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Effects of a pausing procedure and a lecture outline on the notetaking performance of 33 college students with learning disabilities were investigated. Results found the pause procedure most effective for enhancing immediate recall of lecture ideas and completeness of lecture notes. (Author/PB)

Studied the effects of extending the pauses between teacher questions and naming a student to respond (wait time) in 2 experiments involving 194 college students. Extending wait time from 3 to 6 seconds actually lowered higher-level cognitive achievement. (SLD)

This study assessed the differential effectiveness of two types of response delays on correct responding (with communicative gestures) by three individuals with severe mental handicaps to training instructions. Results showed that response delay was effective in increasing the number of correct responses in two of the three individuals. (DB)

Teacher use questioning techniques to evaluate students' learning, check class work and homework, review and summarize lessons, and motivate students to pay attention, learn, develop thinking skills, and investigate independently. Teachers often overestimate the value of such questions. Asking thought-provoking questions and waiting for answers make a difference. (MLH)

To teach culturally and linguistically diverse learners with language-learning disabilities, teachers should ensure that students understand assigned tasks, seat students from similar linguistic backgrounds together, start lessons with lead statements, use varied questioning strategies, ask for summaries, use multimodal approaches, and relate information to students' background. (15 references) (MLH)

The activities described in this article can be used to spur an interest in the study of light and its associated properties. These activities are designed to startle the senses; but with a little time, students usually can come up with a testable hypothesis to explain what they have observed. Wait time is essential. Set the activities up as stations and let the unexpected outcomes stimulate students to generate "I wonder" questions for further exploration.

Tests the use of modeling and wait-time as guided-tour procedures and their use by docents as a strategy for increasing visitor questions. Modeling and wait-time seemed clearly important in encouraging visitors to begin to ask questions. Visitors asked an average of seven times more questions than had been asked on pre-experimental tours. (PVD)

OBJECTIVE: Maximal safe resection is the standard of care for patients presenting with lesions concerning for glioblastoma (GBM) on magnetic resonance imaging (MRI). Currently, there is no consensus on surgical urgency for patients with an excellent performance status, which complicates patient counseling and may increase patient anxiety. This study aims to assess the impact of time to surgery (TTS) on clinical and survival outcomes in patients with GBM. METHODS: This is a retrospective study of 145 consecutive patients with newly diagnosed IDH-wild-type GBM who underwent initial resection at the University of California, San Francisco, between 2014 and 2016. Patients were grouped according to the time from diagnostic MRI to surgery (i.e., TTS): ≤ 7, > 7-21, and > 21 days. Contrast-enhancing tumor volumes (CETVs) were measured using software. Initial CETV (CETV1) and preoperative CETV (CETV2) were used to evaluate tumor growth represented as percent change (ΔCETV) and specific growth rate (SPGR; % growth/day). Overall survival (OS) and progression-free survival (PFS) were measured from the date of resection and were analyzed using the Kaplan-Meier method and Cox regression analyses. RESULTS: Of the 145 patients (median TTS 10 days), 56 (39%), 53 (37%), and 36 (25%) underwent surgery ≤ 7, > 7-21, and > 21 days from initial imaging, respectively. Median OS and PFS among the study cohort were 15.5 and 10.3 months, respectively, and did not differ among the TTS groups (p = 0.81 and 0.17, respectively). Median CETV1 was 35.9, 15.7, and 10.2 cm3 across the TTS groups, respectively (p < 0.001). Preoperative biopsy and presenting to an outside hospital emergency department were associated with an average 12.79-day increase and 9.09-day decrease in TTS, respectively. Distance from the treating facility (median 57.19 miles) did not affect TTS. In the growth cohort, TTS was associated with an average 2.21% increase in ΔCETV per day; however, there was no effect of TTS on SPGR, Karnofsky Performance Status (KPS), postoperative deficits, survival, discharge location, or hospital length of stay. Subgroup analyses did not identify any high-risk groups for which a shorter TTS may be beneficial. CONCLUSIONS: An increased TTS for patients with imaging concerning for GBM did not impact clinical outcomes, and while there was a significant association with ΔCETV, SPGR remained unaffected. However, SPGR was associated with a worse preoperative KPS, which highlights the importance of tumor growth speed over TTS. Therefore, while it is ill advised to wait an unnecessarily long time after initial imaging studies, these patients do not require urgent/emergency surgery and can seek tertiary care opinions and/or arrange for additional preoperative support/resources. Future studies are needed to explore subgroups for whom TTS may impact clinical outcomes.

