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Malinzak EB, Vail EA, Wixson M, Lee A. Enhancing Our Workforce: Recruitment and Retention in Anesthesiology. Int Anesthesiol Clin 2024; 62:26-34. [PMID: 38785107 DOI: 10.1097/aia.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.
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Affiliation(s)
| | - Emily A Vail
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Wixson
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Allison Lee
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Herrera-Quiroz D, Smith BB, Dodoo C, Brown MJ, Hayes SN, Milam AJ. Examining patient demographics and major adverse cardiac events following noncardiac surgery: Applying a health equity lens. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00534-7. [PMID: 38876941 DOI: 10.1016/j.carrev.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Major adverse cardiac events (MACE) are a major contributor to postoperative complications. This study employed a health equity lens to examine rates of postoperative MACE by race and ethnicity. METHODS This single-center, retrospective observational cohort study followed patients with and without pre-existing coronary artery stents from 2008 to 2018 who underwent non-cardiac surgery. MACE was the primary outcome (death, acute MI, repeated coronary revascularization, in-stent thrombosis) and self-reported race and ethnicity was the primary predictor. A propensity score model of a 1:1 cohort of non-Hispanic White (NHW) patients and all other racial and ethnic minority populations (Hispanic and Black) was used to compare the rate of perioperative MACE in this cohort. RESULTS During the study period, 79,686 cases were included in the analytic sample; 950 patients (1.2 %) had pre-existing coronary artery stents. <1 % of patients experienced MACE within 30 days following non-cardiac surgery (0.8 %). After confounder adjustment and propensity score matching, there were no statistically significant differences in MACE among racial and ethnic minority patients compared to NHW patients (OR = 0.77; 95 % CI: 0.48, 1.25). In our sensitivity analyses, stratifying by sex, there were no differences in MACE by race and ethnicity. CONCLUSIONS The study found no statistically significant differences in MACE by race and ethnicity among patients who underwent non-cardiac surgery. Access to a high-volume, high-quality hospital such as the one studied may reduce the presence of healthcare disparities and may explain why our findings are not consistent with previous studies.
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Affiliation(s)
| | - Bradford B Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Christopher Dodoo
- Department of Quantitative Health Sciences, Mayo Clinic; Phoenix, AZ 85054, USA
| | - Michael J Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam J Milam
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; Department of Quantitative Health Sciences, Mayo Clinic; Phoenix, AZ 85054, USA.
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Forkin KT, Render CM, Staffa SJ, Goobie SM. Trends in Gender of Authors of Patient Blood Management Publications. Anesth Analg 2024; 138:1267-1274. [PMID: 38153857 DOI: 10.1213/ane.0000000000006749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Diverse representation in the field of patient blood management (PBM) may help bring varying perspectives to improve patient care. We assessed trends in gender of first and last authorship of recent PBM publications to evaluate diversity within the field. METHODS Publications from 10 high-impact anesthesiology and blood transfusion medicine journals between 2017 and 2021 were reviewed using 19 keywords to identify PBM-related articles. Each publication title was reviewed independently to determine whether it met the inclusion criteria. A software program was used to identify the gender of each first and last author for the most common first names. Author gender that could not be identified through this process was determined by querying institutional websites and professional social networks (eg, ResearchGate). Any publication where the gender of the first and/or last author could not be reliably determined was excluded from the analysis. Trends over time were assessed using the Cochran-Armitage test. RESULTS A total of 2467 publications met the inclusion criteria of the 2873 yielded by the initial search. Gender of the first and last author was identified for 2384 of these publications and included in the final analysis. Approximately 42.8% of publications featured a woman as the first author with the highest from the journals such as the Journal of the American Medical Association ( JAMA ) (48.7%) and Transfusion (48.1%) and the lowest from the journals such as the British Journal of Anaesthesia (24.1%) and Anesthesia & Analgesia (24.4%). Approximately 32.0% of the publications featured a woman as the last author with the highest being Transfusion (36.9%) and Anaesthesia (31.8%) and the lowest being Anesthesia and Analgesia (18.3%) and Anesthesiology (18.6%). Approximately 57.6% of publications had either a woman as the first or last author while 16.3% of the publications had women as both the first and last authors. Women authors comprised 32.6% of the publications with a single author. Women as the first or last authors did not change significantly over the study period ( P = .115 and P = .119, respectively). No significant difference was observed in the percentage of PBM articles with a woman as the first or last author, a woman as the first and last author, or a woman as a single author from 2017 to 2021 ( P = .089, P = .055, and P = .226, respectively). CONCLUSIONS The percentage of women as the first and last authors in PBM publications from the 5-year period of 2017 to 2021 was <50%. Gender equity in PBM authorship was identified as an area for potential future improvement. International mentorship and sponsorship of women remain important in promoting gender equity in PBM authorship.
