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Ellsworth BL, Settecerri DJ, Mott NM, Vastardis A, Hider AM, Thompson J, Dossett LA, Hughes TM. Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change. Ann Surg Oncol 2023; 30:1712-1720. [PMID: 36536198 PMCID: PMC9762864 DOI: 10.1245/s10434-022-12934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Same-day discharge after mastectomy without immediate reconstruction (MwoR) has been shown to be safe, with improved patient satisfaction when compared with patients discharged 1 or more days after surgery. Nevertheless, only 16% of patients undergoing MwoR in Michigan are discharged on the day of surgery, with significant variation between facilities (3-88%). Our objective was to explore determinants of same-day discharge and offer strategies for broader implementation of this practice. METHODS We conducted semi-structured interviews with surgeons performing MwoR across the state of Michigan. Recruitment utilized purposeful and snowball sampling methods. The Tailored Implementation in Chronic Disease (TICD) framework was used to inform the creation of the interview guide. Interviews were transcribed and then analyzed using directed content analysis guided by the TICD framework. Salient determinants were organized into patient, provider, and system-level factors. RESULTS Participants (n = 26) included general surgeons, breast surgeons, and surgical oncologists. Most surgeons (n = 18, 69%) reported that they discharged fewer than 60% of patients the same day after MwoR. The most common barriers included patient knowledge at the patient level; awareness of evidence, surgeon dogma, and peer influence at the provider level; and team processes and operating room logistics at the system level. CONCLUSION We identified surgeon-defined determinants of same-day discharge after MwoR. For the identified barriers, potential implementation strategies could include incorporation of preoperative drain teachings for patients, utilizing consensus statements and opinion leaders to disseminate evidence supporting same-day mastectomies, and conducting workshops with relevant stakeholders to establish consistent facility practice patterns among surgical teams.
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Affiliation(s)
| | - Daniel J Settecerri
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Andrew Vastardis
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmad M Hider
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jessica Thompson
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
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Ellsworth BL, Settecerri DJ, Mott NM, Vastardis A, Hider AM, Thompson J, Dossett LA, Hughes TM. ASO Visual Abstract: Surgeon Perspectives on Determinants of Same-Day Mastectomy: A Roadmap for Implementing Change. Ann Surg Oncol 2023; 30:1721. [PMID: 36627456 DOI: 10.1245/s10434-022-13040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | - Daniel J Settecerri
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Andrew Vastardis
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmad M Hider
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
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Tintle N, Van De Griend K, Ulrich R, Wade RD, Baar TM, Boven E, Cooper CEA, Couch O, Eekhoff L, Fry B, Goszkowicz GK, Hecksel MA, Heynen A, Laughlin JA, Les SM, Lombard TR, Munson BD, Peterson JM, Schumann E, Settecerri DJ, Spry JE, Summerfield MJ, Sunder M, Wade DR, Zonnefeld CG, Brokus SA, Moen FS, Slater AD, Peterson JW, Pikaart MJ, Krueger BP, Best AA. Diarrhea prevalence in a randomized, controlled prospective trial of point-of-use water filters in homes and schools in the Dominican Republic. Trop Med Health 2021; 49:1. [PMID: 33397511 PMCID: PMC7780396 DOI: 10.1186/s41182-020-00291-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Lack of sustainable access to clean drinking water continues to be an issue of paramount global importance, leading to millions of preventable deaths annually. Best practices for providing sustainable access to clean drinking water, however, remain unclear. Widespread installation of low-cost, in-home, point of use water filtration systems is a promising strategy. Methods We conducted a prospective, randomized, controlled trial whereby 16 villages were selected and randomly assigned to one of four treatment arms based on the installation location of Sawyer® PointONE™ filters (filter in both home and school; filter in home only; filter in school only; control group). Water samples and self-reported information on diarrhea were collected at multiple times throughout the study. Results Self-reported household prevalence of diarrhea decreased from 25.6 to 9.76% from installation to follow-up (at least 7 days, and up to 200 days post-filter installation). These declines were also observed in diarrhea with economic or educational consequences (diarrhea which led to medical treatment and/or missing school or work) with baseline prevalence of 9.64% declining to 1.57%. Decreases in diarrhea prevalence were observed across age groups. There was no evidence of a loss of efficacy of filters up to 200 days post-filter installation. Installation of filters in schools was not associated with decreases in diarrhea prevalence in school-aged children or family members. Unfiltered water samples both at schools and homes contained potential waterborne bacterial pathogens, dissolved heavy metals and metals associated with particulates. All dissolved metals were detected at levels below World Health Organization action guidelines. Conclusions This controlled trial provides strong evidence of the effectiveness of point-of-use, hollow fiber membrane filters at reducing diarrhea from bacterial sources up to 200 days post-installation when installed in homes. No statistically significant reduction in diarrhea was found when filters were installed in schools. Further research is needed in order to explore filter efficacy and utilization after 200 days post-installation. Trial registration ClinicalTrials.gov, NCT03972618. Registered 3 June 2019—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-020-00291-y.
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Affiliation(s)
- Nathan Tintle
- Department of Mathematics and Statistics, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Kristin Van De Griend
- Department of Sociology, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Rachel Ulrich
- Department of Mathematical Sciences, Montana State University, P.O. Box 172400, Bozeman, MT, 59717, USA
| | - Randall D Wade
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Tena M Baar
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Emma Boven
- Department of Mathematics and Statistics, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Carolyn E A Cooper
- Chemistry Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Olivia Couch
- Department of Mathematics and Statistics, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Lauren Eekhoff
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Benjamin Fry
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Grace K Goszkowicz
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Maya A Hecksel
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Adam Heynen
- Department of Biology, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Jade A Laughlin
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Sydney M Les
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Taylor R Lombard
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - B Daniel Munson
- Department of Mathematics and Statistics, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Jonas M Peterson
- Chemistry Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Eric Schumann
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | | | - Jacob E Spry
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | | | - Meghana Sunder
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Daniel R Wade
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Caden G Zonnefeld
- Department of Mathematics and Statistics, Dordt University, 700 7th St. NE, Sioux Center, IA, 51250, USA
| | - Sarah A Brokus
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Francesco S Moen
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Adam D Slater
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Jonathan W Peterson
- Geological and Environmental Sciences Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Michael J Pikaart
- Chemistry Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Brent P Krueger
- Chemistry Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA
| | - Aaron A Best
- Biology Department, Hope College, 35 E. 12th St, Holland, MI, 49423, USA.
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