Introduction: Neurology wait times — from referral to consultation — continue to grow, leading to various adverse effects on patient outcomes. Key elements of virtual care can be leveraged to improve efficiency. This study examines the implementation of a novel virtual care model – Virtual Rapid Access Clinics – at the Neurology Centre of Toronto. The model employs a patient-centred care workflow, involving multidisciplinary staff and online administrative tools that are synthesized to expedite care and maintain quality. Methods: Virtual Rapid Access Clinic efficacy was studied by determining average wait times and patient throughput, calculated from anonymous data that was extracted from the clinic patient database (n = 1542). Comparative analysis focused on new patient consultations during the 12-month periods prior to (pre-Virtual Rapid Access Clinic, n = 456) and following (post-Virtual Rapid Access Clinic, n = 1086) Virtual Rapid Access Clinic implementation. Results: After Virtual Rapid Access Clinic implementation, there was a mean 15-day wait time reduction, and a monthly average 52-patient increase in patient throughput. Wait time reductions and increased patient throughput were observed in all three Virtual Rapid Access Clinic sub-clinics – epilepsy, headache and concussion. Respectively, average wait times reduced significantly by 26.4 and 18.9 days and insignificantly by 1.1 days; monthly average patient throughputs increased by 235%, 95% and 161%. Discussion: These findings demonstrated that the Virtual Rapid Access Clinic model of care is effective at reducing patient wait times and increasing patient throughput. While the Virtual Rapid Access Clinic presents a feasible model both during and after pandemic restrictions, further research exploring its scalability in other care contexts, potential changes in care quality and efficiency outside of pandemic restrictions must be performed. [ABSTRACT FROM AUTHOR]

The responses children make during read‐alouds bridge meaning from stories. Educators must grasp the value of children's responses and reactions to literature. Children's discourse is central to the reading process; thus, children must be allowed to participate in this learning process. Due to this, the read‐aloud process in the classroom should focus on the quality of interactions for the sake of literacy growth and development. Engaging learners in read‐alouds permits them to communicate with the teacher and peers, fosters space for ideas to be valued, and results in a community of learning. [ABSTRACT FROM AUTHOR]

Rhythm control is a cornerstone of atrial fibrillation (AF) management. Shorter time between diagnosis of AF and receipt of catheter ablation is associated with greater rates of therapy success. Previous work considered diagnosis-to-ablation time as a binary or categorical variable and did not consider the unique risk profile of patients after a referral for ablation was made. The purpose of this study was to comprehensively assess the impact of diagnosis-to-ablation and referral-to-ablation time on postprocedural outcomes at a population level. This observational cohort study included patients who received catheter ablation to treat AF in Ontario, Canada. Patient demographics, medical comorbidities, AF diagnosis date, ablation referral date, and ablation date were collected. The primary outcomes of interest included a composite of death and hospitalization/emergency department visit for AF, heart failure, or ischemic stroke. Multivariable Cox models assessed the impact of diagnosis-to-ablation and referral-to-ablation times on the primary outcome. Our cohort included 7472 patients who received ablation for de novo AF between April 1, 2016, and March 31, 2022. Median [interquartile range] diagnosis-to-ablation time was 718 [399–1274] days and median referral-to-ablation time was 221 [117–363] days. Overall, 911 patients (12.2%) had the composite endpoint within 1 year of ablation. Increasing diagnosis-to-ablation time was associated with a greater incidence for the primary outcome (hazard ratio [HR]1.02; 95% confidence interval [CI] 1.01–1.02 per month). Increasing referral-to-ablation time did not impact the primary outcome (HR 1.00; 95% CI 0.98–1.01 per month). Delays between AF diagnosis and ablation referral may contribute to adverse postprocedural outcomes and provide an opportunity for health system quality improvements. [Display omitted] [ABSTRACT FROM AUTHOR]

