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Abstract
Implicit bias and microaggressions are well-known phenomenon and have recently been acknowledged as contributing to health care disparities. Within Hand Surgery, implicit bias and microaggressions occur in patient-surgeon, surgeon-peer, surgeon-staff, and training environment interactions. Although racial and gender biases are well studied, biases can also be based on age, sexual orientation, socioeconomic background, and/or hierarchal rank. Academia has well-documented evidence of implicit bias and microaggressions, contributing to current disparate demographics of trainees, physicians, and leaders within Hand Surgery. Awareness is fundamental to combating bias and microaggressions; however, actions must be taken to minimize negative effects and change culture.
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Affiliation(s)
- Kashyap Komarraju Tadisina
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Kelly Bettina Currie
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Sinclair MK, Chhabra AB. Recruiting, Supporting and Retaining Diversity in Hand Surgery. Hand Clin 2023; 39:33-42. [PMID: 36402524 DOI: 10.1016/j.hcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.
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Affiliation(s)
- Micah K Sinclair
- Department of Orthopaedic Surgery & Musculoskeletal Medicine, Children's Mercy Hospital, University of Missouri Kansas City, University of Kansas Medical Center, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, Hand Surgery, University of Virginia Health, PO Box 800159, Charlottesville, VA 22908-0159, USA
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Saggaf MM, Liu K, Ho G, Anastakis EE, Baltzer H. Sex Difference in the Treatment of Dupuytren's Disease: A Systematic Review and Meta-Analysis of Clinical Trials. Plast Surg (Oakv) 2022. [DOI: 10.1177/22925503221141707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: The aim of this study was to assess the sex differences in enrollment into clinical trials for Dupuytren's disease (DD), treatment efficacy, and complications. Methods: Three databases were searched; Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL. Included studies were clinical trials on adult patients with DD. Exclusion criteria were non-English studies and other study designs. Two independent reviewers completed abstract screening, full-text review, and data extraction. The number and percentage of studies that reported ad hoc analyses for sex differences in treatment efficacy, tolerability, and complications were reported. A meta-analysis was performed on the proportion of female participants enrolled in clinical trials for DD. Results: A total of 3172 references were screened, and 59 studies were identified for full-text review. We identified 28 clinical trials for DD of which none reported secondary analyses for sex differences. Only 2 trials discussed sex differences in complications, and one trial reported sex differences in tolerability. The proportion of female participants in the meta-analysis was 19.5% [95% CI: 16.1-23.0%]. Conclusion: Sex differences in the clinical trials for DD are not widely considered in clinical trials despite their critical role. Males and females do not have equal representation in clinical trials for DD. Future studies should account for sex differences in the design and the analysis of clinical trials.
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Affiliation(s)
- Moaath M. Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kathy Liu
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - George Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Emily E. Anastakis
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Heather Baltzer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Hand Program, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Baltzer H. Treating post-menopausal women with symptomatic hand osteoarthritis with hormone replacement therapy. THE LANCET. RHEUMATOLOGY 2022; 4:e654-e655. [PMID: 38265959 DOI: 10.1016/s2665-9913(22)00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2024]
Affiliation(s)
- Heather Baltzer
- Division of Plastic Surgery, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada.
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Mondini Trissino da Lodi C, Landini MP, Asunis E, Filardo G. Women Have Tendons… and Tendinopathy: Gender Bias is a "Gender Void" in Sports Medicine with a Lack of Women Data on Patellar Tendinopathy-A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:74. [PMID: 35670894 PMCID: PMC9174378 DOI: 10.1186/s40798-022-00455-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 04/23/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Patellar tendinopathy is one of the most common musculoskeletal problems associated with sport. While commonly perceived as a predominantly male problem, recent epidemiological studies revealed that it also affects a large number of sport-active women. The aim of this systematic review was to understand how the available treatments apply to women affected by patellar tendinopathy. METHODS We analysed the available literature with a systematic review on three databases (PubMed, Cochrane, Web of Science) on February 2021, retrieving a total of 136 studies published from 1983. RESULTS The overall scientific field offers an astonishingly low number of data on treatment results referring to only 78 women (2%) in the entire literature. Only 5% of the retrieved articles considered focusing only or mostly on men to be a limitation. CONCLUSIONS Women represent only a minority of patients studied for this topic. The few documented cases are further fragmented by being related to different treatments, thus basically offering no solid evidence for results and limitations of any therapeutic approach in women. This literature analysis showed a greater gender gap than what is recognized in science and general medicine; it showed a gender blindness in sports medicine when investigating a common problem like patellar tendinopathy.
