Gender Diversity on Corporate Boards Associated with Ophthalmology

PURPOSE

Enhancing diversity on boards has been linked to greater profitability and innovation. Unfortunately, there remains an underrepresentation of women in executive management and leadership positions in the ophthalmic corporate world. The purpose of these analyses was to examine the gender composition of directors for boards associated with the discipline of ophthalmology.

DESIGN

Cross-sectional research design.

METHODS

Using contemporary data, we examined a specific cohort, the American Academy of Ophthalmology (AAO) Foundation Ophthalmic Business Council corporate members as reported in the annual 2019 meeting program (N = 23). The board composition was analyzed using an online search of publicly available information in January and February 2020. The specific outcome measures included the number and percentage of women board members and their roles.

RESULTS

There were a total of 23 Ophthalmic Business Council members with publicly available data; 37 of 195 total directorship seats (19%) were held by women, and 9 of 23 companies (39%) listed women as previous or current chairs of committees or outside corporations. Four of the 23 (17%) members of the Ophthalmic Business Council corporations had no women directors.

CONCLUSIONS

The boards of directors of the AAO Foundation Ophthalmic Business Council corporate members remain predominately male. Despite the increasing number of women entering the specialty, women remain underrepresented in the corporate world of ophthalmology. Gender parity on boards is essential for the economic well-being of ophthalmic corporations as well as the relationship of the Ophthalmic Business Council with AAO members, health care systems, insurance carriers, government officials, and the public.

Employee Health and Wellness Outcomes Associated With Perceived Discrimination in Academic Medicine: A Qualitative Analysis

IMPORTANCE

Organizational culture and workplace interactions may enhance or adversely impact the wellness of all members of learning and work environments, yet a nuanced understanding of how such experiences within health care organizations impact the health and wellness of their membership is lacking.

OBJECTIVE

To identify and characterize the reported health and wellness outcomes associated with perceived discrimination among academic medicine faculty, staff, and students.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study analyzed anonymously submitted written narratives from 2016 that described experiences related to inclusion in the workplace or lack thereof. Narratives that described health outcomes associated with work- or school-based discrimination were purposively sampled. Participants were faculty, staff, and students at health-related schools or hospitals affiliated with the University of Pennsylvania. Data analysis was performed from March 2019 to January 2020.

EXPOSURES

Self-reported experiences, both witnessed and personal, of discrimination in the workplace.

RESULTS

A total of 315 narratives were collected, and 115 narratives from 115 participants were analyzed. Most respondents identified as female (70 respondents [60.9%]), non-Hispanic White (68 respondents [59.1%]), and heterosexual (89 respondents [77.4%]) and had worked at the institution for at least 1 year (99 respondents [86.0%]). The outcomes associated with adverse workplace experiences were broad and ranged in nature from emotional to mental and physical. Most reported outcomes were emotional (101 respondents [87.8%]), and more than 1 in 10 narratives (14 respondents [12.2%]) described a mental or physical health outcome. Many of the participants felt devaluated, overexerted, and hopeless, resulting in clinically relevant manifestations, such as increased stress and anxiety levels and even elevated blood pressure.

CONCLUSIONS AND RELEVANCE

This qualitative study identified a continuum of negative outcomes on employee health and well-being associated with perceived discrimination and chronic exclusion in the workplace. These findings suggest the need for organizations to promote inclusion as a component of workplace wellness interventions.

Measuring Organizational Cultural Competence to Promote Diversity in Academic Healthcare Organizations

Purpose: To evaluate what drives respondent perceptions of health system organizational cultural competence. Methods: We estimated associations between survey respondent (n=3506) demographic characteristics, length of employment, position, and place of work and their reported perceptions of institutional culture. Results: In adjusted analyses, respondents self-identifying as non-Hispanic black versus non-Hispanic whites, females versus males, and lesbian/gay/bisexual/transgender/queer versus heterosexuals were significantly less likely to rank the cultural competence of their organization above average. Conclusion: Minorities and women were less likely to rank their organization as culturally competent. Organizational efforts to achieve cultural competency would benefit from measuring this factor to target their efforts.

Perceptions of Factors Associated With Inclusive Work and Learning Environments in Health Care Organizations: A Qualitative Narrative Analysis

IMPORTANCE

Diversifying the health care workforce remains a critical goal for health care organizations focused on reducing disparities in care. However, it remains unknown what factors create inclusive health system environments and help organizations retain a diverse workforce.

OBJECTIVE

To understand from members of the health care workforce what factors contribute to inclusive work and learning environments and what can be done to improve inclusion within health care organizations.