Data continue to accumulate demonstrating that those belonging to racialized groups face implicit bias in the emergency care delivery system across many indices, including triage assessment. The Emergency Severity Index (ESI) was developed and widely implemented across the US to improve the objectivity of triage assessment and prioritization of care delivery; however, research continues to support the presence of subjective bias in triage assessment. We sought to assess the relationship between perceived race and/or need for translator and assigned ESI score and whether this was impacted by hospital geography. We performed retrospective EMR-based review of patients presenting to urban and rural emergency departments of a health system in Maine with one of the top ten most common chief complaints (CC) across a 5-year period, excluding psychiatric CCs. We used multivariable regression to analyze the relationships between perceived race, need for translator, and gender with ESI score, wait time, and hallway bed assignments. We found that patients perceived as non-white were more likely to receive lower acuity ESI scores and have longer wait times as compared to patients perceived as white. Patients perceived as female were more likely to receive lower acuity scores and wait longer to be seen than patients perceived as male. The need for an interpreter was associated with increased wait times but not significantly associated with ESI score. After stratification by hospital geography, evidence of subjective bias was limited to urban emergency departments and was not evident in rural emergency departments. Further investigation of subjective bias in emergency departments in Maine, particularly in urban settings, is warranted. [ABSTRACT FROM AUTHOR]

The benefits of wait time in classroom discourses have been well documented in the field of education since the 1970s. While current forensic interview guidelines recognize the importance of pauses, whether there is sufficient empirical evidence to inform wait time guidelines in the legal context remains unanswered. This systematic review aimed to synthesize and provide a holistic update on the available research on the role of wait time when questioning children and recommended future direction to develop wait time guidelines specific to child forensic interviews. Systematic searches were conducted using four databases (PsycINFO, MedLine, ERIC, and Scopus). A total of 3,953 unique articles were returned, following a title and abstract screening, 68 full texts were reviewed, and 26 (including five additional studies identified through a hand search) were included. Inclusion criteria were the study sample included children under 18, published a measure of wait time in a questioning context, and in English. Overall, most knowledge of wait time remains in the field of education. Natural wait time is short, but with training, extended wait time yields significant benefits for both child and adult talk. Only one study examined the role of wait time in the forensic interviewing setting where a 10-s wait time appears to be more productive than shorter pauses. Extended wait time is a promising and simple interviewing practice with the potential to facilitate children's disclosure. The current review is a call for research in the area as it pertains to forensic interviewing of children and youth. [ABSTRACT FROM AUTHOR]

Background: Over one thousand pediatric kidney transplant candidates are added to the waitlist annually, yet the prospective time spent waiting is unknown for many. Our study fills this gap by identifying variables that impact waitlist time and by creating an index to predict the likelihood of a pediatric candidate receiving a transplant within 1 year of listing. This index could be used to guide patient management by giving clinicians a potential timeline for each candidate's listing based on a unique combination of risk factors. Methods: A retrospective analysis of 3757 pediatric kidney transplant candidates from the 2014 to 2020 OPTN/UNOS database was performed. The data was randomly divided into a training set, comprising two-thirds of the data, and a testing set, comprising one-third of the data. From the training set, univariable and multivariable logistic regressions were used to identify significant predictive factors affecting wait times. A predictive index was created using variables significant in the multivariable analysis. The index's ability to predict likelihood of transplantation within 1 year of listing was validated using ROC analysis on the training set. Validation of the index using ROC analysis was repeated on the testing set. Results: A total of 10 variables were found to be significant. The five most significant variables include the following: blood group, B (OR 0.65); dialysis status (OR 3.67); kidney disease etiology, SLE (OR 0.38); and OPTN region, 5 (OR 0.54) and 6 (OR 0.46). ROC analysis of the index on the training set yielded a c-statistic of 0.71. ROC analysis of the index on the testing set yielded a c-statistic of 0.68. Conclusions: This index is a modest prognostic model to assess time to pediatric kidney transplantation. It is intended as a supplementary tool to guide patient management by providing clinicians with an individualized prospective timeline for each candidate. Early identification of candidates with potential for prolonged waiting times may help encourage more living donation including paired donation chains. [ABSTRACT FROM AUTHOR]

