Background  Non-communicable chronic diseases (NCCDs), such as cardiovascular disease, diabetes, and cancer, are the leading cause of death and disability and the leading driver of healthcare costs in the U.S. It is estimated that 80% of chronic diseases and premature deaths are attributable to modifiable lifestyle factors related to smoking and alcohol intake, poor eating patterns, and physical inactivity. Inadequate sleep also plays a significant role. Among other directives, primary care providers (PCPs) have the opportunity to contribute to preventing and treating NCCD in their patients. Comprehensive, evidence-based behavioral counseling interventions are recommended to PCPs as a first-line approach to improving outcomes. However, presumably due to a lack of PCP time, training or resources, most patients report not receiving such services. Currently, the extent to which PCPs in Alabama offer or refer patients to health behavior change (HBC) services is unknown.  Objectives  This study aims to assess the following: (1) Alabama PCPs\' current approaches in facilitating patient HBC in the domains of eating patterns, physical activity, sleep, and stress and (2) the likelihood of the Alabama PCPs referring patients to virtual HBC programs, once developed by an osteopathic medical school in the state.  Methods  Data were collected from clinic personnel who were knowledgeable regarding the clinic\'s approach to facilitating patient HBC via scripted telephone interviews and online surveys sent via email. The clinic list utilized for the study was derived from a list of VCOM-Auburn clinical preceptors. Primary care and specialty clinics were included. Data were analyzed descriptively to determine the number of clinics that (1) provide, recommend, or refer programs, services, or resources to patients to facilitate HBC related to eating patterns, physical activity, sleep, and stress management and (2) are likely to refer patients to free virtual HBC programs, once developed by an osteopathic medical school in the state. Results  Of the 198 clinics that were contacted, 75 were excluded, 46 were \"no response,\" 53 agreed to participate, and 50 completed the survey. Of the 50 clinics that completed the survey, 33 indicated offering resources or referrals for diet, 29 stated they offered resources or referral services for physical activity, 33 indicated offering resources or referrals for sleep, and 28 indicated offering or recommending resources for stress management to patients. Most of the clinics (29/50) felt that their patients would benefit most from a program that facilitates improvement in eating patterns, and 41/50 clinics said that they are either \"somewhat\" or \"extremely\" likely to refer patients to a free VCOM-Auburn HBC program, once available.  Conclusions Findings indicate that a significant percentage of PCP clinics are not offering HBC resources to patients and that most PCP clinics would consider referring patients to free VCOM-Auburn HBC programs, once available. Phone data were significantly different from email data. The primary limitations were a low response rate and potential response bias.

Background: Cardiovascular perfusion is a dynamic healthcare profession where new practices are frequently introduced. Despite the emergence of evidence-based clinical practice guidelines, little is known about their dissemination at the institutional level. Clinical practice surveys have been used to identify current trends in perfusion practice in the areas of equipment, techniques, and staffing. This survey aims to describe clinical perfusion practices across adult cardiac surgical programs located in a large, single, geographical region of the United States. Methods: Following Institutional Review Board (IRB) approval, an 81-question survey was distributed to 167 adult perfusion programs across the Zone IV region of the American Society of Extracorporeal Technology (AmSECT), a non-profit professional society representing the extracorporeal technology community. Surveys were distributed to chief perfusionists through the Research Electronic Data Capture (REDCap) web-based survey response system. Results: Responses were received from 58 of 167 centers across (34.7% response rate). Centrifugal pumps were used at 81% (n = 47) of centers and 96.6% (n = 56) use an open venous system or hard-shell venous reservoir. Del Nido was the most frequently used cardioplegia strategy with 62.1% (n = 36) of centers reporting its use. The use of electronic medical records was reported in 43% (n = 25) of centers, while 84.5% (n = 49) reported using Cardiopulmonary Bypass (CPB) protocols (>75% of all CPB activities). Extracorporeal Membrane Oxygenation (ECMO) support was reported in 93.1% (n = 54) of programs, with 59.2% of programs (n = 34) employing a perfusionist as ECMO Coordinator. The n + 1 staffing model was reported by 50% (n = 29), with 24% supporting the n + 1 staffing for after-hours and on-call procedures. Conclusion: Clinical practice surveys can be effective tools to inform clinicians about contemporary perfusion practice and identify deviations from professional standards and guidelines. Subsequent surveys may describe trends over time, assess standardization of practice, measure adherence to evidence-based guidelines, and foster improved patient care and outcomes.

OBJECTIVE: Cancer patients require implantation of venous access devices to meet their personalized therapeutic needs, which are often complex due to the nature of the medication and the disease status. Therefore, it is essential to have standardized protocols that guarantee the best results in health and patient safety.
METHODS: To learn about the availability of protocols and aspects related to safety in clinical practice and to detect possible opportunities for improvement, a survey has been conducted in various Spanish hospitals, in addition to a review of the evidence regarding the various devices available and complications associated with the administration of chemotherapy.
RESULTS: As a result of both analyses, the Foundation for Excellence and Quality in Oncology (ECO), the Spanish Society of Medical Oncology (SEOM), and the Spanish Society of Oncology Nursing (SEEO) have developed a catheter selection algorithm based on patient characteristics and treatment to facilitate the clinical decision-making process, as well as some recommendations aimed at ensuring patient safety and rational use of available resources.
CONCLUSIONS: In conclusion, both the venous access catheter selection algorithm and the proposed recommendations aim to respond to the needs revealed in clinical practice and to become an integrable tool in electronic prescription systems to offer homogeneous criteria for action in cancer patients that require venous access, optimizing the use of available health resources with the highest safety and quality of life for the patient.