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Affiliation(s)
| | | | - Emanuela Asunis
- II Clinica, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland.,Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.,Facoltà Di Scienze Biomediche, Università Della Svizzera Italiana, Via Buffi 13, 6900, Lugano, Switzerland
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Merone L, Tsey K, Russell D, Nagle C. Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature. WOMEN'S HEALTH REPORTS 2022; 3:49-59. [PMID: 35136877 PMCID: PMC8812498 DOI: 10.1089/whr.2021.0083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 01/13/2023]
Abstract
Background: Historically, medical studies have excluded female participants and research data have been collected from males and generalized to females. The gender gap in medical research, alongside overarching misogyny, results in real-life disadvantages for female patients. This systematic scoping review of the literature aims to determine the extent of research into the medical research sex and gender gap and to assess the extent of misogyny, if any, in modern medical research. Methods: Initial literature searches were conducted using PubMed, Science Direct, PsychINFO and Google Scholar. Articles published between January 01, 2009, and December 31, 2019, were included. An article was deemed to display misogyny if it discussed the female aesthetic in terms of health, but did not measure health or could not be utilized to improve clinical practice. Results: Of the 17 included articles, 12 examined the gender gap in medical research and 5 demonstrated misogyny, assessing female attractiveness for alleged medical reasons. Females remain broadly under-represented in the medical literature, sex and gender are poorly reported and inadequately analyzed in research, and misogynistic perceptions continue to permeate the narrative. Conclusion: The gender gap and misogynistic studies remain present in the contemporary medical literature. Reasons and implications for practice are discussed.
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Affiliation(s)
- Lea Merone
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
| | - Komla Tsey
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
| | - Darren Russell
- School of Health Sciences, James Cook University, Townsville, Queensland, Australia
- Cairns Sexual Health Service, Cairns North, Queensland, Australia
| | - Cate Nagle
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Steinberg JR, Turner BE, Weeks BT, Magnani CJ, Wong BO, Rodriguez F, Yee LM, Cullen MR. Analysis of Female Enrollment and Participant Sex by Burden of Disease in US Clinical Trials Between 2000 and 2020. JAMA Netw Open 2021; 4:e2113749. [PMID: 34143192 PMCID: PMC8214160 DOI: 10.1001/jamanetworkopen.2021.13749] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Although female representation has increased in clinical trials, little is known about how clinical trial representation compares with burden of disease or is associated with clinical trial features, including disease category. OBJECTIVE To describe the rate of sex reporting (ie, the presence of clinical trial data according to sex), compare the female burden of disease with the female proportion of clinical trial enrollees, and investigate the associations of disease category and clinical trial features with the female proportion of clinical trial enrollees. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included descriptive analyses and logistic and generalized linear regression analyses with a logit link. Data were downloaded from the Aggregate Analysis of ClinicalTrials.gov database for all studies registered between March 1, 2000, and March 9, 2020. Enrollment was compared with data from the 2016 Global Burden of Disease database. Of 328 452 clinical trials, 70 095 were excluded because they had noninterventional designs, 167 936 because they had recruitment sites outside the US, 69 084 because they had no reported results, 1003 because they received primary funding from the US military, and 314 because they had unclear sex categories. A total of 20 020 interventional studies enrolling approximately 5.11 million participants met inclusion criteria and were divided into those with and without data on participant sex. EXPOSURES The primary exposure variable was clinical trial disease category. Secondary exposure variables included funding, study design, and study phase. MAIN OUTCOMES AND MEASURES Sex reporting and female proportion of participants in clinical trials. RESULTS Among 20 020 clinical trials from 2000 to 2020, 19 866 studies (99.2%) reported sex, and 154 studies (0.8%) did not. Clinical trials in the fields of oncology (46% of disability-adjusted life-years [DALYs]; 43% of participants), neurology (56% of DALYs; 53% of participants), immunology (49% of DALYs; 46% of participants), and nephrology (45% of DALYs; 42% of participants) had the lowest female representation relative to corresponding DALYs. Male participants were underrepresented in 8 disease categories, with the greatest disparity in clinical trials of musculoskeletal disease and trauma (11.3% difference between representation and proportion of DALYs). Clinical trials of preventive interventions were associated with greater female enrollment (adjusted relative difference, 8.48%; 95% CI, 3.77%-13.00%). Clinical trials in cardiology (adjusted relative difference, -18.68%; 95% CI, -22.87% to -14.47%) and pediatrics (adjusted relative difference, -20.47%; 95% CI, -25.77% to -15.16%) had the greatest negative association with female enrollment. CONCLUSIONS AND RELEVANCE In this study, sex differences in clinical trials varied by clinical trial disease category, with male and female participants underrepresented in different medical fields. Although sex equity has progressed, these findings suggest that sex bias in clinical trials persists within medical fields, with negative consequences for the health of all individuals.