Background: Emergency department (ED) crowding has repercussions on acute care, contributing to prolonged wait times, length of stay, and left without being seen (LWBS). These indicators are regarded as systemic shortcomings, reflecting a failure to provide equitable and accessible acute care. The objective was to evaluate the effectiveness of interventions aimed at improving ED care delivery indicators. Methods: This was a systematic review and meta‐analysis of randomized controlled trials (RCTs) assessing ED interventions aimed at reducing key metrics of time to provider (TTP), time to disposition (TTD), and LWBS. We excluded disease‐specific trials (e.g., stroke). We used Cochrane's revised tool to assess the risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations to rate the quality of evidence. The meta‐analysis was performed using a random‐effects model and Cochrane Q test for heterogeneity. Data were summarized as means (±SD) for continuous variables and risk ratios (RR) with 95% confidence intervals (CIs). Results: We searched MEDLINE, EMBASE, and other major databases. A total of 1850 references were scanned and 20 RCTs were selected for inclusion. The trials reported at least one of the three outcomes of TTD, TTP, or LWBS. Most interventions focused on triage liaison physician and point‐of‐care (POC) testing. Others included upfront expedited workup (ordering tests before full evaluation by a provider), scribes, triage kiosks, and sending notifications to consultants or residents. POC testing decreased TTD by an average of 5–96 min (high heterogeneity) but slightly increased TTP by a mean difference of 2 min (95% CI 0.6–4 min). Utilizing a triage liaison physician reduced TTD by 28 min (95% CI 19–37 min; moderate‐quality evidence) and was more effective in reducing LWBS than routine triage (RR 0.76, 95% CI 0.66–0.88; moderate quality). Conclusions: Operational strategies such as POC testing and triage liaison physicians could mitigate the impact of ED crowding and appear to be effective. The current evidence supports these strategies when tailored to the appropriate practice environment. [ABSTRACT FROM AUTHOR]

Objectives: We empirically investigated to what extent plants in the emergency department (ED) waiting areas influence patient wait experiences (i.e., anxiety, perceived service quality, and perception of wait time) depending on individual differences in cognitive thinking styles and one's bonds with the natural world. Background: Positive effects of nature on patient experiences in healthcare environments are well established by empirical research findings. However, evidence is scarce on the impact of nature on patient wait experiences and the roles of patient traits often related to their backgrounds. Methods: A within-subjects study was conducted (N = 116) with two virtually built ED waiting rooms: with versus without indoor and outdoor plants. Results: Findings confirmed that plants lower anxiety and improve perceptions of service quality and wait time. Cognitive thinking style significantly moderated how plants affected patient wait experiences. Although participants with higher connectedness to nature showed more positive responses to the nature condition, connectedness to nature did not significantly affect the association between nature and wait experiences. Conclusions: This study contributes to the existing body of knowledge on nature's effects in healthcare environments by examining the roles of individual differences in patients' and visitors' cognitive styles and connectedness to nature. Results highlighted the impact of these differences in patient experiences for effective implications of nature in waiting areas of healthcare facilities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined if emergency department (ED) operational metrics, such as wait time or length of stay, are associated with interest in substance use disorder (SUD) treatment referral among patients at high risk of opioid overdose. METHODS: In this observational study, 648 ED patients at high risk of opioid overdose completed a baseline questionnaire. Operational metrics were summarized using electronic health record data. The association between operational metrics and treatment interest was estimated with multivariable logistic regression. RESULTS: Longer time to room (adjusted odds ratio [AOR]=1.12, 95% confidence interval [CI]=1.01-1.25) and length of stay (AOR=1.02, 95% CI=1.00-1.05) were associated with treatment referral interest. Time to provider and number of treating providers showed no significant association. CONCLUSION: Longer rooming wait times and longer ED visits were associated with increased SUD treatment referral interest. This suggests patients who wait for longer periods may be motivated for treatment and warrant further resource investment. [ABSTRACT FROM AUTHOR]