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Affiliation(s)
- Katherine T Forkin
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Caroline M Render
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Martin SR, Kain ZN. The intersection of pediatric anesthesiology and social determinants of health. Curr Opin Anaesthesiol 2024; 37:271-276. [PMID: 38441068 PMCID: PMC11042989 DOI: 10.1097/aco.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE OF REVIEW There is increasing evidence of racial and ethnic disparities in pediatric perioperative care, which indicates a need to identify factors driving disparities. Social determinants of health (SDOH) play a fundamental role in pediatric health and are recognized as key underlying mechanisms of healthcare inequities. This article summarizes recent research exploring the influence of SDOH on pediatric perioperative outcomes. RECENT FINDINGS Despite the scarcity of research exploring SDOH and pediatric perioperative outcomes, recent work demonstrates an association between SDOH and multiple outcomes across the perioperative care continuum. Measures of social disadvantage were associated with preoperative symptom severity, longer hospital stays, and higher rates of postoperative complications and mortality. In some studies, these adverse effects of social disadvantage persisted even when controlling for medical comorbidities and clinical severity. SUMMARY The existing literature offers compelling evidence of the impact of SDOH on perioperative outcomes in children and reveals a critical area in pediatric anesthesia that necessitates further exploration and action. To improve outcomes and address care inequities, future efforts should prioritize the integration of SDOH assessment into pediatric perioperative research and practice.
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Affiliation(s)
- Sarah R. Martin
- Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Irvine CA
- Center on Stress & Health, University of California Irvine, Irvine, CA
- Emergency Medicine, Children’s Hospital of Orange County, Orange, CA
| | - Zeev N. Kain
- Department of Anesthesiology and Perioperative Care, University of California Irvine School of Medicine, Irvine CA
- Center on Stress & Health, University of California Irvine, Irvine, CA
- Yale University Child Study Center, New Haven, Connecticut
- Children’s Hospital of Orange County, Orange, CA
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Diallo MS, Hasnain-Wynia R, Vetter TR. Social Determinants of Health and Preoperative Care. Anesthesiol Clin 2024; 42:87-101. [PMID: 38278595 DOI: 10.1016/j.anclin.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients.
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Affiliation(s)
- Mofya S Diallo
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, 4650 Sunset Boulevard, MS#3, Los Angeles, CA 90027, USA.
| | - Romana Hasnain-Wynia
- Academic Affairs and Public Health, Denver Health, University of Colorado School of Medicine, 601 Broadway Street, 9th Floor, MC 6551, Denver, CO 80203, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA
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Dixit AA, Sekeres G, Mariano ER, Memtsoudis SG, Sun EC. Association of Patient Race and Hospital with Utilization of Regional Anesthesia for Treatment of Postoperative Pain in Total Knee Arthroplasty: A Retrospective Analysis Using Medicare Claims. Anesthesiology 2024; 140:220-230. [PMID: 37910860 PMCID: PMC10872475 DOI: 10.1097/aln.0000000000004827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Regional anesthesia for total knee arthroplasty has been deemed high priority by national and international societies, and its use can serve as a measure of healthcare equity. The association between utilization of regional anesthesia for postoperative pain and (1) race and (2) hospital in patients undergoing total knee arthroplasty was estimated. The hypothesis was that Black patients would be less likely than White patients to receive regional anesthesia, and that variability in regional anesthesia would more likely be attributable to the hospital where surgery occurred than race. METHODS This study used Medicare fee-for-service claims for patients aged 65 yr or older who underwent primary total knee arthroplasty between January 1, 2011, and December 31, 2016. The primary outcome was administration of regional anesthesia for postoperative pain, defined as any peripheral (femoral, lumbar plexus, or other) or neuraxial (spinal or epidural) block. The primary exposure was self-reported race (Black, White, or Other). Clinical significance was defined as a relative difference of 10% in regional anesthesia administration. RESULTS Data from 733,406 cases across 2,507 hospitals were analyzed: 90.7% of patients were identified as White, 4.7% as Black, and 4.6% as Other. Median hospital-level prevalence of use of regional anesthesia was 51% (interquartile range, 18 to 79%). Black patients did not have a statistically different probability of receiving a regional anesthetic compared to White patients (adjusted estimates: Black, 53.3% [95% CI, 52.5 to 54.1%]; White, 52.7% [95% CI, 52.4 to 54.1%]; P = 0.132). Findings were robust to alternate specifications of the exposure and outcome. Analysis of variance revealed that 42.0% of the variation in block administration was attributable to hospital, compared to less than 0.01% to race, after adjusting for other patient-level confounders. CONCLUSIONS Race was not associated with administration of regional anesthesia in Medicare patients undergoing primary total knee arthroplasty. Variation in the use of regional anesthesia was primarily associated with the hospital where surgery occurred. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Anjali A Dixit
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Gabriel Sekeres
- Stanford Institute for Economic Policy Research, Stanford University, Stanford, California
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Stavros G Memtsoudis
- Departments of Anesthesiology and Public Health, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine and Department of Health Policy, Stanford University, Stanford, California
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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Expanding Horizons: How Anesthesiologists Can Improve Health Equity. Anesth Analg 2022; 134:1164-1165. [PMID: 35595690 DOI: 10.1213/ane.0000000000006009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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