The rarity and heterogeneity of sarcomas make performing appropriately powered studies challenging and magnify the significance of large databases in sarcoma research. Established large tumor ...registries and population‐based databases have become increasingly relevant for answering clinical questions regarding sarcoma incidence, treatment patterns, and outcomes. However, the validity of large databases has been questioned and scrutinized because of the inaccuracy and wide variability of coding practices and the absence of clinically relevant variables. In addition, the utilization of large databases for the study of rare cancers such as sarcoma may be particularly challenging because of the known limitations of administrative data and poor overall data quality. Currently, there are several large national cancer databases, including the Surveillance, Epidemiology, and End Results database, the National Cancer Data Base of the American College of Surgeons and the American Cancer Society, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention. These databases are often used for sarcoma research, but they are limited by their dependence on administrative or billing data, the lack of agreement between chart ors on diagnosis codes, and the use of preexisting documented hospital diagnosis codes for tumor registries, which lead to a significant underestimation of sarcomas in large data sets. Current and future initiatives to improve databases and big data applications for sarcoma research include increasing the utilization of sarcoma‐specific registries and encouraging national initiatives to expand on real‐world, evidence‐based data sets.
The primary aim of this article is to demonstrate the limitations of databases specifically for sarcoma research. Current initiatives formed to improve the application of big data for rare malignancies are also described.
IMPORTANCE: Physicians who are mothers face challenges with equal distribution of domestic duties, which can be an obstacle in career advancement and achieving overall job satisfaction. OBJECTIVES: ...To study and report on the association between increased domestic workload and career dissatisfaction and if this association differed between proceduralists and nonproceduralists. DESIGN, SETTING, AND PARTICIPANTS: Data for this study were gathered from April 28 to May 26, 2015, via an online survey of 1712 attending physician mothers recruited from the Physician Moms Group. Statistical analysis was performed from August 25, 2017, to November 20, 2018. MAIN OUTCOMES AND MEASURES: Univariate analysis was performed for respondents who reported sole responsibility for 5 or more vs fewer than 5 main domestic tasks. Independent factors associated with career dissatisfaction or a desire to change careers were identified using a multivariate logistic regression model. RESULTS: Of the 1712 respondents, most were partnered or married (1698 99.2%), of which 458 (27.0%) were in procedural specialties. Overall, respondents reported having sole responsibility for most domestic tasks, and there were no statistically significant differences between procedural and nonprocedural groups. Physician mothers in procedural specialties primarily responsible for 5 or more domestic tasks reported a desire to change careers more often than those responsible for fewer than 5 tasks (105 of 191 55.0% vs 114 of 271 42.1%; P = .008). This difference was not noted in physician mothers in nonprocedural specialties. In multivariate analysis of the proceduralist cohort, primary responsibility for 5 or more tasks was identified as a factor independently associated with the desire to change careers (odds ratio, 1.5; 95% CI, 1.0-2.2; P = .05). CONCLUSIONS AND RELEVANCE: Physician mothers report having more domestic responsibilities than their partners. For proceduralist mothers, self-reported higher levels of domestic responsibility were associated with career dissatisfaction. Increasing numbers of mothers in the medical workforce may create a demand for more equitable distribution and/or outsourcing of domestic tasks.
Overtreatment in the United States Lyu, Heather; Xu, Tim; Brotman, Daniel ...
PloS one,
09/2017, Letnik:
12, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, ...and implications of overtreatment.
2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.
The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.
From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Enhanced recovery after surgery pathways may have a significant long‐term impact on oncologic‐specific outcomes for patients with cancer undergoing surgery.
IMPORTANCE In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. OBJECTIVE To determine whether patient satisfaction is ...independent from surgical process measures and hospital safety. DESIGN We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. SETTING Thirty-one US hospitals. PARTICIPANTS Patients and hospital employees. INTERVENTIONS There were no interventions for this study. MAIN OUTCOMES AND MEASURES Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. RESULTS Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = −0.216 P = .24; appropriate hair removal, R = −0.012 P = .95; Foley catheter removal, R = −0.089 P = .63; deep vein thrombosis prophylaxis, R = 0.101 P = .59). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 P = .11). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 P = .07), working conditions (R = 0.191 P = .30), or perceptions of management (R = 0.223 P = .23); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 P = .01), safety climate (R = 0.395 P = .03), and stress recognition (R = −0.462 P = .008). CONCLUSIONS AND RELEVANCE Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator.