DESIGN, SETTING, AND PARTICIPANTS

A qualitative narrative analysis of responses to a weekly email call for narratives within health care organizations sent June 1, 8, 15, and 22, 2016. The email contained an anonymous link to 2 open-ended stimulus questions asking for stories reflecting inclusion or lack thereof within participants' work environments as well as demographic questions. The study took place at 6 hospitals, including a free-standing children's hospital and a Veterans Affairs medical center, 4 health sciences schools (Medicine, Nursing, Dental, and Social Policy and Practice), and outpatient facilities within a university-based health care system in Pennsylvania. There were 315 completed narratives submitted from health care system executives (n = 3), staff (n = 113), academic faculty (n = 97), trainees or students (n = 99), and 3 who declined to specify their positions.

MAIN OUTCOMES AND MEASURES

Workplace experiences with inclusivity, implications of these experiences, and recommendations to improve inclusion within environments.

RESULTS

Of 315 narratives submitted from members of the health care system, in 188 (59.7%) the writer self-identified as female; in 10 (3.2%), as transgender/queer; in 38 (12.1%), as non-Hispanic black; in 152 (48.3%), as non-Christian; in 31 (9.8%), as having a language other than English as their primary language; and in 14 (4.4%), as having a disability. Analysis of the narratives revealed 6 broad factors that affected inclusion within health care organizations: (1) the presence of discrimination; (2) the silent witness; (3) the interplay of hierarchy, recognition, and civility; (4) the effectiveness of organizational leadership and mentors; (5) support for work-life balance; and (6) perceptions of exclusion from inclusion efforts. Challenges with inclusion had negative effects on job performance and well-being, with reports of stress, anxiety, and feelings of hopelessness. Most respondents referenced a systemic culture that influenced their interpersonal dynamics and provided specific strategies to improve organizational culture that focused on leadership training and expanding collegial networks.

CONCLUSIONS AND RELEVANCE

This narrative analysis provides a taxonomy of factors that health care organizations can use to assess inclusion within their learning and work environments as well as strategies to improve inclusion and retain a diverse health care workforce.

Advancing LGBT Health at an Academic Medical Center: A Case Study

Academic health centers are strategically positioned to impact the health of lesbian, gay, bisexual and transgender (LGBT) populations by advancing science, educating future generations of providers, and delivering integrated care that addresses the unique health needs of the LGBT community. This report describes the early experiences of the Penn Medicine Program for LGBT Health, highlighting the favorable environment that led to its creation, the mission and structure of the Program, strategic planning process used to set priorities and establish collaborations, and the reception and early successes of the Program.

Minority primary care physicians' knowledge, attitudes, and practices on eye health and preferred sources of information

BACKGROUND

Racial and ethnic disparities exist in the prevalence of certain eye diseases. Minority primary care physicians are in a unique position to help prevent vision loss and blindness, especially among minority populations.

METHODS

To measure physicians' knowledge and attitudes regarding eye health and to better understand the facts regarding patient information and counseling concerning eye health and disease, the National Eye Institute included key eye health knowledge, attitude, and practice questions in the 2007 DocStyles Survey, a Web-based survey of primary care physicians about physician perceptions and attitudes concerning communication with patients.

RESULTS

A total of 428 minority primary care physicians responded to the survey. Results indicate that minority primary care physicians have favorable attitudes regarding eye health and the role they should play in talking with patients about eye health. Approximately 60% indicated that they could identify patients at higher risk for eye disease; however, only 52% of physicians indicated that they have adequate knowledge to advise their patients on vision health. Regarding information sources, most minority physicians prefer to obtain information about vision and eye health from professional journals, medical Web sites, and continuing medical education.

CONCLUSIONS

Findings from this research reveal both a need and an opportunity with regard to increasing physician confidence in identifying patients at higher risk for eye disease and advising their patients on eye health.

VIP Immunoreactivity in Human Aqueous Humor

PURPOSE

To demonstrate the presence of vasoactive intestinal pep-tide (VIP)-immunoreactive molecule in the human aqueous humor collected from eyes undergoing either cataract or glaucoma surgeries and to identify them asses of molecules responsible for the VIP immunoreactivity.

METHODS

Aqueous humor specimens were collected by parencentesis from nine cataract patients and also from eight patients undergoing glaucoma surgery following the creation of the limbal based conjunctival flap, partial dissection of the scleral flap, and application of mitomycin-C. The aqueous humor specimens were analyzed by radioimmunoassay to determine the level of VIP immunoreactivity. Specimens from 10 other cataract patients were pooled and analyzed for VIP immunoreactivity by Western blot analysis.

RESULTS

Levels of VIP immunoreactivity in aqueous humor of cataract and glaucoma patients were significantly different and were 610 +/- 160 and 260 +/- 64 pg VIP/ml, respectively (p = 0.03), while there was no correlation between the donor age and the level of VIP immunoreactivity. VIP immunoreactivity was detected as a single molecule with a molecular weight of 9000.