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Affiliation(s)
- Jecca R. Steinberg
- Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Brandon E. Turner
- Harvard Radiation Oncology Program, Massachusetts General Hospital and the Joint Center for Radiation Therapy, Boston
| | - Brannon T. Weeks
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Christopher J. Magnani
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Bonnie O. Wong
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, California
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Mark R. Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California
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Feldman S, Ammar W, Lo K, Trepman E, van Zuylen M, Etzioni O. Quantifying Sex Bias in Clinical Studies at Scale With Automated Data Extraction. JAMA Netw Open 2019; 2:e196700. [PMID: 31268541 PMCID: PMC6613296 DOI: 10.1001/jamanetworkopen.2019.6700] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Analyses of female representation in clinical studies have been limited in scope and scale. OBJECTIVE To perform a large-scale analysis of global enrollment sex bias in clinical studies. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, clinical studies from published articles from PubMed from 1966 to 2018 and records from Aggregate Analysis of ClinicalTrials.gov from 1999 to 2018 were identified. Global disease prevalence was determined for male and female patients in 11 disease categories from the Global Burden of Disease database: cardiovascular, diabetes, digestive, hepatitis (types A, B, C, and E), HIV/AIDS, kidney (chronic), mental, musculoskeletal, neoplasms, neurological, and respiratory (chronic). Machine reading algorithms were developed that extracted sex data from tables in articles and records on December 31, 2018, at an artificial intelligence research institute. Male and female participants in 43 135 articles (792 004 915 participants) and 13 165 records (12 977 103 participants) were included. MAIN OUTCOMES AND MEASURES Sex bias was defined as the difference between the fraction of female participants in study participants minus prevalence fraction of female participants for each disease category. A total of 1000 bootstrap estimates of sex bias were computed by resampling individual studies with replacement. Sex bias was reported as mean and 95% bootstrap confidence intervals from articles and records in each disease category over time (before or during 1993 to 2018), with studies or participants as the measurement unit. RESULTS There were 792 004 915 participants, including 390 470 834 female participants (49%), in articles and 12 977 103 participants, including 6 351 619 female participants (49%), in records. With studies as measurement unit, substantial female underrepresentation (sex bias ≤ -0.05) was observed in 7 of 11 disease categories, especially HIV/AIDS (mean for articles, -0.17 [95% CI, -0.18 to -0.16]), chronic kidney diseases (mean, -0.17 [95% CI, -0.17 to -0.16]), and cardiovascular diseases (mean, -0.14 [95% CI, -0.14 to -0.13]). Sex bias in articles for all categories combined was unchanged over time with studies as measurement unit (range, -0.15 [95% CI, -0.16 to -0.13] to -0.10 [95% CI, -0.14 to -0.06]), but improved from before or during 1993 (mean, -0.11 [95% CI, -0.16 to -0.05]) to 2014 to 2018 (mean, -0.05 [95% CI, -0.09 to -0.02]) with participants as the measurement unit. Larger study size was associated with greater female representation. CONCLUSIONS AND RELEVANCE Automated extraction of the number of participants in clinical reports provides an effective alternative to manual analysis of demographic bias. Despite legal and policy initiatives to increase female representation, sex bias against female participants in clinical studies persists. Studies with more participants have greater female representation. Differences between sex bias estimates with studies vs participants as measurement unit, and between articles vs records, suggest that sex bias with both measures and data sources should be reported.
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Affiliation(s)
- Sergey Feldman
- Allen Institute for Artificial Intelligence, Seattle, Washington
| | - Waleed Ammar
- Allen Institute for Artificial Intelligence, Seattle, Washington
| | - Kyle Lo
- Allen Institute for Artificial Intelligence, Seattle, Washington
| | - Elly Trepman
- Allen Institute for Artificial Intelligence, Seattle, Washington
- University of South Alabama College of Medicine, Mobile
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Oren Etzioni
- Allen Institute for Artificial Intelligence, Seattle, Washington
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