Press Ganey Ratings in Urology: Who is at Risk of Bias?

OBJECTIVE: To evaluate effect of patient and physician demographics on Press Ganey (PG) survey ratings for urologists. METHODS: PG surveys (02/2020-08/2021) for urologists at a single tertiary care center were analyzed. Univariate and multivariate logistic regression models were used to assess the relationship between patient and physician-level covariates and the primary outcome of a "topbox" Overall Doctor Rating (topbox-ODR) score of 9 or 10 of 10. RESULTS: A total of 4155 surveys of 20 attending urologists (8 female (F)) across 7 subspecialties, were assessed. Mean ODR score for F physicians was 9.2 (SD 1.7) compared to 9.5 (SD 1.3) for males (M), P < .001. Univariate regression demonstrated that F patients are less likely (OR 0.27, P < .001) to give topbox-ODRs than M patients, and F physicians are 58% less likely (OR 0.42, P = .01) to receive topbox-ODRs than M physicians. Oncologists are more likely to receive topbox-ODRs (OR 3.3, P = .009) than all other subspecialists. Multivariate regression demonstrated that M patients are more likely to give M physicians top-box-ODRs (OR 0.32, P = .02), while F patients are less likely to give topbox-ODRs to physicians of both genders (M: OR 0.24, P < .001; F: 0.21, P < .001). Physicians in practice for >10 years are 66% less likely to receive topbox-ODRs (OR 0.33, P = .002). CONCLUSION: Urologists who care for F patients are at risk of being affected by bias in PG physician ratings. M physicians who care for M patients appear to be at the least risk; while F physicians who care for F patients appear to be at the highest risk.

Promoting Organizational Change: A Urology Department-wide Wellness Program to Reduce Burnout.

INTRODUCTION: We developed a comprehensive wellness initiative to address burnout with specific interventions targeted at faculty, residents, nurses, administrators, coordinators, and other departmental personnel. METHODS: A department-wide wellness initiative was implemented in October 2020. General interventions included monthly holiday-themed lunches, weekly pizza lunches, employee recognition events, and initiation of a virtual networking board. Urology residents received financial education workshops, weekly lunches, peer support sessions, and exercise equipment. Faculty were offered personal wellness days to use at their discretion at no penalty to their calculated productivity. Administrative and clinical staff were given weekly lunches and professional development sessions. Pre- and post-intervention surveys included a validated single-item burnout instrument and the Stanford Professional Fulfillment Index. Outcomes were compared using Wilcoxon rank-sum tests and multivariable ordinal logistic regression. RESULTS: Among 96 department members, 66 (70%) and 53 (55%) participants completed the pre- and post-intervention surveys, respectively. Burnout scores were significantly improved after the wellness initiative (mean 2.06 vs 2.42, mean difference -0.36, P = .012). An improvement was also observed in the sense of community (mean 4.04 vs 3.36, mean difference 0.68, P < .001). Adjusting for role group and gender, completion of the curriculum was associated with decreased burnout (OR 0.44, P = .025), increased professional fulfillment (OR 2.05, P = .038), and increased sense of community (OR 3.97, P < .001). The highest-rated components were monthly gatherings (64%), sponsored lunches (58%), and employee of the month (53%). CONCLUSIONS: A department-wide wellness initiative with group-specific interventions can help reduce burnout and may improve professional fulfillment and workplace community.

Beyond Occupational Hazards: Abuse of Day Laborers and Health.

With the increase in labor market flexibility and worksite immigration enforcement, day labor is a common type of informal employment arrangement among immigrants. Our study contextualized day laborers' physical and mental health within work- and community-level factors. We use a nationally representative sample of 2015 day laborers from the National Day Labor Survey. Multivariable logistic regression models estimated the association of occupational and socioenvironmental abuses with self-rated health (SRH), a positive PHQ-2 screening, morbidities, and workplace injuries. Employer abuse was associated with fair/poor SRH, workplace injuries, morbidity, and PHQ-2; business owner abuse was associated with PHQ-2 and workplace injuries; and crime and having a dangerous job are both associated with workplace injuries. Health disadvantages stem from unsafe occupational conditions and an overlapping array of adverse social experiences. These findings highlight the need to develop and evaluate policies that protect all workers regardless of socioeconomic position and immigration status.

Somatosensory cortical evoked potentials for intraoperative monitoring of spinal surgery

El primer caso reportado en Puerto Rico en donde potenciales somatosensoriales evocados en la corteza cerebral para el "monitoreo" intraoperatorio de cirugía de columna vertebral ha sido presentado. Potenciales evocados del nervio común peroneal fueron medidos en este procedimiento de alto riesgo. El procedimiento consistió en la estabilización de la columna vertebral torácica que estaba seriamente debilitada por envolvimiento tumoral de los cuerpos vertebrales T4 y T5. Se encontró una correlación directa entre hipotensión y deterioro de SER. La importancia de SER en el "monitoreo" intraoperatorio de la función del cordón espinal es enfatizada con este reporte. Es la intención de los autores estimular el diseño de ensayos clínicos que conduzcan al uso de SER en nuestra práctica diaria para poder mejorar los resultados finales en procedimientos quirúrgicos de columna vertebral y cordón espinal