Browsing by Subject "Specialty"

Now showing 1 - 6 of 6
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    An exploration of delegation practices regarding the utilization of genetic counseling assistants for disclosure of genetic testing results
    (Wiley, 2025) Ranson, David; Allison, Camille O.; Wetherill, Leah; Delk, Paula R.; Stone, Kristyne; Medical and Molecular Genetics, School of Medicine
    Genetic counselors (GCs) play a crucial role in the healthcare system, providing education, support and guidance regarding genetic risk assessment, testing and results interpretation. To help GCs practice at the highest level of their expertise, the role of the genetic counseling assistant (GCA) was introduced, focusing on tasks like administrative support and patient care coordination. Although GCs typically handle the disclosure of test results, there is limited research on the delegation of results disclosure to GCAs. This study explores GCs' perspectives on delegating negative and variant of uncertain significance (VUS) genetic test results disclosures to GCAs. A quantitative survey was conducted among GCs practicing in the United States and Canada. Results revealed that while the majority of GCs were willing to delegate both negative and VUS results, few currently do so. Oncology GCs exhibited greater willingness and actual delegation of VUS disclosures relative to other specialties. Effective communication skills, level of genetics knowledge, and willingness to seek help were identified as the most influential attributes on GCs' confidence in GCAs' abilities to disclose test results. The most frequent concern about GCAs disclosing negative and VUS results was remaining suspicion for an underlying genetic etiology. Additionally, GCs were concerned about delegating VUS disclosures since patients more frequently struggle to understand those results. A triaging system to determine suitable results for a GCA to disclose and extensive shadowing of GCs disclosing results were proposed as methods of building GCs' confidence in the ability of a GCA to disclose test results. Ultimately, a better understanding of the discrepancy between GCs' willingness to delegate results disclosures and actual delegation practices is essential if the GCA scope of practice were to include results disclosure.
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    Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery
    (Sage, 2022) Loewenstein, Scott N.; Bamba, Ravinder; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods: We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results: Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) (P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) (P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions: Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.
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    Parent Perspectives for Type B Ulnar Polydactyly Management
    (Sage, 2023) Goebel, Gunnar J.; Loewenstein, Scott N.; Adkinson, Joshua M.; Graduate Medical Education, School of Medicine
    Background: Type B ulnar polydactyly is one of the most commonly encountered congenital hand differences and can be treated with ligation or excision. The purpose of this study was to determine what factors families consider in selecting treatment for their child with type B ulnar polydactyly. Methods: We reviewed treatment outcomes and administered a survey by telephone to parents of children with type B ulnar polydactyly treated at a pediatric hospital between 2015 and 2020. We assessed satisfaction, reasons for choosing treatment, and post-management complications. Results: The families of 70 of the 156 consecutive treated patients were successfully contacted and agreed to participate (45% response rate). The mean follow-up was 27 months. Twenty-eight chose in-office suture ligation and 42 chose excision. Rapid treatment was prioritized by those who opted for in-office ligation (P = .044). The complication rate for suture ligation was significantly higher than excision (P < .0001), with the most common complication being a residual remnant (nubbin or neuroma stump) (64%). Respondents with residual remnant reported significantly less satisfaction with the appearance of their child's hand (P < .001) and with treatment outcomes (P = .028) compared to those without residual remnants. Conclusions: Factors considered by parents in choosing type of treatment for type B ulnar polydactyly vary and may be significantly influenced by the surgeon. Although the majority of parents remain extremely satisfied with their child's outcome regardless of management type, time to treatment plays a determinative role in parents opting for ligation rather than excision in the operating room.
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    Primary Repair of Chronic Distal Biceps Tendon Tears
    (Sage, 2024) Schmidt, Gregory J.; Dmochowski, Jakub M.; Gudeman, Andrew S.; Cage, Emily S.; Greenberg, Jeffrey A.; Hoyer, Reed W.; Graduate Medical Education, School of Medicine
    Background: This study reports the clinical results following primary repair of distal biceps tendon ruptures more 6 weeks after injury. Methods: A retrospective review of distal biceps tendon repairs performed by 8 different hand surgeons from January 1, 2015 to October 15, 2020 was performed. Patients with complete tears surgically treated ≥6 weeks after injury without tendon graft were included. Thirty patients qualified and underwent chart review for complication and range of motion (ROM) data. They were contacted for final patient-reported outcome measures (PROMs) using Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient Reported Elbow Evaluation (PREE) scores. Final PROMs were obtained from 21 patients with an average follow-up of 31.3 months (range: 4-71 months). Results: Average time from injury to repair was 71 days (range: 42-204). The average QuickDASH score was 6.6 (±6.2) and PREE score was 7.8 (±8.0). The amount of elbow flexion necessary to complete the repair was documented in 21 patients and averaged 64º (±10º). Postoperatively, patients achieved an average extension/flexion of 1º (±1º) to 138º (±2º) and pronation/supination of 76º (±4º) to 77º (±3º). Complications were reported in 14 patients (47%) and included 2 re-ruptures, 1 adhesive scar formation, 1 superficial infection, 1 intraoperative lateral antebrachial cutaneous nerve laceration, 12 neuropraxias, and 1 case of heterotopic ossification (HO). Conclusions: Primary repair of chronic distal biceps tendon tears greater than 6 weeks from injury demonstrated excellent PROMs and elbow ROM. However, the complication rate may be higher than early repair.
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    The Association of Insurance Status and Complications After Carpal Tunnel Release
    (Sage, 2023) Sun Cao, Phoebus; Loewenstein, Scott N.; Timsina, Lava R.; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR. Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included. Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2%) had Medicare, 7027 (26.9%) had Medicaid, and 16 462 (62.9%) had commercial insurance. Compared with Medicare, Medicaid status (P < .001) and commercial insurance status (P < .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications. Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.
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    Use of an Abductor Pollicis Brevis Tendon Slip for Reconstruction of the Radial Collateral Ligament of the Thumb Metacarpophalangeal Joint: An Anatomical Investigation
    (Sage, 2023) Schmidt, Gregory J.; Crosby, Nicholas E.; Merrell, Gregory A.; Graduate Medical Education, School of Medicine
    Background: Reconstruction of the radial collateral ligament (RCL) of the thumb metacarpophalangeal (MP) joint is commonly performed for chronic injuries. This study aims to evaluate the anatomical feasibility and reliability of using the abductor pollicis brevis (APB) tendon to reconstruct the RCL. Methods: Ten cadaver arms were dissected to evaluate the relationship between insertions of the RCL and APB. A slip of the APB was divided from tendon and reflected proximally. The dissected tendon was deemed sufficient for reconstruction if it could be reflected to the footprint of the RCL origin. The size of the dissected APB slip was then compared with that of the RCL. Results: The dissected slip of the APB could be fully reflected proximally to the RCL origin in all specimens. The APB insertion was also found to be closely approximated to the RCL insertion, averaging 2.1 mm distal and 1.8 mm dorsal. Significant differences existed between the lengths (P < .001) of the APB slip and RCL, with no significant difference in widths (P = .051). Conclusions: A sufficient APB tendon slip can be obtained to reliably reconstruct the RCL of the thumb MP. The location of the APB insertion closely approximates the RCL insertion.