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Ranasinghe PD, Zhou A. Women physicians and the COVID-19 pandemic: gender-based impacts and potential interventions. Ann Med 2023; 55:319-324. [PMID: 36594806 PMCID: PMC9815224 DOI: 10.1080/07853890.2022.2164046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: These are extraordinary times caused by the first global pandemic in our modern era. Physicians and other frontline healthcare providers face unique challenges, for which they have had little formal preparation. This combination of challenge and deficit leads to significant negative impacts, not only on what medical practices and health care systems can deliver to the public, but also on the individual healthcare providers themselves.Methods: In this essay, we specifically address women physicians, and explore the considerable impact they bear from the COVID-19 pandemic, particularly in the contexts of response to stress, social isolation, work-life integration, and autonomy. Because the language we use is important, we think it necessary to clarify that when we refer to 'women physicians,' we are referring to physicians that self-identify as women, and we acknowledge that not all the references we cite may use the same definition.Results: We offer several potential interventions that turn the challenges women physicians are facing into opportunities to address longstanding inequity. These interventions include tackling barriers to work-life balance, addressing gender and maternal bias, and promoting women physician representation in leadership.Conclusion: The COVID-19 pandemic is likely to become a chronic part of our lives; protecting vulnerable populations, such as women physicians, through thoughtful intervention is paramount.KEY MESSAGESWomen physicians experience considerable adversity during the COVID-19 pandemic, particularly in the contexts of response to stress, social isolation, work-life integration, and autonomy.These challenges create opportunities for interventions to improve equity in medicine during the COVID-19 pandemic and in the long-term, including tackling barriers to work-life balance, addressing gender and maternal bias, and promoting women physician representation in leadership.
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Affiliation(s)
| | - Ashley Zhou
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Tabibian JH, Bertram AK, Yeh HC, Cofrancesco J, Codori N, Block L, Miller ER, Ranasinghe PD, Marinopoulos SS. Health and wellness among incoming resident physicians: A multi-domain survey. ACTA ACUST UNITED AC 2018; 1. [PMID: 31897450 PMCID: PMC6939760 DOI: 10.33582/2637-4900/1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Burnout and depression are well-described in medical students and physicians and can lead to adverse personal and patient outcomes; however, their time course and risk factors remain understudied. Here, we measured multiple domains of mental and physical health and wellness and assessed gender differences among incoming physician trainees beginning residency at an academic medical center. Methods Using a cross-sectional study design, all incoming trainees (i.e. housestaff) at Johns Hopkins Hospital received a questionnaire assessing depression, burnout, sleep, exercise, and alcohol consumption, among other domains. Standardized instruments were utilized for questionnaire development. Tests of significance were two-tailed. Results 196 of 229 incoming housestaff (86%) completed the survey, and 49% were female. A history of depression was reported in 8%, and 5.4% met criteria for at least moderate depression by Patient Health Questionnaire (PHQ-9). Females were more likely to report a history of depression than males (13% vs. 3%, p=0.02) but had similar PHQ-9 scores. Four percent of participants reported feeling they were in the wrong profession. Goal and mean sleep were 7 and 6.7 hours/night, respectively. Forty-seven percent reported exercising once/week or not at all. While mean reported weekly alcohol consumption was three drinks, participants reported consuming ≥5 drinks in one sitting on average 1.6 times in the prior 6 months, and 4% used alcohol to sleep. Conclusions Incoming housestaff reported generally favorable mental and physical health at the beginning of residency training. However, exercise rates were low, and ill-suited alcohol consumption was noted, though infrequent. The few areas of possible improvement were largely similar between males and females. Wellness interventions might capitalize on the relatively high morale and health at the completion of medical school by helping to promote healthy habits, including regular exercise and avoidance of excess alcohol consumption, throughout future training and practice.
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Affiliation(s)
- James H Tabibian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Amanda K Bertram
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, MD
| | - Joseph Cofrancesco
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nancy Codori
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,University Health Services, Johns Hopkins University, Baltimore, MD
| | - Lauren Block
- Department of Health Policy and Management, Bloomberg School of Public Health, Baltimore, MD.,Department of Medicine, North Shore-LIJ Health System, New Hyde Park, NY
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD
| | - Padmini D Ranasinghe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Spyridon S Marinopoulos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,University Health Services, Johns Hopkins University, Baltimore, MD
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Abstract
International medical graduates (IMGs) play a vital role in the US health care system. These graduates represent 26% of physicians in practice and 24% of residents in specialty programs. All IMGs go through US medical licensing examination and credentialing verification to receive certification from the Educational Commission for Foreign Medical Graduates to become eligible to enter the US graduate medical education process. Compared with US graduates, IMGs tend to practice in primary care specialties and in underserved and rural areas. The author summarizes available data regarding IMGs in training and in practice to convey the role IMGs play in the US health care system.
