'It's more emotionally based': Prince Edward Island horse owner perspectives of horse weight management.

Horse obesity is a growing concern that can result in negative welfare. The role horse owners play in horse weight management is not well understood. This study aimed to: (1) explore the attitudes, beliefs, and perceptions of owners with overweight or obese horses regarding their horses' weight; and (2) understand the motivators and barriers for owners to implement, improve and maintain weight management-related strategies.

Nonclinical factors associated with the treatment of older women with newly diagnosed low-grade ductal carcinoma in situ.

Background: Ductal carcinoma in situ (DCIS) is the most common form of noninvasive breast cancer and is associated with an excellent prognosis. As a result, there is concern about overdiagnosis and overtreatment of DCIS because most patients with DCIS are treated as though they have invasive breast cancer and undergo either breast-conserving surgery (BCS)-most commonly followed by radiation therapy (RT)-or mastectomy. Little research to date has focused on nonclinical factors influencing treatments for DCIS.

Barriers and Strategies Used to Continue School-Based Health Services During the COVID-19 Pandemic.

Objective: To examine perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality.

Methods: We developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. We compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs.

Adherence to hormonal therapy after surgery among older women with ductal carcinoma in situ: Implications for breast cancer-related adverse health events.

Background: Evidence from randomized clinical trials (RCTs) shows that receipt of hormonal therapy after surgery for estrogen receptor-positive ductal carcinoma in situ (DCIS) reduces the risk of DCIS and contralateral invasive breast cancer (IBC) but not death from breast cancer. RCTs examined homogeneous samples, and therefore whether this evidence can be generalized to diverse populations is unclear.

Methods: Population-based data from four state cancer registries (California, New Jersey, New York, and Texas) were analyzed on women aged 65 years and older newly diagnosed with DCIS who underwent surgery with or without radiation during the years 2006-2013.

The development of a suitable training model for students with disabilities at a training institution in South Africa.

Background: The large South African population of people with disabilities presents unique challenges for training organisations because there is no training model that accommodates the demands of all disabilities. The site of the research was a private, nonprofit training institution with disability-friendly infrastructure which did not adequately prepare students for employment.

Objectives: The intention was to interrogate training models used at the institution, from the perspectives of students, facilitators and prospective employers.

Association Between Receipt of Definitive Treatment for Localized Prostate Cancer and Adverse Health Outcomes: A Claims-Based Approach.

Objectives: This study aimed to examine adverse health outcomes associated with receipt of definitive treatments (prostatectomy, intensity-modulated radiation therapy [IMRT] and brachytherapy).

Methods: We identified men aged 65 years and older who received a new diagnosis of localized prostate cancer from 4 state cancer registries (CA, FL, NJ, and TX) during the years 2006 to 2013. We merged the registry records for this cohort with Medicare enrollment and claims.

The Influence of Practice Structure on Urologists' Treatment of Men With Low-Risk Prostate Cancer.

Background: Vertical and horizontal integration among health care providers has transformed the practice arrangements under which many physicians work.

Objective: To examine the influence of type of practice structure, and by implication the financial incentives associated with each structure, on treatment received among men newly diagnosed with low-risk prostate cancer.

Research Design: We compiled a unique database from cancer registry records from 4 large states, Medicare enrollment and claims for the years 2005-2014 and SK & A physician surveys corroborated by extensive internet searches.

School-Based Health Services in Virginia and the COVID-19 Pandemic.

Background: Schools have a long history of delivering health services, but it is unclear how the COVID-19 pandemic may have disrupted this. This study examined changes in school-based health services and student needs before and during the pandemic and the factors important for delivering school-based health services.

Methods: A web-based survey regarding the impact of the pandemic on school-based health services was distributed via email to all 1178 Virginia public elementary schools during May 2021.

Vertical Integration Versus Physician Owners: Trends in Practice Structure Among Breast Cancer Surgeons.

Objective: The objective of this study was to document changes in physician practice structure among surgeons who treat women with breast cancer.

Design: We merged cancer registry records from 5 large states with Medicare Part B claims to identify each surgeon who treated women with breast cancer. We added information from SK&A surveys and extensive internet searches.

Documenting Horizontal Integration Among Urologists Who Treat Prostate Cancer.

Relatively little is known about the extent and effects of horizontal mergers among physician specialists. We developed and implemented a methodology to document changes in physician practice structure resulting from horizontal integration among urology groups. We merged cancer registry records from four large states with Medicare Part B claims to identify all urologists who treated men with prostate cancer.

Effect of early-stage Alzheimer's disease on household financial outcomes.

Significant limitations and rapid declines in financial capacity are a hallmark of patients with early-stage Alzheimer's disease (AD). We use linked Health and Retirement Study and Medicare claims data spanning 1992-2014 to examine the effect of early-stage AD, from the start of first symptoms to diagnosis, on household financial outcomes. We estimate household fixed-effects models and examine continuous measures of liquid assets and net wealth, as well as dichotomous indicators for a large change in either outcome.

Treatments and Health Outcomes of Medicare Patients With Back Pain.

Back pain treatments are costly and frequently involve use of procedures that may have minimal benefit on improving patients' functional status. Two recent studies evaluated adverse outcomes (mortality and major medical complications) following receipt of spinal surgery but neither examined whether such treatments affected functional ability. Using a sample composed of Medicare patients with persistent back pain, we examined whether functional ability improved after treatment, comparing patients treated with back surgery or spinal injections to nonrecipients.

