Completeness of ultrasound reporting impacts time to biopsy for benign and malignant thyroid nodules.

BACKGROUND: The objective was to evaluate reporting of guideline-recommended elements for thyroid ultrasound (US), and to determine whether element reporting was associated with the time to cytological and/or surgical diagnosis. METHODS: US reports of adults who underwent thyroid surgery for benign (n = 106) or malignant (n = 105) thyroid nodules between 2009 and 2014 were retrospectively reviewed for inclusion of 11 elements. RESULTS: On average 5.1 elements of 11 (46.4%) were included in US reports of all nodules. The setting of the US (academic versus community center) also influenced the number of elements reported (6.3 in academic versus 4.9 in community, p < 0.001). A higher number of reported elements were significantly associated with fewer days between US and FNAB, FNAB and OR, and US and OR (p < 0.001, p = 0.007, and p < 0.001, respectively). CONCLUSIONS: Under-reporting of guideline-recommended US elements is associated with delayed cytological diagnosis and surgical treatment of thyroid nodules.

The impact of industry representative's visits on utilization of coronary stents.

BACKGROUND: The interaction between physicians and industry is complex and essential for improvement of medical care. However, conflict of interests may affect decision process. Our aim was to test if promotional visits by industry representatives affect treatment patterns and the use of various stents during percutaneous coronary interventions. METHODS: Medical records of 1,145 consecutive patients who underwent percutaneous coronary intervention in an academic institution over 1-year period were retrospectively reviewed and linked to presence or absence of industry representative. We compared use of bare-metal stents, drug-eluting stents (DES), and balloon catheters according to company presence. RESULTS: A total of 1,785 stents were implanted in 1,145 patients; 60.8% were DES. More DES per case were implanted when a representative was present (1.71 ± 0.9 vs 1.60 ± 0.93, P = .023). There was no difference in the utilization of balloons and bare-metal stents between groups. Stent cost per case was higher when a representative was present (Can $1,703.5 ± 1,314.4 vs 1,468.9 ± 1,273.3, P < .001). For all companies marketing DES, there was increase in the use of the company's DES when their sale representative was present with less use of the competitors' stents. CONCLUSIONS: Sale representative presence was associated with increased use of the representative company's stents during percutaneous coronary interventions. The effect was more pronounced on use of the company's DES and resulted in higher procedural cost.