Targeted Telehealth Education Increases Interest in Using Telehealth among a Diverse Group of Low-Income Older Adults.

Telehealth allows older adults to take control over their health and preventive care; however, they are less likely to use telehealth. Minority older adults use telehealth services less than their White counterparts. During COVID-19, the U.S. Medicare system allowed for telehealth delivery of Annual Wellness Visits, which are known to improve use of preventive services. To increase telehealth use, we targeted vulnerable, low-income, minority older adults and provided education to improve knowledge of and identify barriers to telehealth use. Ultimately, this could serve as a means of improving health and preventive care services. Participants resided at independent living facilities, low-income housing, and elders of the Native American coalition; N = 257. Participants received written education materials; a subset attended a 20-min presentation. In this quasi-experimental study, participants completed a pre-post survey. Results were analyzed using Chi-Squared and Fisher's Exact tests. Participants included 54 'in-person' and 203 'at-home' learners. Most were female (79%), single/widowed (51%), and white (65%). At baseline, 39% were familiar with telehealth; following education 73% stated understanding on accessing telehealth. Nearly 40% of participants said they would use telehealth in the future; a larger proportion of "in-person" (73%) learners were willing to use telehealth than "at-home" learners (41%) (p = 0.001). Divorced older adults and Blacks voiced greater likelihoods of using telehealth than their married/widowed and White counterparts, respectively (Χ2(3, N = 195) = 9.693, p = 0.02), (p = 0.01). This education program demonstrates an increase likelihood in health promotion among older adults by increasing confidence in accessing and future use of telehealth; therefore, we achieved our aim of promoting telehealth use and improving health promotion.

A pen pal program during COVID-19 pandemic increases student interest for careers in geriatrics.

Social isolation and loneliness are serious issues facing older adults that have been intensified during COVID-19. Through a pen pal program, we connected 69 healthcare professional students with 180 older adults in our community to help reduce social isolation and loneliness. Participants were connected through letters, e-mails, and phone calls for three months. At the end of the program, we surveyed students (response rate: 62%). Half of the students reported spending less than 20 minutes per week on the project. Of the survey respondents roughly 91% were white, 74.4% were enrolled in the College of Medicine, and 51.1% were in their first year of their respective program. Students increased their knowledge of social isolation and loneliness (p = .0001), their interest in volunteering (p = .018) and working with older adults (p = .028), and their comfort communicating with older adults (p = .002). Students reported that their wellness improved and that they practiced skills that would be used in their future careers. By providing volunteer experiences to students, we can increase their exposure to the geriatric population, hopefully increasing the number of students who enter geriatrics while simultaneously reducing social isolation and loneliness in older adults.

Gender differences in authorship among Hepato-pancreatico-biliary surgeons.

BACKGROUND: While studies have explored the gender gap in scientific publications, no study has investigated surgical literature in much detail. We examined the gender gap in Hepato-pancreato-biliary publications over the last decade. METHODS: All physician authored original clinical science articles published in HPB, Annals of Surgery, Surgery, Annals of Surgical Oncology, and JAMA Surgery were reviewed from 2008 to 2017. Chi square analysis was used to compare the proportions of female and male authors and Cochrane-Armitage test was used for comparisons over time. RESULTS: Of the 1067 publications, 84.0% of all authorships were held by men. Women physicians made up 10.3% of senior and 21.4% of first authorships with increased representation from 2.13% in 2007 to 14.8% in 2017 (p = 0.001). Women physicians comprised 14.1% of senior authors in JAMA Surgery, but only 2.46% in Annals of Surgical Oncology. Male authors were five times more likely to publish multiple articles compared to their female counterparts. Female first authors progressed to senior authors at a rate of 1.13% versus 5.73% for male authors (p = 0.89). CONCLUSION: These findings elucidate the continued underrepresentation of women in senior research roles and the need to recruit and mentor women in all stages of their academic careers.

Public health service increased risk donor kidney grafts for transplant into children, a survey of pediatric nephrologists.

BACKGROUND: Kidney transplant is the best treatment for end-stage renal disease (ESRD); however, access is limited by severe organ shortage. Public Health Service increased risk donors (PHS-IRD) represent a significant portion of available organs which are discarded at disproportional rates. METHODS: Pediatric nephrologists were surveyed regarding PHS-IRD kidneys to understand attitudes and perceived barriers to the use of these grafts in children. We sought to elucidate what methods may help increase the likelihood of PHS-IRD acceptance. RESULTS: Twenty-two responses were received from United States pediatric nephrologists representing 11 UNOS regions (response rate 5.9%). Of respondents, 50% had been practicing for 20+ years, 77% in academic hospitals, and 63% in cities with over 1 000 000 people. All respondents worked in an institution with a kidney transplant program. 41% reported that they would not accept PHS-IRD kidneys under any circumstance, 45% would accept depending on the candidate's medical status, and 14% routinely accepted PHS-IRD kidneys. Infectious transmission was the biggest disincentive reported (59%), with only 55% of respondents feeling comfortable counseling families on the associated risks. 82% of respondents did not perceive all PHS-IRD as the same, and 90% supported stratifying PHS-IRD into tiers based on risk, which would increase the likelihood of organ acceptance (82%) and assist in counseling families (91%). CONCLUSIONS: With improved utilization, PHS-IRD kidneys offer a step toward decreasing the organ shortage. These findings suggest hesitance in use of PHS-IRD kidneys for pediatric recipients. Further stratification of risk could aid in provider organ acceptance and counseling patients.

Gendered Differences in Letters of Recommendation for Transplant Surgery Fellowship Applicants.

BACKGROUND: No published study has explored gender differences in letters of recommendation for applicants entering surgical subspecialty fellowships. METHODS: We conducted a retrospective review of letters of recommendation to a transplant surgery fellowship written for residents finishing general surgery residency programs. A dictionary of communal and agentic terms was used to explore differences of the letters based on applicant's gender as well as the academic rank and gender of the author. RESULTS: Of the 311 reviewed letters, 228 were letters of recommendation written for male applicants. Male surgeons wrote 92.4% of the letters. Male applicant letters were significantly more likely to contain agentic terms such as superb, intelligent, and exceptional (p = 0.00086). Additionally, male applicant letters were significantly more likely to contain "future leader" (p = 0.047). Letters written by full professors, division chiefs, and program directors were significantly more likely to describe female applicants using communal terms like compassionate, calm, and delightful (p = 0.0301, p = 0.036, p = 0.036, respectively). In letters written by assistant professors, female letters of recommendation had significantly more references to family (p = 0.036). CONCLUSIONS: Gendered differences exist in letters of recommendation for surgical fellowship applicants. This research may provide insight into the inherent gender bias that is revealed in letters supporting candidates entering the field.