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Desai V, Cottrell J, Sowerby L. No longer a blank cheque: a narrative scoping review of physician awareness of cost. Public Health 2023; 223:15-23. [PMID: 37595425 DOI: 10.1016/j.puhe.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Healthcare costs have been steadily rising, and attention to cost containment in healthcare systems is increasingly important. It has been previously established that physicians lack adequate awareness of cost in health care and that by increasing awareness, costs can be reduced. This scoping review examines cost awareness of medications, investigations and procedures and identifies potential interventions that may serve to improve physician awareness. STUDY DESIGN A scoping review was performed to evaluate the literature based on established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS A review of electronic databases was performed for studies regarding physician awareness of cost, including PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar. RESULTS An initial 4350 citations were identified, and 76 articles were included for full text analysis. Combined, these studies assessed 18,901 physicians. The overwhelming majority (91%) found cost awareness in physicians was low and demonstrated significant room for cost reduction. Eighteen of the 76 studies assessed an intervention to improve physician awareness of cost and used either a price list (89%) or a teaching session (11%) as the primary intervention. CONCLUSIONS Research demonstrates that there is still a lack of awareness among physicians of the costs of medications, investigations and procedures/consumables. Initial approaches using price display and teaching sessions have shown promise. Further research into best practices for education around cost, beginning in medical school and continuing into established medical and surgical practices, may lead to increased cost savings in health care.
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Affiliation(s)
- V Desai
- School of Medicine, Queen's University, Kingston, ON, Canada.
| | - J Cottrell
- Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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Thamboo A, Kilty S, Witterick I, Chan Y, Chin CJ, Janjua A, Javer A, Lee J, Monterio E, Rotenberg B, Scott J, Smith K, Sommer DD, Sowerby L, Tewfik M, Wright E, Desrosiers M. Canadian Rhinology Working Group consensus statement: biologic therapies for chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2021; 50:15. [PMID: 33750471 PMCID: PMC7945300 DOI: 10.1186/s40463-021-00493-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence suggests that biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of chronic rhinosinusitis with nasal polyposis (CRSwNP). There remains a population in CRSwNP that despite medical therapy and endoscopic sinus surgery have persistent signs and symptoms of disease. Therefore, biologics, monoclonal antibody agents, could be beneficial therapeutic treatments for these patients. There have been eight randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL-5R, IL-33, and immunoglobulin (Ig)E. However, there are no formal recommendations for the optimal use of biologics in managing Chronic Rhinosinusitis (CRS) within the Canadian health care environment. METHODS A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. 17 fellowship trained rhinologists across Canada evaluated the 28 original statements on a scale of 1-10 and provided comments. A rating within 1-3 indicated disagreement, 8-10 demonstrated agreement and 4-7 represented being neutral towards a statement. All ratings were quantitively reviewed by mean, median, mode, range and standard deviation. Consensus was defined by removing the highest and lowest of the scores and using the "3 point relaxed system". RESULTS After three rounds, a total of 11 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with CRS. CONCLUSION This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of patients with CRS, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.
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Affiliation(s)
- Andrew Thamboo
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - S Kilty
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - I Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Y Chan
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Chin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - A Janjua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - A Javer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, 2600-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - E Monterio
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - B Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - J Scott
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - K Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - M Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - E Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - M Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
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Bachert C, Sousa A, Han J, Schlosser R, Sowerby L, Hopkins C, Maspero J, Kante O, Karidi-Andrioti D, Chaker A. P503 MEPOLIZUMAB FOR CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: COMORBID ASTHMA, NSAID EXACERBATED RESPIRATORY DISEASE, EOSINOPHIL STRATIFICATION. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chan Y, Angel D, Aron M, Hartl T, Moubayed SP, Smith KA, Sommer DD, Sowerby L, Spafford P, Mertz D, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada. J Otolaryngol Head Neck Surg 2020; 49:76. [PMID: 33106189 PMCID: PMC7586368 DOI: 10.1186/s40463-020-00466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.
