OBJECTIVE: Head and neck radiation therapy (HNRT) has traditionally been considered a contraindication to vocal fold medialization procedures. Although safety has been demonstrated, we hypothesize that actual management varies. This study evaluates practice patterns of otolaryngologists regarding vocal fold medialization in patients after HNRT.
METHODS: A 25-question survey evaluating respondents\' management of patients status post HNRT with vocal fold paresis/paralysis was distributed to 357 otolaryngologists. Practice patterns regarding injection laryngoplasty (IL), medialization thyroplasty (MT), and arytenoid adduction (AA) were queried.
RESULTS: Eight-two clinicians (23%) completed the survey. Ninety-one percent of respondents were laryngologists, 9% head and neck surgeons, 3% comprehensive otolaryngologists, and 3% \"other.\" Eleven (15%) had been in practice <5 years, 19 (25%) for 5-10 years, and 46 (61%) for >10 years. No respondents considered HNRT a contraindication to IL, and 11 (14%) reported complications from the procedure. Hyaluronic acid (58, 75%) was most commonly injected. Twenty percent considered HNRT a contraindication to MT, and 37% considered it a contraindication to AA. Gore-Tex was used most commonly (65%). Twenty-seven percent reported major complications after MT. All complications occurred in the >10-year practice group, and this group was more likely to delay surgery after HNRT (p = 0.022). Respondents with complications were more likely to perform MT in HNRT patients (p = 0.0191).
CONCLUSIONS: Otolaryngologists generally do not consider HNRT to be a contraindication to IL, but some consider it a contraindication to MT/AA. Previous complications do not appear to deter surgeons from performing MT.
METHODS: N/A (Survey Study) Laryngoscope, 2024.

BACKGROUND: General practitioners (GPs) make numerous care decisions throughout their workdays. Extended periods of decision making can result in decision fatigue, a gradual shift toward decisions that are less cognitively effortful. This study examines whether observed patterns in GPs\' prescribing decisions are consistent with the decision fatigue phenomenon. We hypothesized that the likelihood of prescribing frequently overprescribed medications (antibiotics, benzodiazepines, opioids; less effortful to prescribe) will increase and the likelihood of prescribing frequently underprescribed medications (statins, osteoporosis medications; more effortful to prescribe) will decrease over the workday.
METHODS: This study used nationally representative primary care data on GP-patient encounters from the Bettering the Evaluation and Care of Health program from Australia. The association between prescribing decisions and order of patient encounters over a GP\'s workday was assessed with generalized linear mixed models accounting for clustering and adjusting for patient, provider, and encounter characteristics.
RESULTS: Among 262,456 encounters recorded by 2,909 GPs, the odds of prescribing antibiotics significantly increased by 8.7% with 15 additional patient encounters (odds ratio [OR] = 1.087; confidence interval [CI] = 1.059-1.116). The odds of prescribing decreased significantly with 15 additional patient encounters by 6.3% for benzodiazepines (OR = 0.937; CI = 0.893-0.983), 21.9% for statins (OR = 0.791; CI = 0.753-0.831), and 25.0% for osteoporosis medications (OR = 0.750; CI = 0.690-0.814). No significant effects were observed for opioids. All findings were replicated in confirmatory analyses except the effect of benzodiazepines.
CONCLUSIONS: GPs were increasingly likely to prescribe antibiotics and were less likely to prescribe statins and osteoporosis medications as the workday wore on, which was consistent with decision fatigue. There was no convincing evidence of decision fatigue effects in the prescribing of opioids or benzodiazepines. These findings establish decision fatigue as a promising target for optimizing prescribing behavior.
CONCLUSIONS: We found that as general practitioners progress through their workday, they become more likely to prescribe antibiotics that are reportedly overprescribed and less likely to prescribe statins and osteoporosis medications that are reportedly underprescribed.This change in decision making over time is consistent with the decision fatigue phenomenon. Decision fatigue occurs when we make many decisions without taking a rest break. As we make those decisions, we become gradually more likely to make decisions that are less difficult.The findings of this study show that decision fatigue is a possible target for improving guideline-compliant prescribing of pharmacologic medications.

Alopecia areata (AA) is a clinically heterogeneous, immune-mediated, non-scarring hair loss disorder. This real-world chart review sought to characterize treatment patterns and healthcare resource use among patients with severe AA in South Korea. A web-based chart review of 40 dermatologists was conducted in which the medical charts of 151 adult patients diagnosed with severe AA between May 2019 and April 2021 were reviewed. Anonymized data on patient characteristics, treatment patterns, healthcare resource use, and clinical outcomes were extracted from the date of severe disease diagnosis until the date of data collection (September-November 2022). Sixty-six percent of patients were diagnosed with severe disease at initial presentation, while 34% were re-classed to severe during the disease course. Mean estimated patient age at the time of diagnosis of severe AA was 37.1 (range 22-68) years. Fifty-three percent of patients were male. Most patients (93.4%) received pharmacological treatment for their condition; 45.5% received ≥2 lines of treatment with a mean duration of 24 months. First-line treatment discontinuation due to lack of efficacy occurred in 46.0% of cases. Hair regrowth occurred in 71.0% of patients, 59.2% of whom experienced major regrowth (≥60%) during the follow-up period. Median (95% confidence interval) time to regrowth was 13.7 (11.0-20.6) months. Treatment visit rates per person-year ranged from two (phototherapy) to 10 (topical treatment), dermatologist visits occurred at a rate of 12.9 per person-year and 6.0% of patients were hospitalized due to alopecia areata. The majority of hospitalizations were related to treatment and occurred in patients who received pulse systemic corticosteroid therapy. The patient and economic burden of AA in South Korea is high and there remains a critical unmet need among patients with severe AA with respect to the effectiveness of commonly used treatment strategies.