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Ranasinghe PD, Maruthur NM, Nicholson WK, Yeh HC, Brown T, Suh Y, Wilson LM, Nannes EB, Berger Z, Bass EB, Golden SH. Comparative effectiveness of continuous subcutaneous insulin infusion using insulin analogs and multiple daily injections in pregnant women with diabetes mellitus: a systematic review and meta-analysis. J Womens Health (Larchmt) 2015; 24:237-49. [PMID: 25713996 DOI: 10.1089/jwh.2014.4939] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We systematically reviewed the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) with insulin analogs compared with multiple daily injections (MDI) in pregnant women with diabetes mellitus. We searched Medline®, Embase®, and the Cochrane Central Register of Controlled Trials through May 2013. Studies comparing CSII with MDI in pregnant women with diabetes mellitus were included. Studies using regular insulin CSII were excluded. We conducted meta-analyses where there were two or more comparable studies based on the type of insulin used in the MDI arm. Seven cohort studies of pregnant women with type 1 diabetes reported improvement in hemoglobin A1c (HbA1c) in both groups. Meta-analysis showed no difference in maternal and fetal outcomes for CSII versus MDI. Results were similar when CSII was compared with MDI with insulin analogs or regular insulin. Studies had moderate to high risk bias with incomplete descriptions of study methodology, populations, treatments, follow up, and outcomes. We conclude that observational studies reported similar improvements in HbA1c with CSII and MDI during pregnancy, but evidence was insufficient to rule out possible important differences between CSII and MDI for maternal and fetal outcomes. This highlights the need for future studies to examine the effectiveness and safety of CSII with insulin analogs and MDI in pregnant women with diabetes mellitus.
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Gudzune KA, Monroe AK, Sharma R, Ranasinghe PD, Chelladurai Y, Robinson KA. Effectiveness of combination therapy with statin and another lipid-modifying agent compared with intensified statin monotherapy: a systematic review. Ann Intern Med 2014; 160:468-76. [PMID: 24514899 DOI: 10.7326/m13-2526] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Some patients do not tolerate or respond to high-intensity statin monotherapy. Lower-intensity statin combined with nonstatin medication may be an alternative, but the benefits and risks compared with those of higher-intensity statin monotherapy are unclear. PURPOSE To compare the clinical benefits, adherence, and harms of lower-intensity statin combination therapy with those of higher-intensity statin monotherapy among adults at high risk for atherosclerotic cardiovascular disease (ASCVD). DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to July 2013, with an updated MEDLINE search through November 2013. STUDY SELECTION Randomized, controlled trials published in English. DATA EXTRACTION Two reviewers extracted information on study design, population characteristics, interventions, and outcomes (deaths, ASCVD events, low-density lipoprotein [LDL] cholesterol level, adherence, and adverse events). Two independent reviewers assessed risk of bias. DATA SYNTHESIS A total of 36 trials were included. Low-intensity statin plus bile acid sequestrant decreased LDL cholesterol level 0% to 14% more than mid-intensity monotherapy among high-risk hyperlipidemic patients. Mid-intensity statin plus ezetimibe decreased LDL cholesterol level 5% to 15% and 3% to 21% more than high-intensity monotherapy among patients with ASCVD and diabetes mellitus, respectively. Evidence was insufficient to evaluate LDL cholesterol for fibrates, niacin, and ω-3 fatty acids. Evidence was insufficient for long-term clinical outcomes, adherence, and harms for all regimens. LIMITATION Many trials had short durations and high attrition rates, lacked blinding, and did not assess long-term clinical benefits or harms. CONCLUSION Clinicians could consider using lower-intensity statin combined with bile acid sequestrant or ezetimibe among high-risk patients intolerant of or unresponsive to statins; however, this strategy should be used with caution given the lack of evidence on long-term clinical benefits and harms. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Goyal M, Singh S, Sibinga EMS, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med 2014; 174:357-68. [PMID: 24395196 PMCID: PMC4142584 DOI: 10.1001/jamainternmed.2013.13018] [Citation(s) in RCA: 1022] [Impact Index Per Article: 102.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
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Affiliation(s)
- Madhav Goyal
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sonal Singh
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Erica M S Sibinga
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Neda F Gould
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | | | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Zackary Berger
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Dana Sleicher
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
| | - David D Maron
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Hasan M Shihab
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | - Shauna Linn
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Shonali Saha
- Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
| | - Eric B Bass
- Department of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
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Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA, Cramer H. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. Deutsche Zeitschrift für Akupunktur 2014. [DOI: 10.1016/j.dza.2014.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Le EN, Gerstenblith MR, Gelber AC, Manno RL, Ranasinghe PD, Sweren RJ, McGirt LY. The use of blind skin biopsy in the diagnosis of intravascular B-cell lymphoma. J Am Acad Dermatol 2008; 59:148-51. [DOI: 10.1016/j.jaad.2008.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 02/24/2008] [Accepted: 03/10/2008] [Indexed: 12/23/2022]
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