Abstract Objective Non‐Hispanic Black (NHB) and Hispanic/Latino (Hispanic) patients wait longer in the emergency department (ED) to see practitioners when compared with non‐Hispanic White (NHW) patients. We investigate factors contributing to longer wait times for NHB and Hispanic patients using a linear decomposition approach. Methods This retrospective observational study included patients presenting to one tertiary hospital ED from 2019 to 2021. Median wait times among NHW, NHB, and Hispanic were calculated with multivariable linear regressions. The extent to which demographic, clinical, and hospital factors explained the differences in average wait time among the three groups were analyzed with Blinder‒Oaxaca post‐linear decomposition model. Results There were 310,253 total patients including 34.7% of NHW, 34.7% of NHB, and 30.6% of Hispanic patients. The median wait time in NHW was 9 min (interquartile range [IQR] 4‒47 min), in NHB was 13 min (IQR 4‒59 min), and in Hispanic was 19 min (IQR 5‒78 min, p

This report examines the implementation and early functioning of a new infectious diseases (ID) eConsult program. We recorded the reasons for placing ID eConsults, time to eConsult completion, in-person clinic wait times, and referring provider satisfaction following implementation of our outpatient eConsult program. Our data suggest that this ambulatory eConsult program led to improved access to ID subspecialty care, both via eConsults directly, and by reducing clinic wait times for patients who required an in-person evaluation. [ABSTRACT FROM AUTHOR]

Wait time for surgeries can be lengthy and its effect on postoperative outcome remains largely unknown. We evaluated the effect of wait time on postoperative outcome and on clinical course while awaiting surgery for lumbar spinal stenosis. This was a retrospective cohort study. A convenience sample (n=134) from prospective longitudinal studies that provided preoperative Oswestry Disability Index (ODI) data at two different time points and follow-up of ≥12 months. Wait time was the period between the initial consultation and immediately preoperatively. The primary outcome was the ODI minimal clinically important difference (MCID) (<30% vs ≥30% improvement) at 1 year. The median wait time was 5.9 (interquartile range (IQR) 8.2) months and postoperative follow-up was 19.2 (IQR 8.1) months. Wait time was not associated with absolute postoperative change in ODI scores, but patients with wait times <12 months were significantly more likely to reach the ODI MCID at last follow-up (66 (73.3%) for <12 months versus 13 (46.4%) for ≥12 months, p=.008; odds ratio=0.29 (95% confidence interval 0.12–0.75), p=.011). During wait time, there was no difference in patients deteriorating above the MCID for each time point (10 [9.7%] versus 5 [16.1%], p=.320). Longer wait times did not negatively influence postoperative outcome in patients with lumbar spinal stenosis using absolute values, but may impact individual patients' ability to achieve MCID. Patient-reported pain-related disability from the initial surgical consultation to surgery is relatively stable in most patients for at least 6 to 12 months. [ABSTRACT FROM AUTHOR]

