Korean medical services due to the industry's aggressive marketing/PR was identified as a facilitator. Most informants did not recognize possible negative health outcomes of obtaining services in Korea such as inappropriate follow up care if having abnormal findings. Educational programs are needed to educate KAs about the benefits and risks of getting the services in Korea and proper follow up care in the US. Health care providers need to know the different cancer risks and screening needs for this population.

[New drugs in oncology--features of clinical trials for market authorisation and arguments for the rapid implementation of independent clinical trials following approval]. / Neue Arzneimittel in der Onkologie: Merkmale klinischer Zulassungsstudien und Argumente für die rasche Durchführung unabhängiger klinischer Studien nach der Zulassung.

The market authorisation or extension of indication for all oncology drugs in Europe is now based on Regulation (EC) No. 726/2004, a centralised procedure of the European Medicines Agency (EMA). Studies in recent years have highlighted deficiencies in pivotal studies. For example, the requirements of the EMA are not always consistently followed and studies are stopped prematurely after only interim analysis that at this time point shows improved efficacy with regard to the comparator arm. Our current analysis of the European Assessment Reports (reporting period: 01/01/2009 to 08/13/2012) on 29 drugs for 39 oncology indications shows that the quality of the trials for market authorisation has improved in several respects. Primary endpoints recommended by the EMA and the Food and Drug Administration (FDA) such as overall survival and progression-free survival are used, and only one study was conducted as a phase II trial with no comparator arm. In contrast, oncology drugs that are approved for the treatment of rare diseases (orphan drugs) are based on small studies which are often carried out without blinding, are not randomised and investigate surrogate endpoints. To answer patient-relevant issues following market authorisation, it is necessary to conduct independent clinical studies. Increased public funding needs to be provided and bureaucratic hurdles have to be reduced. Only this will permit a more efficient use of limited health care resources and allow to improve the quality of care for cancer patients.

Say what? Integrating hearing into an ophthalmology practice.

More people experience hearing loss than any other undiagnosed medical problem. Vision and hearing are our two most important senses. Your patients must see and hear sufficiently to maximize their quality of life; it makes sense to treat them together. This hearing testing program is part of your ophthalmology practice; effectively administering the program and delivering the message is what works. The patients are already in your office, i.e., same age demographic as for hearing loss. They and their family wish their ophthalmologist had a program to address their hearing related needs. They trust their ophthalmic physician. They know that they receive quality care.