Specialization as an Organizing Principle: The Case of Ambulatory Surgery Centers.

Ambulatory surgery centers (ASCs) recently have grown to become the dominant provider of specific surgical procedures in the United States. While the majority of ASCs focus primarily on a single specialty, many have diversified to offer a wide range of surgical specialties. We exploited a unique data set from Pennsylvania for the years 2004 to 2014 to conduct an empirical investigation of the relative cost of production in ASCs over varying degrees of specialization.

Specialization and production cost efficiency: evidence from ambulatory surgery centers.

In the U.S. health care sector, the economic logic of specialization as an organizing principle has come under active debate in recent years.

Examining Drivers of Health Care Spending: Evidence on Self-referral Among a Privately Insured Population.

Background: Despite the enactment of laws to restrict the practice of self-referral, exceptions in these prohibitions have enabled these arrangements to persist and proliferate. Most research documenting the effects of self-referral arrangements analyzed claims records from Medicare beneficiaries. Empirical evidence documenting the effects of self-referral on use of services and spending incurred by persons with private insurance is sparse.

Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures.

Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to physician self-referral arrangements. No recent research has examined whether physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain.

Implementation of a structured programme of preceptorship for newly qualified midwives in a maternity unit.

This article discusses the application of a structured approach to the development and implementation of preceptorship programmes with an evidence-based content to support newly qualified midwives (NQMs). The development of a programme of preceptorship for NQMs is discussed and recommendations made for current practice. All NHS trusts should consider how preceptorship programmes can be developed and implemented with a clear, robust audit trail to identify how allocated funding is used.

Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons' Ownership of Physical Therapy Services.

Objective: To examine whether the course of physical therapy treatments received by patients who undergo total knee replacement (TKR) surgery differs depending on whether the orthopedic surgeon has a financial stake in physical therapy services.

Data: Sample of Medicare beneficiaries who underwent TKR surgery during the years 2007-2009.

Study Design: We used regression analysis to evaluate the effect of physician self-referral on the following outcomes: (1) time from discharge to first physical therapy visit; (2) episode length; (3) number of physical therapy visits per episode; (4) number of physical therapy service units per episode; and (5) number of physical therapy services per episode expressed in relative value units.

A Comparison of Ambulatory Surgery Center Production Costs and Medicare Payments: Evidence on Colonoscopy and Endoscopy.

Background: Ambulatory surgery centers (ASCs) are freestanding facilities that specialize in surgical and diagnostic procedures that do not require an overnight stay. While it is generally assumed that ASCs are less costly than hospital outpatient surgery departments, there is sparse empirical evidence regarding their relative production costs.

Objectives: To estimate ASC production costs using financial and claims records for procedures performed by surgery centers that specialize in gastroenterology procedures (colonoscopy and endoscopy).

Factors affecting receipt of expensive cancer treatments and mortality: evidence from stem cell transplantation for leukemia and lymphoma.

Objective: To identify factors that affect whether patients diagnosed with either leukemia or lymphoma receive a stem cell transplant and secondly if receipt of stem cell transplantation is linked to improved survival.

Data: California inpatient discharge records (2002-2003) for patients with either leukemia or lymphoma linked with vital statistics death records (2002-2005).

Study Design: Bivariate Probit treatment effects model that accounts for both the type of treatment received and survival while controlling for nonrandom selection due to unobservable factors.

Urologists' use of intensity-modulated radiation therapy for prostate cancer.

Background: Some urology groups have integrated intensity-modulated radiation therapy (IMRT), a radiation treatment with a high reimbursement rate, into their practice. This is permitted by the exception for in-office ancillary services in the federal prohibition against self-referral. I examined the association between ownership of IMRT services and use of IMRT to treat prostate cancer.

Urologists' self-referral for pathology of biopsy specimens linked to increased use and lower prostate cancer detection.

Federal law allows physicians in some circumstances to refer patients for additional services to a facility in which the physician has a financial interest. The practice of physician self-referral for imaging and pathology services has been criticized because it can lead to increased use and escalating health care expenditures, with little or no benefit to patients. This study examined Medicare claims for men in a set of geographically dispersed counties to determine how the "in-office ancillary services" exception affected the use of surgical pathology services and cancer detection rates associated with prostate biopsies.

Linkages between utilization of prostate surgical pathology services and physician self-referral.

Objective: Federal law prohibits a physician from referring Medicare patients for procedures or services to health care entities in which the physician has a financial relationship. This law has exceptions which enable physicians to self-refer under certain conditions. This study evaluates the effects of self-referral on use rates of surgical pathology services performed in conjunction with prostate biopsies and whether such changes are linked to urologist self-referral arrangements.

Distraction osteogenesis-induced muscle fibrosis may not be associated with TGF-β1.

Background: Transforming growth factor-β 1 (TGF-β1) participates in the synthesis and deposition of collagen. It has been implicated in fibrosis of tendons in wound-healing models but has never been studied in muscles with respect to distraction osteogenesis.

Methods: Using a rabbit model of distraction osteogenesis, we distracted the left tibias of 36 New Zealand white rabbits at 0.