In this study, a traffic queue model is employed to simulate traffic parameters for optimization purposes. The primary objective is to enhance the average queue length, cumulative delay, and cumulative reward for varying numbers of vehicles generated using an innovative approach. The proposed methodology integrates deep Reinforcement Q-Learning techniques implemented through a realistic simulator, Simulation of Urban MObility, based on OpenStreetMap. This simulator is used to balance the flow of traffic by monitoring traffic conditions and adjusting signals (Red/Yellow/Green) accordingly. The research extensively evaluates simulation outcomes across different scenarios involving 50, 100, 500, and 1000 vehicles, with episodes 10, 50 and 100. The results provide valuable insights into training times, simulation durations, and total rewards obtained, indicating improvements in mitigating traffic congestion. The introduction of a traffic control strategy enhances model effectiveness through the utilization of four-layer deep neural network architectures with 400 neurons in hidden layers. However, the study also highlights persistent challenges related to real-time implementation and complexities in state-action-agent relationships. The progress highlights improvements in reducing congestion and enhancing efficiency at junctions by dynamically adjusting signal phases while leveraging historical data. The results highlight the potential of dynamic traffic management strategies in effectively addressing urban traffic challenges. [ABSTRACT FROM AUTHOR]

Outpatient clinics globally grapple with the uncertainty of patient wait times, a critical factor affecting patient satisfaction. Extended waiting periods are often perceived as a hindrance to timely care, generating stress for both patients and healthcare providers. Accurate prediction of patient wait times can substantially improve patient satisfaction by reducing uncertainty. This study aims to predict patient Consultation Wait Time efficiently in a multispecialty hospital outpatient clinic utilizing a Multilayer Perceptron approach. Feature Selection Methods were employed to enhance the predictive efficiency of the model. The study evaluated various performance metrics, including Accuracy, Recall, Precision, F-measure, and Area Under the Receiver Operating Characteristic Curve (AUC). Temporal features, specifically Visit Time and Consultation Start Time, emerged as significant predictors in the model. Additionally, Vitals Examination was identified as a key factor in predicting Consultation Wait Time. Notably, the model incorporating variables selected through Reciprocal Ranking exhibited robust performance in predicting Consultation Wait Times. [ABSTRACT FROM AUTHOR]

Objective. Delays in initiation of advanced therapies, which include biologics and targeted synthetic disease-modifying antirheumatic drugs, contribute to poor patient outcomes. The objective of this quality improvement project was to identify factors that lead to a delay in the initiation of advanced therapy and to perform plan-do-study-act cycles to decrease the time to start advanced therapy. Methods. A retrospective chart review identified factors involved in delay to start advanced therapy. The primary outcome of the study was the number of days to advanced therapy start as measured by the date of rheumatologist recommendation to the date advanced therapy was initiated by the patient. An Advanced Therapy Coordinator role was created to standardize the workflow, optimize communication, and ensure a safety checklist was instituted. Results. A total of 125 patients were reviewed for the study with 18 excluded. Preintervention median wait time was 82.0 (IQR 46.0-80.5) days. Median wait time during the intervention improved to 49.5 (IQR 34.0-69.5) days (April 2021 to January 2022), with nonrandom variation post intervention. Nonrandom variation was also noted in the latter baseline data (March 2020 to March 2021). Conclusion. This study demonstrates improved wait time to advanced therapy initiation through the role of an Advanced Therapy Coordinator to facilitate communication pathways. [ABSTRACT FROM AUTHOR]

Aim: Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre‐ and post‐HCP access to inform hypotheses around the effects of healthcare use and mortality risk. Methods: Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6‐ and 12 month periods post‐HCP access for 16 629 older adults. Results: Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait‐time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post‐receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post‐HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post‐HCP periods compared with in the wait time (AU$7.9, AU$7.1). Conclusions: Increased spending post‐HCP on inpatient care or non‐health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899–905. [ABSTRACT FROM AUTHOR]

BackgroundAlthough insurance status is important to patients' ability to access care, it varies significantly by race, age, and socioeconomic status. Novel coronavirus disease 2019 (COVID-19) negatively impacted access to care, while simultaneously widening pre-existing health-care disparities. The purpose of the present study was to document this phenomena within orthopedics.MethodsPatients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California, were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center, and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients who underwent arthroplasty before the pandemic (March 2020) and those after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.ResultsTwo-hundred sixty-nine (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher body mass index, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. A comparison of case volumes showed a larger decrease at ZSFGH than at UCSF after COVID. Wait times between the two sites before and after COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH before COVID were more than double the wait times at UCSF after COVID.ConclusionsCOVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with nonprivate insurance were affected the most.

Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018–29 February 2020 (pre-pandemic) and 1 March 2020–22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22–48] pre-pandemic and 35 [24–49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes.

Michael Balas,1 Diana Vasiliu,2 Gener Austria,2 Tina Felfeli3– 5 1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Health System Intelligence Team, Health System Performance & Support Portfolio, Ontario Health, Toronto, ON, Canada; 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 4Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada; 5The Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, CanadaCorrespondence: Tina Felfeli, Toronto Western Hospital, 399 Bathurst Street, 6-East Room 432, Toronto, ON, M5T 2S8, Canada, Tel +1 647 678 1634, Fax +1 416 340 3459, Email tina.felfeli@mail.utoronto.caObjective: To investigate the effects of the COVID-19 pandemic on case volumes and wait-times for ophthalmic surgery in Ontario, Canada.Design: Population-based retrospective cohort study.Participants: Patients undergoing ophthalmic surgery in Ontario, Canada, from 2010 to 2021, collected from the Ontario Health Wait Times Information System (WTIS) database.Methods: The WTIS contains non-emergent surgical case volume and wait-time data for six ophthalmic subspecialty surgery types, three priority levels (low, medium, high) and 14 different regions in Ontario. Case volume and wait-times were compared between the COVID-19 pandemic (2020– 2021) and the preceding time period (2010– 2019) across all stratifications.Results: There was a significant decrease in case volumes and significant increase in wait-times across geographic regions, priority levels, and subspecialty surgeries from the pre-pandemic to pandemic period. Moreover, COVID-19 exacerbated pre-existing wait-time disparities between sexes, with females waiting 4.1 days longer than males overall to receive surgery in 2010– 2019 compared to waiting 8.8 days longer in 2020– 2021 (117% increase).Conclusion: These findings highlight the impact of the COVID-19 pandemic on ophthalmic surgical wait times in Ontario. Cataract, strabismus and oculoplastic surgeries, the Waterloo Wellington, Central, and South East regions of Ontario, and those with female sex had the greatest relative increases in wait-times during the pandemic.Keywords: ophthalmology, surgery, wait time

BackgroundLow back pain (LBP) accounts for a significant proportion of primary care visits. Despite the development of evidence-based guidelines, studies point to the inefficient use of healthcare resources, resulting in over 60.0% of patients with LBP being referred to spine surgeons without any surgical indication. Centralized waiting lists (CWLs) have been implemented to improve access to specialized care by managing asymmetry between supply and demands. To date, no study has provided data on patients’ clinical profiles and referral patterns to medical specialists for LBP in the context of a publicly funded healthcare system operating a prioritization model. The objective of this study was to evaluate the appropriateness of specialized care referrals for LBP after the implementation of a CWL.MethodsA retrospective cross-sectional analysis of 500 randomly selected electronic health records of patients who attended the outpatient neurosurgery clinic of the administrative Mauricie-et-Centre-du-Québec region was performed. Inclusion criteria were neurosurgery consultation referrals for adults ≥18 years suffering from a primary complaint of LBP, and performed between September 1st, 2018, and September 1st, 2021. Data relevant for drawing a comprehensive portrait of patients referred to the neurosurgery service and for judging referrals appropriateness were manually extracted.ResultsOf the 500 cases analyzed, only 112 (22.4%) were surgical candidates, while 221 (44.2%) were discharge from the neurosurgery service upon initial assessment. Key information was inconsistently documented in medical files, thus preventing the establishment of a comprehensive portrait of patients referred to the neurosurgery service for LBP. Nevertheless, over 80.0% of referrals made during the study period were deemed inappropriate. Inappropriate referrals were characterized by higher proportion of patients symptomatically improved, presenting a back-dominant chief complaint, exhibiting no objective neurological symptoms, and diagnosed with non-specific LBP.ConclusionThis study reveals a significant proportion of inappropriate referrals to specialized care for LBP. Further research is needed to better understand the factors that prompt referrals to medical specialists for LBP, and the criteria considered by neurosurgeons when selecting the appropriate management strategy. Recent studies suggest that triaging approaches led by musculoskeletal experts may improve referral appropriateness to specialized care.