CONCLUSIONS

The disease status and the treatments of the eye that led to surgery and procedures applied to the eye immediately before aqueous humor collection, but not the age of the patients, affected the level of VIP immunoreactivity in the aqueous humor. The relationship between the 9000 Da VIP-immunoreactive molecule and the authentic (3326 Da) VIP remains to be studied.

Histologic effect of diode laser sclerostomy in human cadaver eyes

BACKGROUND AND OBJECTIVES

To study tissue effects and thresholds of efficacy in producing a full-thickness scleral fistula in human eyes obtained from cadavers. The effect of laser sclerostomies created with indocyanine green (ICG) was also evaluated.

MATERIALS AND METHODS

Ab externo laser sclerostomies were produced in 12 fresh human eyes obtained from cadavers using a 200-micron diameter fiber optic connected to a diode laser system. Power settings were 500, 750, 1000, 1250, 1500, and 2000 mW with a constant duration of 100 and 200 ms. The same diode laser settings were repeated in the tissues injected with ICG.

RESULTS

The laser sclerostomies were associated with heat coagulation damage adjacent to the burn margins, with disruption of stromal collagen. Tissue damage was greater at higher power and longer duration. Scleral injection of ICG prior to laser sclerostomy did not enhance laser penetration.

CONCLUSION

The diode laser can create a sclerostomy in human sclera with an optimum level of 1500 mW and 100 ms. ICG did not significantly enhance the ease of penetration or reduce the association thermal damage to the sclera.

Clinical management of women at increased risk for breast cancer

A large number of women in the population are at risk for the development of breast cancer. Methods now exist to accurately assess risk and to provide quantitative estimates of the chance of a woman developing breast cancer in her lifetime. Histologic assessment of premalignant breast pathology aids in the evaluation of risk. The availability of primary chemoprevention clinical trials reduces the number of indications for prophylactic mastectomy. Women at risk for breast cancer and women who have had a malignant lesion at another anatomic site have an increased risk for new cancers at multiple sites. We propose screening strategies based on epidemiologic information about the risks of these diseases and on the predictive value of the available screening tests. The merits and inadequacies of specific management strategies are considered. We review the risks and benefits of estrogen replacement therapy for women at increased risk for breast cancer and consider the ethical implications of both risk assessment and the various interventions.

Sympathetic ophthalmia following neodymium:YAG cyclotherapy

Neodymium:YAG cyclotherapy has been demonstrated to lower intraocular pressure dramatically in patients with uncontrolled glaucoma, with potentially fewer side-effects than cyclocryotherapy. We report the clinical course and histopathological features of a case of sympathetic ophthalmia occurring soon after YAG cyclotherapy.

Effects of ascorbic acid on trabecular meshwork cells in culture

We examined the effects of ascorbic acid on trabecular meshwork cells in culture. Bovine trabecular meshwork cells were plated for 6 days and were exposed to media containing either no ascorbic acid or ascorbic acid in the following concentrations for 24 hr: 50-, 100-, 500-, and 750 micrograms ml-1. Fresh media were then added and incubation was continued for an additional 24 hr. The cell number was subsequently determined for the effects of the various concentrations of ascorbic acid on cell growth. In a parallel experiment, cells were labeled with [35S] sulfate (50 microCi ml-1) and [3H]glucosamine (15 microCi ml-1) for 24 hr with or without ascorbic acid for glycosaminoglycan studies. Results indicated that ascorbic acid stimulated the trabecular cell growth in culture at concentrations of 50-, 100-, and 250 micrograms ml-1. However, at 750 micrograms ml-1, cell growth was inhibited. In addition, cells exposed to 100 micrograms ml-1 of ascorbic acid demonstrated increased incorporation of [3H]glucosamine and [35S]sulfate; enhancement of incorporation of [35S]sulfate was also noted at 250 micrograms ml-1. Incorporation of labels was otherwise either unchanged or retarded at other concentrations. These data suggest that the ascorbic acid level in the aqueous humour may influence trabecular meshwork cell metabolism.

Multifocal defects and splenomegaly in sarcoidosis: a new scintigraphic pattern

Sarcoidosis involves the spleen in a significant percentage of patients afflicted with this disease. The most commonly applied modality for studying such patients is the (99m)Tc-sulfur colloid scan. Different patterns have been recognized: "normal" spleen and nonspecific splenic enlargement, with or without focal areas of photon deficiency, which was thought to represent an infarction in a previous report. We have encountered two patients showing splenomegaly and multifocal photon deficiencies secondary to sarcoid granulomata. These cases are presented to inform clinicians of a new pattern. Our patients were managed with systemic corticosteroids and palliation of pain. If symptoms persist or worsen, splenectomy may be necessary to avoid spontaneous rupture. An abbreviated differential diagnosis of the enlarged spleen with multiple focal defects is discussed.