Guidelines recommend adults with pituitary disease in whom GH therapy is contemplated, to be tested for GH deficiency (AGHD); however, clinical practice is not uniform. Aims (1) To record current practice of AGHD management throughout Europe and benchmark it against guidelines; (2) To evaluate educational status of healthcare professionals about AGHD. Design Online survey in endocrine centres throughout Europe. Patients and methods Endocrinologists voluntarily completed an electronic questionnaire regarding AGHD patients diagnosed or treated in 2017–2018. Results Twenty-eight centres from 17 European countries participated, including 2139 AGHD patients, 28% of childhood-onset GHD. Aetiology was most frequently non-functioning pituitary adenoma (26%), craniopharyngioma (13%) and genetic/congenital midline malformations (13%). Diagnosis of GHD was confirmed by a stimulation test in 52% (GHRH+arginine: 45%; insulin-tolerance: 42%, glucagon: 6%; GHRH alone and clonidine tests: 7%); in the remaining, ≥3 pituitary deficiencies and low serum IGF-I were diagnostic. Initial GH dose was lower in older patients, but only women <26 years were prescribed a higher dose than men; dose titration was based on normal serum IGF-I, tolerance and side-effects. In one country, AGHD treatment was not approved. Full public reimbursement was not available in four countries and only in childhood-onset GHD in another. AGHD awareness was low among non-endocrine professionals and healthcare administrators. Postgraduate AGHD curriculum training deserves being improved. Conclusion Despite guideline recommendations, GH replacement in AGHD is still not available or reimbursed in all European countries. Knowledge among professionals and health administrators needs improvement to optimise the care of adults with GHD.
Background: In the modern digital age, patients are increasingly consulting online physician reviews prior to making healthcare decisions. Physician review websites are being used in many medical fields including orthopaedic surgery. The purpose of this study is to investigate trends in online physician reviews and determine which factors are most strongly correlated with the likelihood that an orthopaedic surgeon is to be recommended by patients. Methods: Healthgrades.com, the most comprehensive physician rating and comparison database, was queried for “orthopaedic surgery” in the state of New Jersey. Demographic information, fellowship training status, years of experience, malpractice/disciplinary actions, physician ratings and the likelihood to recommend score (LTRS) was collected for all physicians. Quantitative analysis was conducted using descriptive statistics, student t-test, and one-way ANOVA. Qualitative analysis of randomly selected positive comments and all negative comments was conducted. Common themes were identified using frequency-based word cloud generator. Results: 834 board certified orthopaedic surgeons (800 Males, 34 Females), with a mean age of 55.7±12.5 years and an average LTRS of 4.1±0.84 were included for analysis. Compared with non-fellowship trained orthopaedic surgeons, fellowship trained surgeons were more likely to be recommend by patients [3.8 vs. 4.3; P< 0.0001]. Physicians with waiting time <10min were more likely to be recommended compared with their counterparts with waiting time >10min (P< 0.0001). No differences were observed in LTRS between male and female orthopaedic surgeons (P= 0.79) or based on malpractice status (P= 0.61). Qualitative analysis of a randomly selected sample of 4,151 out of a total of 12,168 positive comments and 1,113 total negative comments revealed that positive comments centered on surgeon competence and professionalism, while negative comments centered on surgeon personality and waiting time. Conclusion: Orthopaedic surgeons have generally favorable ratings and mostly positive comments. Fellowship status and waiting time are important factors that impact LTRS. Patients were more likely to write positive comments about surgeon competence and professionalism, and negative comments pertaining to surgeon personality and waiting time. Knowledge of surgeon specific attributes that are important to patients may help educate orthopaedic surgeons to improve patient care, patient satisfaction and online ratings. Tables and Figures [Table: see text][Table: see text][Figure: see text]
Introduction:Orthopaedic surgery resident case exposure is an important component of surgical training and is monitored by the Accreditation Council for Graduate Medical Education (ACGME) to ensure resident readiness for graduation. The purpose of this study was to investigate trends in exposure to adult orthopaedic surgical procedures and analyze the impact of the 2013 update in ACGME case logging expectations.Methods:A retrospective review of ACGME case log data was conducted for adult orthopaedic procedures performed by graduating orthopaedic surgery residents from 2012 to 2020. Trends in the number of cases logged and the case share by anatomical location were investigated. Linear regression analysis was performed to analyze changes in case number over the 9-year period.Results:For all surgical categories, there was stability in the average case number per resident from 2012 to 2013, followed by a precipitous decrease from 2013 to 2014. From 2014 to 2020, there has been a gradual increase in case number for all categories except “other musculoskeletal (MSK),” resulting in a total 46% recovery since the 2014 decline. Concomitant with the decline, there was a relative increase in pelvis/hip and femur/knee procedures and decrease in shoulder, other MSK, and spine procedures. From 2014 to 2020, shoulder, humerus/elbow, pelvis/hip, leg/ankle, foot/toes, and spine cases have gradually accounted for a larger proportion of total cases while femur/knee and “other MSK” cases have accounted for less.Conclusions:The 2013 update in ACGME case logging expectations was associated with a significant decrease in case number. This is likely a reflection of residents correctly entering 1 primary Current Procedural Terminology code for each surgical case. Programs should be aware of a general increase in case number since 2014 and acknowledge the fact that some procedure types may be given priority from a logging standpoint when multiple Current Procedural Terminology codes apply.
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