Early Integrated Palliative Care Within a Surgical Oncology Clinic

JAMA Network Open, Год журнала: 2023, Номер 6(11), С. e2341928 - e2341928

Опубликована: Ноя. 7, 2023

Importance Advance directive (AD) designation is an important component of advance care planning (ACP) that helps align with patient goals. However, it underutilized in high-risk surgical patients cancer, and multiple barriers contribute to the low AD rates this population. Objective To assess association early palliative integration changes among cancer who underwent surgery. Design, Setting, Participants This cohort study was a retrospective analysis prospectively maintained registry adult elective surgery for advanced abdominal soft tissue malignant tumors at oncology clinic comprehensive center expertise regional therapeutics between June 2016 May 2022, median (IQR) postoperative follow-up duration 27 (15-43) months. Data conducted from December 2022 April 2023. Exposure Integration ACP recommendations consultations into workflow 2020 using electronic health records (EHR), preoperative checklists, resident education. Main Outcomes Measures The primary outcomes were documentation. Multivariable logistic regression performed factors associated Results Among 326 (median [IQR] age 59 [51-67] years; 189 female [58.0%]; 243 non-Hispanic White [77.9%]) surgery, 254 (77.9%) designated ADs. rate increased 72.0% (131 182 patients) before 85.4% (123 144 after ( P = .004). documentation did not increase significantly (48.9% [89 182] ADs documented vs 56.3% [81 144] documented; .19). consultation (odds ratio [OR], 41.48; 95% CI, 9.59-179.43; < .001), palliative-intent treatment (OR, 5.12; 1.32-19.89; .02), highest quartile 3.79; 1.32-10.89; .01), 2.05; 1.01-4.18; .048). Patients self-identified as race or ethnicity other than less likely have 0.36; 0.17-0.76; .008). consulation 4.17; 2.57- 6.77; .001) 2.41; 1.21-4.79; .01). Conclusions Relevance An integrated initiative These findings demonstrate feasibility importance modifying clinical pathways, integrating EHR-based interventions, cohabiting physicians care.

Язык: Английский

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Diversity in Medical School, Orthopaedic Surgery Residency, and ACGME-Accredited Foot and Ankle Orthopaedic Surgery Fellowship Training by Gender, Race, and Ethnicity

Foot & Ankle Specialist, Год журнала: 2025, Номер unknown

Опубликована: Янв. 28, 2025

Increasing diversity in the US health care workforce is a topic of increasing scrutiny and interest. This study analyzes pipeline demographic for Accreditation Council Graduate Medical Education (ACGME)-accredited foot ankle orthopaedic surgery fellowship training. was cross-sectional medical students, residents, fellows at US-accredited training programs from 2013 to 2022. Self-reported data were available trainees compared with 2020 Census according federal guidelines. Participation-to-prevalence ratios (PPRs) calculated analyzed classify representation groups as overrepresented (PPR > 1.2), equivalent = 0.8-1.2), underrepresented < 0.8). Disparities existed among ACGME-accredited women (48.4% vs 16.1% 20.1, P .001), black (6.9% 4.6% 4.5%, Asian (23.9% 14.1% 23.9%, Hispanic (6.1% 3.0%, .001) trainees. There no self-reported American Indian/Alaska Native Hawaiian/Pacific Islander 0). Women 0.40), 0.36), 0.16) relative population. In contrast, 3.45), men 1.61), white 1.21) lack gender, racial, ethnic patient population earlier stages Increased efforts recruit may promote inclusion emerging workforce. III.

Язык: Английский

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The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review

Spine Deformity, Год журнала: 2025, Номер unknown

Опубликована: Март 6, 2025

Язык: Английский

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Impact of Limited Access to Surgical Care in Medically Underserved Communities

The American Surgeon, Год журнала: 2025, Номер unknown

Опубликована: Март 27, 2025

Summary/Background Medically underserved communities and ethnic minorities constitute a significant portion of the vulnerable population within United States. Recent changes in health care structure, rising inflation with decline median household income, SARS-CoV-2 pandemic have disproportionately impacted low socioeconomic status. Healthcare providers federal organizations must be aware how these factors influence access to surgical tailor treatment, interventions, policies better meet needs populations. Method We systematically reviewed 19 articles identify key influencing barriers for minority populations dynamic healthcare structures can further exacerbate this divide. Discussion face due like housing instability, lack insurance. These areas often shortages primary providers, healthy foods, high-value that may lead unfavorable outcomes. Poor utilization services also affect hospital systems, leading decreased funding increased closures. Despite intervention policy changes, need support rural institutions remains, requiring financial assistance, resource allocation improvements, incentives investors. Conclusion systems work towards bridging gap by implementing targeted outreach programs ensuring equitable distribution. Additionally, fostering partnerships community enhance awareness address specific face.