IMPORTANCE: Women are disproportionately underrecognized as award winners within medical societies. The presence of this disparity has not been investigated in training programs. OBJECTIVE: To ...determine the presence of a gender disparity in award winners in general surgery residency programs. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective survey study, 32 geographically diverse academic and independent general surgery residency programs were solicited for participation. The 24 participating programs (75.0%) submitted deidentified data regarding the gender distribution of residents and trainee award recipients for the period from July 1, 1996, to June 30, 2017. Data were analyzed from September 11, 2017, to December 21, 2018. EXPOSURES: Time and the proportion of female trainees. MAIN OUTCOMES AND MEASURES: The primary outcome was the percentage of female award winners. A multilevel logistic regression model accounting for the percentage of female residents in each program compared the odds of a female resident winning an award relative to a male resident. This analysis was repeated for the first and second decades of the study. Award winners were further analyzed by type of award (clinical excellence, nonclinical excellence, teaching, or research) and selection group (medical students, residents, or faculty members). RESULTS: A total of 5030 of 13 760 resident person-years (36.6%) and 455 of 1447 award winners (31.4%) were female. Overall, female residents were significantly less likely to receive an award compared with male residents (odds ratio OR, 0.44; 95% CI, 0.37-0.54; P < .001). During the first decade of the study, female residents were 70.8% less likely to receive an award compared with male residents (OR, 0.29; 95% CI, 0.19-0.45; P < .001); this improved to 49.9% less likely in the second decade (OR, 0.50; 95% CI, 0.42-0.61; P < .001). Female residents were less likely to receive an award for teaching (OR, 0.33; 95% CI, 0.26-0.42; P < .001), clinical excellence (OR, 0.44; 95% CI, 0.31-0.61; P < .001), or nonclinical excellence (OR, 0.69; 95% CI, 0.48-0.98; P = .04). No statistical difference was observed for research award winners (OR, 0.76; 95% CI, 0.42-1.12; P = .17). The largest discrepancies were observed when award recipients were chosen by residents (OR, 0.23; 95% CI, 0.14-0.39; P < .001) and students (OR, 0.32; 95% CI, 0.25-0.42; P < .001) compared with faculty members (OR, 0.52; 95% CI, 0.42-0.66; P < .001). CONCLUSIONS AND RELEVANCE: This study found that female residents were significantly underrepresented as award recipients. These findings suggest the presence of ongoing implicit bias in surgery departments and training programs.
BACKGROUND:Women surgeons are underrepresented in academic surgery and may be subject to implicit gender bias. In colorectal surgery, women comprise 42% of new graduates, but only 19% of Diplomates ...in the United States.
OBJECTIVE:We evaluated the representation of women at the 2017 American Society of Colon and Rectal Surgeons Scientific and Tripartite Meeting and assessed for implicit gender bias.
DESIGN:This was a prospective observational study.
SETTING:The study occurred at the 2017 Tripartite Meeting.
MAIN OUTCOME MEASURES:The primary outcome measured was the percentage of women in the formal program relative to conference attendees and forms of address.
METHODS:Female program representation was quantified by role (moderator or speaker), session type, and topic. Introductions of speakers by moderators were classified as formal (using a professional title) or informal (using name only), and further stratified by gender.
RESULTS:Overall, 31% of meeting attendees who are ASCRS members were women, with higher percentages of women as Candidates (44%) and Members (35%) compared with Fellows (24%). Women comprised 28% of moderators (n = 26) and 28% of speakers (n = 80). The highest percentage of women moderators and speakers was in education (48%) and the lowest was in techniques and technology (17%). In the 41 of 47 sessions evaluated, female moderators were more likely than male moderators to use formal introductions (68.7% vs 54.0%, p = 0.02). There was no difference when female moderators formally introduced female versus male speakers (73.9% vs 66.7%, p = 0.52); however, male moderators were significantly less likely to formally introduce a female versus male speaker (36.4% vs 59.2%, p = 0.003).
LIMITATIONS:Yearly program gender composition may fluctuate. Low numbers in certain areas limit interpretability. Other factors potentially influenced speaker introductions.
CONCLUSIONS:Overall, program representation of women was similar to meeting demographics, although with low numbers in some topics. An imbalance in the formality of speaker introductions between genders was observed. Awareness of implicit gender bias may improve gender equity and inclusiveness in our specialty. See Video Abstract at http://links.lww.com/DCR/A802.
...the zero, or near-zero, female representation when awards were chosen by residents points to the potential role of stereotypical power dynamics that could influence our decisions beyond choosing ...award recipients. ...in line with the pipeline theory, female trainees may find themselves compromising their aspiration for work in light of other responsibilities including child care, maternity leave, and domestic duties. ...while this editorial does not further explore inequity in other equally important topics including, but not limited to, race and sexual orientation, gender bias may be confounded by these significant issues that need to be tackled simultaneously.
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