Comprehensive framework of factors accounting for worse aortic aneurysm outcomes in females: A scoping review.

Sex-based outcome studies have consistently documented worse results for females undergoing care for abdominal aortic aneurysms. This review explores the underlying factors that account for worse outcomes in the females sex. A scoping review of studies reporting sex-based disparities on abdominal aortic aneurysms was performed. The review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. Factors that account for worse outcomes in the females sex were identified, grouped into themes, and analyzed. Key findings of each study are reported and a comprehensive framework of these factors is presented. A total of 35 studies were identified as critical in highlighting sex-based disparities in care of patients with aortic aneurysms. We identified the following 10 interrelated themes in the chain of aneurysm care that account for differential outcomes in females: natural history, risk factors, pathobiology, biomechanics, screening, morphology, device design and adherence to instructions for use, technique, trial enrollment, and social determinants. Factors accounting for worse outcomes in the care of females with aortic aneurysms were identified and described. Some factors are immediately actionable, such as screening criteria, whereas device design improvement will require further research and development. This comprehensive framework of factors affecting care of aneurysms in females should serve as a blueprint to develop education, outreach, and future research efforts to improve outcomes in females.

Unmasking bias and perception of lead surgeons in the operating room: A simulation based study.

BACKGROUND: Perception of a surgeon based on physical attributes in the operating room (OR) environment has not been assessed, which was our primary goal. METHODS: A common OR scenario was simulated using 8 different actors as a lead surgeon with combinations of age (<40 vs. >55), race (white vs. black), and gender (male vs. female). One video scenario with a survey was electronically distributed to surgeons, residents, and OR nurses/staff. The overall rating, assessment, and perception of the lead surgeon were assessed. RESULTS: Of 974 respondents, 64.5% were females. There were significant differences in the rating and assessment based upon surgeon's age (p = .01) favoring older surgeons. There were significant differences in the assessments of surgeons by the study group (p = .03). The positive assessments as well as perceptions trended highest towards male, older, and white surgeons, especially in the stressful situation. CONCLUSION: While perception of gender bias may be widespread, age and race biases may also play a role in the OR. Inter-professional education training for OR teams could be developed to help alleviate such biases.

Clerkship Experiences During Medical School: Influence on Specialty Decision.

OBJECTIVE: Clinical rotations during medical school are the time when most students select their specialty. Limited or lack of exposure could deter students from certain sub-specialties, and thus, insight into the selection process is essential. This study assesses the role of limited clinical rotations and perception of students on specialty selection. METHODS: All graduating medical students were surveyed at our US-based institution for 2 years. The survey included both open- and close-ended questions related to influence of clerkship experience and other factors on specialty choice and suggestions for improvement. The data were analyzed descriptively and thematically. RESULTS: Majority of students (87%) had minimal exposure to their chosen residency specialty prior to the third-year clerkships. Role of a clerkship experience in selecting a specialty was significant for 70% students, especially interaction with attendings (92%) and residents (86.3%). The most influential reasons for specialty choice to change were clerkship experience (41%) and mentors (21%). Approximately 34% students chose a specialty that was not a part of third-year core clerkships, and the most significant factors influencing their choice were shadowing experience (21%) and lifestyle (18%). Further, thematic analysis suggested that earlier and more clinical exposure to various specialties and formal mentoring could make specialty selection process easier. CONCLUSIONS: Along with specialty content, the relationship of learners and teachers in the clinical setting plays a significant role in selecting and/or rejecting certain specialty by medical students. The study provides broader baseline data for medical schools and educators in preparation of curriculum and future physician workforce composition.

Management of upper extremity deep venous thrombosis in a hospice patient.

BACKGROUND: In this case report, upper extremity deep venous thrombosis (UEDVT) is discussed with special attention to the diagnosis, treatment, and prevention in palliative care patients. METHODS: A 43-year-old female with a history of metastatic breast cancer presented with a UEDVT. Standard anticoagulation was unsuccessful, so after a complete discussion about the treatment options, alternative therapy was used for clot lysis. CONCLUSION: Aggressive treatment of UEDVT in a palliative care setting has the potential for improving the quality of life, yet because of the increased risk of complications and philosophy of palliative medicine, the treatment strategy for each patient should be carefully considered.

Factors affecting radiation injury.

INTRODUCTION: During the past several decades, the number of diagnostic tests and procedures that require the administration of radiation has increased dramatically. Understanding which factors affect radiation injury and how to mitigate these to protect patients has become critical for physicians to understand. Informed consent for these procedures has to include a discussion of the risks of radiation. METHODS: Factors that affect radiation injury, as well as ways to mitigate these, are discussed. Informed consent is also reviewed. RESULTS: Technical factors of the radiation delivery and patient factors both influence the dose of radiation received. Minimizing exposure is critical, and close examination of the patient is warranted to diagnose radiation injury. True informed consent includes a frank discussion of the radiation risks as well as the benefits of the procedure. CONCLUSION: Minimizing patient radiation exposure and accurately diagnosing radiation injury are key skills with which any physician ordering or performing tests or procedures requiring the use of radiation needs to be familiar. Informed consent includes a discussion of the risks as well as the benefits of the proposed radiation exposure.

Recurrence of a popliteal venous aneurysm.

We report the case of a 40-year-old man with a recurrent popliteal vein aneurysm diagnosed 2 years after initial lateral aneurysmectomy. Definitive management consisted of popliteal vein aneurysm resection and reconstruction with an interposition spiral vein graft. Our case suggests that aneurysm vein resection and interposition vein graft should be the preferred surgical option. Also, patients treated may benefit from longer follow-up in light of the potential morbidity from recurrence if undetected.

Transanal endoscopic drainage of abdominopelvic sepsis.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an evolving experimental field exploring the technical feasibility and outcome of therapeutic interventions performed through the natural orifices of the body. The knowledge accumulating in NOTES is the result of animal experimentation and ongoing early clinical experience in humans. In this report we describe a patient treated with transanal endoscopic drainage of postoperative abdominopelvic sepsis.

Endoscopic stenting of colovaginal fistula: the transanal and transvaginal "kissing" wire technique.

Interventional endoscopy is a rapidly evolving field allowing surgeons and endoscopists to approach surgical conditions nonoperatively. Stenting of benign colorectal disease has been limited due to technical issues and lack of long-term data. Colovaginal fistula can be a challenging condition to treat. In this report, we describe the technical aspect and results of endoscopic stenting of benign colovaginal fistula in 2 patients, using the combined transanal and transvaginal approach.