Язык: Английский

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Social Responsibility in Surgical Practice

Опубликована: Янв. 1, 2025

Язык: Английский

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The Use of Brief Mindfulness Interventions in the Context of Perioperative Care

The American Surgeon, Год журнала: 2024, Номер 90(6), С. 1657 - 1665

Опубликована: Янв. 28, 2024

The purpose of this review was to synthesize and categorize the literature on use brief mindfulness interventions for both patients physicians across spectrum perioperative care. Web-based discovery services discipline-specific databases were queried. Brief defined as sessions lasting 30 min or less any single occasion, with a total practice accumulation not exceeding 100 per week, duration up 4 weeks. Study screening data extraction facilitated through Covidence software platform. After 1047 potential studies, 201 articles identified based initial abstract title screening; 10 studies ultimately met inclusion criteria. All ten published between 2019 2023; most (n = 9) reports focused (total joint arthroplasty, n 3; stereotactic breast biopsy, 2; minimally invasive foregut surgery, 1; septorhinoplasty, cardiac other/multiple procedures, 1); one studied investigated among surgeons. varied (3 29 min). common issue that intervention aimed address pain 6), followed by narcotic 3), anxiety 2), delirium 1), patient satisfaction 1). While included small sample size had inconclusive results, noted impact various health-related outcomes, including mental health anxiety, perception. Mindfulness may be scalable, low-cost, time-limited has optimize well-being surgical outcomes broadly construed.

Язык: Английский

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The Impact of Racial Disparities and the Social Determinants of Health on Esophageal and Gastric Cancer Outcomes

Surgical Oncology Clinics of North America, Год журнала: 2024, Номер 33(3), С. 595 - 604

Опубликована: Янв. 21, 2024

Язык: Английский

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Surgical Outcomes and Sociodemographic Disparities Across All Races: An ACS-NSQIP and NHIS Multi-Institutional Analysis of Over 7.5 Million Patients

Annals of Surgery Open, Год журнала: 2024, Номер 5(3), С. e467 - e467

Опубликована: Июль 16, 2024

This study aims to fill the gap in large-scale, registry-based assessments by examining postoperative outcomes across diverse races/ethnicities. The focus is on identifying disparities and comparing them with socioeconomic demographics.

Язык: Английский

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Determining identity in medical research

BMJ, Год журнала: 2023, Номер unknown, С. p2410 - p2410

Опубликована: Окт. 23, 2023

Язык: Английский

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Medical Maximizing Preferences and Beliefs About Cancer Among US Adults

JAMA Network Open, Год журнала: 2024, Номер 7(6), С. e2417098 - e2417098

Опубликована: Июнь 14, 2024

Importance Medical overutilization contributes to significant health care expenditures and exposes patients questionably beneficial surgery unnecessary risk. Objectives To understand public attitudes toward medical utilization the association of these with beliefs about cancer. Design, Setting, Participants In this cross-sectional survey study conducted from August 26 October 28, 2020, US-based, English-speaking adults were recruited general using Prolific Academic, a research participant platform. Quota-filling was used obtain sample demographically representative US population. Adults personal history cancer other than nonmelanoma skin excluded. Statistical analysis completed in July 2022. Main Outcome Measures preferences characterized validated, single-item Maximizer-Minimizer Elicitation Question. preferring take action medically ambiguous situations (hereafter referred as “maximizers”) compared those who leaned waiting seeing “nonmaximizers”). Beliefs emotions incidence, survivability, preventability assessed validated measures. Logistic regression modeled factors associated maximize utilization. Results Of 1131 participants (mean [SD] age, 45 [16] years; 568 women [50.2%]), 287 (25.4%) classified maximizers, 844 (74.6%) nonmaximizers. revealed that self-reporting very good or excellent status (compared good, fair, poor; odds ratio [OR], 2.01 [95% CI, 1.52-2.65]), Black race White race; OR, 1.88 1.22-2.89]), high levels worry low levels; 1.62 1.09-2.42]), overestimating incidence accurate estimation underestimating; 1.58 1.09-2.28]) significantly maximizing preferences. Those believed they personally had higher-than-average risk developing more likely be maximizers (23.6% [59 250] vs 17.4% [131 751]; P = .03); factor not analyses. Conclusions Relevance adults, tendencies often overestimated higher cancer-related worry. Targeted personalized education its may help reduce oncologic care.

Язык: Английский

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