Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Screening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers.</p> <p>Methods</p> <p>The authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling.</p> <p>Results</p> <p>The final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, χ2 = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, χ2 = 37.5, p ≤ 0.0001).</p> <p>In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, χ2 = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, χ2 = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs.</p> <p>Conclusions</p> <p>The findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics.</p

What is the appropriate length of time to restrict movement of the upper extremity after cardiac implantable electronic device placement?

Background: There is no consensus across providers and healthcare systems regarding the duration of upper extremity movement restrictions following implantation of transvenous cardiac devices. A recent study surveyed health care systems and found a wide variation in practice ranging from restricting all activity for up to six weeks 6 weeks to no activity restriction. Maine Medical Center uses the following discharge instructions “avoid excessive lifting, reaching, or strenuous activities for one week in the arm on the side where the device was placed, then slowly increase activity to normal over two to three weeks.” It is undetermined if these instructions lead to fewer complications than national averages. In a state where ? of the population relies on manual dexterity for their occupation, it is also uncertain if work limitation is justified. Due to upper extremity movement restrictions many patients are dependent on others for the completion of activities of daily living and those that work experience loss of wages. It is hypothesized that 1 week of upper extremity movement restrictions will not result in an increased risk of complications compared to the national average. Research Objectives: To identify all patients at Maine Medical Center who had implantation of transvenous cardiac devices and of this population the rate of complications compared with the national average. Methods: All patients at Maine Medical Center who had a transvenous cardiac device placed between July 2016 to July 2018 will be identified using retrospective electronic medical record analysis. Of the patients who had a transvenous cardiac device placed all patients who were hospitalized for a complication resulting from implantation will be identified by searching for CPT codes associated with common complications from implantation. Results: Using a retrospective review of the electronic medical record, 790 patients were identified as having a transvenous cardiac device placed over the study period. Of these patients; 5 (0.6%) had a complication that resulted in hospitalization within 2 years. Of the 5 subjects identified with readmission, 2 subjects were diagnosed with Twiddler\u27s syndrome, 2 with lead failure and 1 with a pocket infection. Conclusion: Based on the results, the rate of complication is far below the national average, which is approximately 5% of patients experience a complication within 2 years of implantation that leads to hospitalization. Maine Medical Center’s complication rate would suggest that discharge instructions are appropriate and activity restriction does correlate with decreased complications

Feasibility and safety of uninterrupted and nearly uninterrupted DOAC use in patients undergoing radiofrequency ablation for atrial fibrillation in a tertiary community medical center

Background: Atrial fibrillation (AF) ablation in the setting of uninterrupted anticoagulation (AC) has been studied by large university based medical centers in randomized controlled trials. This strategy has not been looked at in a clinical based Electrophysiology (EP) program at a tertiary hospital. Methods: Patients aged 18 years or older who presented to Maine Medical Center and captured in the American Heart Association (AHA) Get With The Guidelines: Afib database between 1/1/2015 and 6/1/2019 were eligible. Inclusion criteria were any patient with a left side AF procedure (Pulmonary vein isolation [PVI] or other lesions). Patients were excluded if follow-up data were incomplete. We compared subgroup data in bivariate analyses using Pearson?s chi-square test or Fisher?s exact test for categorical data and ANOVA or Kruskal-Wallis test for continuous data. Results: 586 eligible AF procedures were performed over a 4.5-year period. Anticoagulants prescribed to patients included warfarin and three direct oral anticoagulants (DOACs): apixaban, dabigatran, and rivaroxaban. 68.2% of patients continued AC uninterrupted, and 31.7% of patients had brief interruption of 1-2 doses at the time of ablation. Major complications between the groups were not different despite the different baseline characteristics, anticoagulation strategies, and mean CHADs2-Vasc (C2V) scores (mean C2V scores were 1.8, 2.1, 2.8 for uninterrupted DOAC, interrupted DOAC, and warfarin groups, respectively, p\u3c0.001). Conclusion: This study suggests the strategy of uninterrupted or minimally interrupted periprocedural anticoagulation is safe and effective in a large clinical electrophysiology practice