Faculty Bibliography

OBJECTIVE:To determine the representation of Black/AA women surgeons in academic medicine among U.S. medical school faculty and to assess the number of NIH grants awarded to Black/AA women surgeon-scientists over the past 2 decades. SUMMARY OF BACKGROUND DATA/BACKGROUND:Despite increasing ethnic/racial and sex diversity in U.S. medical schools and residencies, Black/AA women have historically been underrepresented in academic surgery. METHODS:A retrospective review of the Association of American Medical Colleges 2017 Faculty Roster was performed and the number of grants awarded to surgeons from the NIH (1998-2017) was obtained. Data from the Association of American Medical Colleges included the total number of medical school surgery faculty, academic rank, tenure status, and department Chair roles. Descriptive statistics were performed. RESULTS:Of the 15,671 U.S. medical school surgical faculty, 123 (0.79%) were Black/AA women surgeons with only 11 (0.54%) being tenured faculty. When stratified by academic rank, 15 (12%) Black/AA women surgeons were instructors, 73 (59%) were assistant professors, 19 (15%) were associate professors, and 10 (8%) were full professors of surgery. Of the 372 U.S. department Chairs of surgery, none were Black/AA women. Of the 9139 NIH grants awarded to academic surgeons from 1998 and 2017, 31 (0.34%) grants were awarded to fewer than 12 Black/AA women surgeons. CONCLUSION/CONCLUSIONS:A significant disparity in the number of Black/AA women in academic surgery exists with few attaining promotion to the rank of professor with tenure and none ascending to the role of department Chair of surgery. Identifying and removing structural barriers to promotion, NIH grant funding, and academic advancement of Black/AA women as leaders and surgeon-scientists is needed.

BACKGROUND:Emergency Medical Services (EMS) is an important resource that interacts with our most vulnerable patients during transport home after hospital discharge. EMS providers may be appropriately situated to support the transition of care to the home environment. OBJECTIVES/OBJECTIVE:This study aimed to determine whether patients transported home by ambulance experience higher rates of return emergency department (ED) visits and readmission compared with similar patients transported home by other means. METHODS:This was a retrospective cohort study conducted at a U.S. tertiary care academic hospital. Patients aged 65 years and over transported home via ambulance after hospital discharge between January and March 2012 were included. Rates of 72-h and 30-day ED revisits and 30-day hospital readmissions were calculated. Odds ratios were calculated and revisit rates between groups were compared. RESULTS:There were 207 patients aged 65 and over transported home by ambulance. Matched controls were found for 162 patients. Compared with the matched controls, the exposed group experienced a statistically significant higher rate of 30-day ED returns (18.519% vs. 10.494%; odds ratio [OR] 1.939; p = 0.043). The exposed group also experienced a higher rate of 72-h ED returns (2.469% vs. 0.617%; OR 4.076) and 30-day readmissions (12.346% vs. 6.173%; OR 2.141), though results did not reach statistical significance. CONCLUSION/CONCLUSIONS:The study findings suggest that transport home via ambulance after hospital discharge could be predictive of a high risk of recidivism independent of established readmission risk factors. Programs that expand the role of EMS to include post-transport interventions may warrant further exploration.

This study examined the interrelated and longitudinal impacts of parent-child shared book reading, parenting stress, and early relational health, as measured by both parental warmth and parent sensitivity, from infancy to toddlerhood. To extend findings from previous studies of collateral effects that have been conducted in parenting interventions, we examined parenting behaviors in a broader context to determine whether shared book reading would confer collateral benefits to the parent and parent-child relationship beyond those expected (i.e., language and literacy). It was hypothesized that positive parent-child interactions, such as shared reading, would have positive impacts on parent outcomes such as parenting stress, parental warmth, and sensitivity. The sample consisted of 293 low-income mothers and their children who participated in a randomized controlled trial. Shared book reading, parenting stress, and parental warmth were assessed when children were 6 and 18 months old. We computed a series of cross-lagged structural equation models to examine longitudinal interrelations among these three factors. Results indicated that shared book reading at 6 months was associated with increases in observed and reported parental warmth and observed sensitivity and decreases in parenting stress at 18 months, controlling for baseline risk factors and treatment group status. These findings suggest that early parent-child book reading can have positive collateral impacts on parents' stress and the parent-child relationship over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVES/OBJECTIVE:To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types. METHODS:Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas. RESULTS:We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02). CONCLUSIONS:ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values. KEY POINTS/CONCLUSIONS:• Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.

BACKGROUND: Alcohol and drug use are often under-identified in primary care settings. While prior research indicates that patients are generally supportive of alcohol screening, less is known about attitudes toward drug screening or the collection of this information in electronic health records (EHRs). As a part of an implementation study of EHRintegrated substance use screening in primary care, conducted in the NIDA Clinical Trials Network, patients were surveyed on their attitudes toward screening for substance use during medical visits.
METHOD(S): Surveys were administered to patients in four urban academic primary care clinics on a quarterly basis, for one year following the introduction of a screening program. English-speaking adult patients presenting for a primary care visit were eligible. Participants were recruited from the waiting room and self-administered an 18-item survey exploring attitudes toward screening and discussing substance use with healthcare providers.
RESULT(S): A total of 479 patients completed the survey (mean age 54.1; 58% female; 58% white, 23% black; 19% Hispanic/Latino). Participants overwhelmingly felt that they should be asked about their substance use (91%), and deemed it appropriate for their doctor to recommend reducing use if it could adversely affect their health (92%). Most (87%) were equally comfortable discussing alcohol or drug use. A majority (63%) preferred discussing substance use with their doctor over other medical staff. Responses weremixed regarding screening modality: 55%preferred face-to-face, 22% had no preference, 14% preferred self- administration. Participants reported that they would be honest with their provider (94%), but 32% were concerned about medical record confidentiality.
CONCLUSION(S): Primary care patients strongly supported being screened for drug and alcohol use, and would be comfortable discussing it with their doctor. However, patients' concerns about having their substance use documented in their medical record could pose a barrier to achieving accurate responses. These findings suggest a need to educate patients on the confidentiality of medical records and the value of disclosing substance use for their medical care