In Ireland, the extent of outpatient orthopedic waiting lists results in long waiting times for patients, delays in processing referrals, and variation in the consultant caseload. At the study site, the Define, Measure, Analyze, Improve, and Control (DMAIC) Lean Six Sigma framework was applied to evaluate sources of Non-Value-Added (NVA) activity in the process of registering and triaging patients referred to the trauma orthopedic service from the Emergency Department. A pre- (October–December 2021)/post- (April–August 2022) intervention design was employed, utilizing Gemba, Process Mapping, and the TIMWOODS tool. Embracing a person-centered approach, stakeholder Voice of Customer feedback was sought at each stage of the improvement process. Following data collection and analysis, a co-designed pilot intervention (March 2022) was implemented, consisting of a new triage template, dedicated trauma clinic slots, a consultant triage roster, and a new option to refer directly to physiotherapy services. This resulted in the total wait time of patients for review being reduced by 34%, a 51% reduction in the process steps required for registering, and an increase in orthopedic consultant clinic capacity of 22%. The reduction in NVA activities in the process and the increase in management options for triaging consultants have delivered a more efficient trauma and orthopedic pathway. [ABSTRACT FROM AUTHOR]

Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018–29 February 2020 (pre-pandemic) and 1 March 2020–22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22–48] pre-pandemic and 35 [24–49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes. [ABSTRACT FROM AUTHOR]

Models to predict ramp meter queue length from traffic detector data are potentially useful tools in improving traffic operations and safety. Existing research, however, has been based on microscopic simulation or relied on extensive calibration of Kalman filter and related models to produce reliable queue length estimates. This research seeks to develop methodologies for improving and simplifying the calibration process of existing queue length models by applying loop detector data including volume, occupancy, and the metering rate data for ramp meters along I-15 in Utah. A conservation model and several variations of a Kalman filter model generated estimated queues that were compared to observed queue lengths in 60 s bins. A modified Kalman filter model and a new heuristic model derived from cluster analysis—the models that yielded the best results—provided queue length estimates that were generally within approximately eight vehicles of the observed queue length. Using the ramp metering rate, the queue length estimates were converted into wait times that were generally within approximately 30 s of the actual wait time, producing a viable method to predict wait time from up-to-the-minute traffic detection information with relatively little required calibration. The implementation of the ramp meter queue length and wait time estimation algorithms presented in this research will allow departments of transportation to better assess freeway and ramp conditions, which can then aid in reducing congestion throughout the freeway network.

Abstract Background Individuals living with a rheumatic pain condition can face delays in accessing pain clinics, which prevents them from receiving timely treatment. Little is known regarding their specific healthcare utilization in order to alleviate pain while waiting to obtain services in pain clinics. Hence, the aim of this study was to explore the perceptions and experiences of persons living with rheumatic conditions regarding healthcare utilization while waiting to access a pain clinic. Methods In this qualitative descriptive study, semi-structured interviews were conducted with adults living with a painful rheumatic condition that reported either being waiting for admission in a pain clinic, having been referred but then denied pain clinic services, or having received services during the previous six months, in the province of Quebec, Canada. The interviews were transcribed verbatim, and an inductive thematic analysis was performed. Results Twenty-six individuals were interviewed (22 women and 4 men; mean age 54 ± 10 years). Three themes were identified: 1) lacking guidance in identifying solutions to their complex and multidimensional needs, 2) struggling to obtain and maintain services due to systemic access barriers, and 3) displaying resilience through a search for accessible and sustainable self-management strategies. Conclusions The current approaches and structures of health services fail to adequately answer the service needs of individuals experiencing painful rheumatic conditions. Important shifts are required in pain education, in increasing access to multidisciplinary approaches at the primary care level and in breaking down barriers individuals with chronic pain face to receive appropriate and timely care.