BACKGROUND: As the number of nursing home residents with multiple healthcare needs grows, the demand for nursing expertise increases. The implementation of new care models involving nurses with expanded roles is crucial for ensuring quality care in nursing homes.
OBJECTIVE: To investigate the characteristics and activities of nurses employed in nursing homes in expanded roles and the factors associated with variation in the activities performed.
METHODS: This multicentre cross-sectional survey in Switzerland collected data from a convenience sample of 118 nursing homes between September 2018 and October 2019. From a subsample of 62 nursing homes, we analysed the characteristics and activities of 104 nurses in expanded roles. Associations between the activities performed and the educational background of the nurses in expanded roles, their direct supervisors\' positions and the presence of physicians in the nursing homes were examined.
RESULTS: Most Registered Nurses in expanded roles were diploma educated (48%), with fewer having a bachelor\'s (35%) or master\'s degree (17%). Overall, direct clinical practice and guidance and coaching activities were conducted monthly to weekly; consultation, evidence-based practice, collaboration and ethical decision-making activities were conducted monthly. We saw variations where a higher educational background was associated with more frequent evidence-based practice activities (z = 3.47, p < 0.001), and if direct supervisors were ward managers, nurses in expanded roles worked more frequently below their scope of practice (z = 4.10, p < 0.001).
CONCLUSIONS: This is the first study to use Hamric\'s integrative Advanced Practice Nursing model to examine the activities of nurses in expanded roles in nursing homes. We found considerable variation in their activities, where nursing homes seem to adapt their roles to their educational background and the local context.
CONCLUSIONS: Our findings show the importance of clarifying role expectations for Registered Nurses in expanded roles, allowing them to practice at the top of the licence to meet residents\' complex healthcare needs.

UNASSIGNED: Vogt-Koyanagi-Harada (VKH) syndrome is an inflammatory condition characterized by bilateral, granulomatous panuveitis with or without systemic manifestations, and accounts for up to 18% of referrals for panuveitis at tertiary centers in the United States of America. Despite ongoing research, there is limited evidence and no clear consensus on how to diagnose and treat patients with VKH, leading to variations in practice patterns among uveitis specialists.
UNASSIGNED: An anonymous, online survey was distributed to uveitis specialists in the American Uveitis Society (AUS). The survey included 21 questions that asked for non-identifiable demographics and covered topics such as preferred imaging modalities, treatment for the first episode of VKH, and perceived efficacy of immunomodulatory therapy (IMT).
UNASSIGNED: A total of 104 surveys were included for analysis, representing a 38.4% response rate from the AUS listserv. A majority of respondents were uveitis fellowship trained and practiced in North America in an academic setting. Fluorescein angiography and enhanced depth imaging with optical coherence tomography were rated as the most consistently useful methods for the diagnosis of VKH. For treatment of acute initial-onset VKH, responses were divided between a preference for high-dose systemic corticosteroids with IMT (61.5%) and without IMT (37.5%). Methotrexate and mycophenolate mofetil were the most common IMTs to be used as first-line therapies, but adalimumab and infliximab were perceived to be the most effective for the treatment for VKH.
UNASSIGNED: While there are some common trends in the practice patterns for the diagnosis and treatment of patients with VKH, there was no clear consensus on the topic of IMT. There was a slight preference among uveitis specialists to use both IMT and systemic corticosteroids for the first episode of acute VKH.

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BACKGROUND: While brief duration primary care appointments may improve access, they also limit the time clinicians spend evaluating painful conditions. This study aimed to evaluate whether 15-minute primary care appointments resulted in higher rates of opioid prescribing when compared to ≥ 30-minute appointments.
METHODS: We performed a retrospective cohort study using electronic health record (EHR), pharmacy, and administrative scheduling data from five primary care practices in Minnesota. Adult patients seen for acute Evaluation & Management visits between 10/1/2015 and 9/30/2017 scheduled for 15-minute appointments were propensity score matched to those scheduled for ≥ 30-minutes. Sub-groups were analyzed to include patients with acute and chronic pain conditions and prior opioid exposure. Multivariate logistic regression was performed to examine the effects of appointment length on the likelihood of an opioid being prescribed, adjusting for covariates including ethnicity, race, sex, marital status, and prior ED visits and hospitalizations for all conditions.
RESULTS: We identified 45,471 eligible acute primary care visits during the study period with 2.7% (N = 1233) of the visits scheduled for 15 min and 98.2% (N = 44,238) scheduled for 30 min or longer. Rates of opioid prescribing were significantly lower for opioid naive patients with acute pain scheduled in 15-minute appointments when compared to appointments of 30 min of longer (OR 0.55, 95% CI 0.35-0.84). There were no significant differences in opioid prescribing among other sub-groups.
CONCLUSIONS: For selected indications and for selected patients, shorter duration appointments may not result in greater rates of opioid prescribing for common painful conditions.

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A survey was completed by 183 clinicians at a pediatric hospital to investigate knowledge, confidence, and practice patterns defining, identifying, and quantifying dystonia in children. The definition of dystonia was correctly identified by 86% of participants. While 88% reported identifying dystonia, only 42% of physicians and therapists reported quantifying dystonia. A weak, significant correlation, rs =.339, p ≤ .001, was found between years of pediatric experience and confidence identifying dystonia. Clinician reported higher confidence levels identifying and quantifying dystonia if they perform a neurological exam. Clinical training initiatives are needed to improve standardization and build confidence in defining, identifying, and quantifying dystonia.