A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: To compare findings of emergency echocardiography (rescue echo) in the intra‐ operative period to findings of rescue echo in the ICU setting. Design: We queried a database of perioperative echo for all rescue echo studies done over a two year period. We compared the frequency of left ventricular (LV) and right ventricular (RV) systolic dysfunction, LV diastolic dysfunction, LV segmental wall motion abnormalities, and hypovolemia of the intraoperative and ICU studies. Results: LV and RV systolic dysfunction were more prevalent in ICU rescue echo studies compared to intra‐op rescue studies (22% vs. 10%, and 34% vs. 13%, respectively, p<0.05 for each). LV diastolic dysfunction was more prevalent in ICU rescue echo studies compared to intra‐op rescue studies (60% vs. 48%, p<0.05). Segmental wall motion abnormalities (SWMA) were more prevalent in the ICU compared to intra‐op setting (38% vs. 19%, p<0.05). Conclusion: In an observational study of real‐world rescue echo, the incidence of LV and RV systolic dysfunction, LV diastolic dysfunction, and LV SWMA were all more common in the ICU compared to the intra‐op studies. This could reflect the differences in patient population, differences in reasons clinicians perform rescue echo in the OR and in the ICU, or the hemodynamic effects of anesthesia.

Background: Cancer is the second leading cause of death in economically developed countries. The use and availability of oral treatment for cancer has increased dramatically in the past 10 years. Few studies have described the use of oral chemotherapy in non-traditional ambulatory settings by health care professionals across different specialties. Objective: The purpose of this study is to describe the usage of oral chemotherapeutic medications in ambulatory settings. Methods: Cross sectional study of 2007 NAMCS Survey analysis involving 21,761 subjects aged 18 years and above with cancer who participated in the 2007 National Ambulatory Medical Survey (NAMCS). Main Outcome Measure: Physician-reported use of oral chemotherapeutic medications (includes all major drug classes) as indicated on questionnaire for 2007 NAMCS survey. Results: Health care providers in non-traditional settings are less likely to prescribe oral chemotherapy than in traditional ambulatory settings (Adjusted odds ratio (AOR)=0.65{95% confidence interval: 0.61-0.69}). The study results suggest that oncologists are prescribing oral anti-cancer drugs the most as compared to other physician specialties. Conclusion: Health care providers in non-traditional settings are less likely to prescribe oral chemotherapy than in traditional ambulatory settings. Primary care physicians may have limited experience in monitoring and prescribing these potentially toxic medications. Clear guidelines are required for the use of oral chemotherapy medications, considering the potential for their use in non-traditional ambulatory settings and by non-oncologists.