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Affiliation(s)
- Y Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - D Angel
- Division of Otolaryngology - Head & Neck Surgery, Memorial University of Newfoundland, St. John's, NL, Canada
| | - M Aron
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - T Hartl
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - S P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, University of Montreal, Montreal, QC, Canada
| | - K A Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Otolaryngology - Head & Neck Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, ON, Canada
| | - P Spafford
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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Ayad T, Stephenson K, A L Smit D, Ben-Ari O, Késmárszky R, Lechien JR, Sobol S, Meller C, Sargi Z, Maunsell R, De Siati RD, Jia H, Krishnan V, North H, Eter EG, Metwaly O, Peer S, Teissier N, Sowerby L, Hong P, Fakhry N. Young Otolaryngologists of International Federation of Oto-rhino-laryngological Societies (YO-IFOS) committees. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S61-S65. [PMID: 30174261 DOI: 10.1016/j.anorl.2018.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- T Ayad
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
| | - K Stephenson
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - D A L Smit
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - O Ben-Ari
- Tel Aviv Sourasky Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - J R Lechien
- Centre Hospitalier Universitaire de Bruxelles, Site Saint-Pierre, Bruxelles, Belgium
| | - S Sobol
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - C Meller
- Prince of Wales and Sydney Hospitals, Sydney, Australia
| | - Z Sargi
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Fl, USA
| | - R Maunsell
- Setor de Otorrinolaringologia Pediátrica, FCM-UNICAMP, Campinas, Brazil
| | - R D De Siati
- Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - H Jia
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - V Krishnan
- Madras ENT Research Foundation, Raja Annamalaipuram, Chennai, India
| | - H North
- Westmead Hospital, Sydney, Australia
| | - E G Eter
- Saint joseph University, School of Medecine, Beirut, Lebanon
| | - O Metwaly
- Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - S Peer
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | - L Sowerby
- St. Joseph's Healthcare, Western University, London, Canada
| | - P Hong
- IWK Health Centre, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia
| | - N Fakhry
- Hôpital de la Conception, Marseille, France
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Dewan AK, Sowerby L, Jadeja S, Lian C, Wen P, Brown JR, Fisher DC, LeBoeuf NR. Pityriasis rubra pilaris-like erythroderma secondary to phosphoinositide 3-kinase inhibition. Clin Exp Dermatol 2018; 43:890-894. [PMID: 29851132 DOI: 10.1111/ced.13608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Phosphoinositide 3-kinase (PI3K) inhibitors are a class of small-molecule inhibitors approved for the treatment of certain leukaemias and lymphomas. Their dermatological adverse event profile is poorly described. AIM To characterize a rare cutaneous adverse event from PI3K inhibitors in order to help dermatologists and oncologists identify and effectively manage such eruptions. METHODS This was a retrospective analysis of patients receiving PI3K inhibitors referred to the Skin Toxicities Program in The Center for Cutaneous Oncology. RESULTS Three patients on PI3K inhibitors for treatment of malignancy developed diffuse erythroderma and keratoderma. Clinical and histopathological findings were consistent with pityriasis rubra pilaris (PRP)-like reactions. All patients improved with topical and oral corticosteroids, oral acitretin, and drug discontinuation. CONCLUSIONS PRP-like cutaneous eruptions may develop secondary to PI3K inhibition. Early dermatological evaluation of cutaneous toxicities to PI3K inhibitors as well as rapid initiation of disease-specific treatments may help keep patients on life-prolonging anti-cancer therapies.
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Affiliation(s)
- A K Dewan
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - L Sowerby
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - S Jadeja
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - C Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - P Wen
- Department of Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J R Brown
- Chronic Lymphocytic Leukemia Center and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - D C Fisher
- Division of Hematologic Malignancies and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - N R LeBoeuf
- Department of Dermatology, The Center for Cutaneous Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
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