The thoracic spine (TS) is relatively under-researched compared to the neck and low back. As the challenge of managing spinal pain persists, understanding current physiotherapy clinical practice for TS pain and dysfunction is necessary to inform future research in this area.
To investigate physiotherapy practice for managing thoracic spine pain and dysfunction (TSPD) in the UK, with a secondary focus on examining differences across settings and expertise.
A cross sectional e-survey informed by existing evidence was designed. Comprising closed and open questions, the survey is reported in line with Checklist for Reporting Results of Internet E-Surveys. Eligible participants were UK-trained physiotherapists managing patients with TSPD, recruited for 9 weeks up to 8/2/16. Data analysis included descriptive analyses (closed questions) and thematic analysis (open questions).
From the 485 respondents, fulfilling the required sample size, key findings included.
Active motion testing, palpation and postural assessment was \'always\' undertaken by >89% of respondents.
Active (exercises) and passive (e.g. mobilisations) techniques were used by >85% of respondents, with ∼50% using manipulation, taping and acupuncture. Practice settings: Although broadly similar passive techniques were used more in private practice and sport. Expertise: Broadly similar patterns were seen for use of exercise across levels of expertise, although differences observed for electrotherapy and manipulation.
Despite limited research exercise is widely used in all areas of practice and across all level of expertise. Further research is required to investigate exercise prescription for TSPD and implementation of evidence-based practice.

BACKGROUND: Distal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated.
METHODS: Clinical practice survey among a random selection of 111 general practitioners (GP) and 56 vascular medicine physicians (VMP) working in Languedoc-Roussillon (France) to assess and compare iDDVTs management by GP and VMP.
RESULTS: In case of DVT, GP manage their patients alone in 35% of cases. In case of collaborative management, VMP initiate and stop anticoagulants (>74% of cases) whereas GP monitor anticoagulation (>76% of cases). With iDDVT, there was no difference between GP and VMP in terms of use (94% vs. 92%) and intensity of anticoagulation (full dose: 99%vs.100%). Duration of anticoagulation differed: GP modulated less frequently duration of anticoagulation in presence of a transient risk factor (58% vs. 90%, p<0.05) or according to the deep-calf or muscular location of iDDVT (6% vs. 36%, p<0.05) and treated more frequently iDDVT as long as proximal DVT (49% vs. 13%, p<0.05). When comparing GP, there was no significant difference in terms of therapeutic management between those who used to manage DVT alone and those who used to manage in collaboration with a thrombosis expert.
CONCLUSIONS: Treatment of iDDVT differed between GP and VMP. Half of GP don\'t modulate treatment according to anatomical location or to the provoked/unprovoked character of DVT. Given the low frequency of exposure to DVT in general practice, systematic referral to a thrombosis expert rather than continuous medical formation program seems appropriate to improve management.

BACKGROUND: When and how best to perform breast reconstruction in the setting of radiation therapy is a much debated topic.
OBJECTIVE: To investigate the approaches that Canadian plastic surgeons are taking to breast reconstruction in patients who require or may require radiation therapy.
METHODS: In April 2009, a survey invitation was sent to Canadian plastic surgeons via e-mail. Survey responses were collected over a two-month period.
RESULTS: Of the 307 invitees, 90 surgeons responded, of whom 76 met the inclusion criteria. Most surgeons (66%) do not perform immediate reconstruction in patients who require postmastectomy radiation. Most respondents (64%) perform immediate reconstructions for patients whose need for radiation is uncertain at the time of mastectomy. Expander and implants is their preferred option, followed by free transverse rectus abdominis myocutaneous (TRAM) flap. Thirty-five per cent use the delayed immediate technique in these cases. Twenty-one per cent are unfamiliar with the delayed-immediate technique. For delayed reconstruction of the irradiated patient, the pedicled TRAM is the most common choice.
CONCLUSIONS: The reconstructive options are increasing for patients who may need postmastectomy radiation. The use of the delayed immediate technique could increase as physicians gain more knowledge of the technique.
Le moment et la manière de procéder à une reconstruction mammaire en présence de radiothérapie constituent un sujet controversé.
Explorer les approches qu’adoptent les plasticiens canadiens en matière de reconstruction mammaire chez les patientes qui ont besoin ou sont susceptibles d’avoir besoin de radiothérapie.
En avril 2009, les chercheurs ont invité par courriel les plasticiens du Canada à participer à un sondage et ont colligé leurs réponses sur une période de deux mois.
Quatre-vingt-dix chirurgiens ont répondu aux 307 invitations, et 76 respectaient les critères d’inclusion. La plupart des chirurgiens (66 %) ne procèdent pas à une reconstruction immédiate chez les patientes qui ont besoin d’une radiothérapie après une mastectomie. La plupart des répondants (64 %) procèdent toutefois à une reconstruction immédiate chez les patientes dont on ne connaît pas les besoins en radiothérapie au moment de la mastectomie. Les expanseurs et les implants sont la solution favorisée, suivis d’un lambeau du grand droit abdominal. Trente-cinq pour cent utilisent alors la technique immédiate différée, mais 21 % ne la connaissent pas. En cas de reconstruction différée des patientes irradiées, le lambeau du grand droit abdominal pédiculé est le choix le plus courant.
Les options de reconstruction augmentent pour les patientes qui peuvent avoir besoin d’une radiothérapie après une mastectomie. Le recours à la technique immédiate différée pourrait augmenter à mesure que les médecins la connaîtront mieux.