Bullying, harassment and sexual discrimination among ophthalmologists in Australia and New Zealand.

BACKGROUND: Discrimination, bullying and sexual harassment (DBSH) impact the psychological well-being of doctors and contribute to poor health outcomes. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) commissioned independent surveys to evaluate DBSH among members/trainees. METHODS: Anonymous online surveys by Best Practice Australia were undertaken in 2015 and 2018. Cross-sectional analysis was prevalence of perceived DBSH, rates of reporting, intervention and resolution undertaken. Response rate was 50% (658/1319) in 2015 and 40% (557/1401) in 2018. In both surveys, 29% were female. This is representative of the distribution of the RANZCO members. RESULTS: In a 2015 survey, 37.6% of respondents experienced DBSH, with prevalence being the highest for females (62.3%; N = 104 cf males 27.7%; N = 167) and trainees (49.2%; N = 61). In 2018, 49.2% of respondents reported DBSH with rates low for all forms of DBSH (22%-29%). Sexual harassment was reported by 12% and the least discussed or reported. Respondents strategy for taking action included draw on personal support network (25-43%), official complaints to supervisors (16-22%), human resources (2%-10%) and RANZCO (0%-6%). Reasons for not taking action included fear of impact of future career options (54.1%-60.7%), fear of victimization (35.7%-50.4%) and afraid of not being believed (31.9%-52.4%). Satisfactory resolution rates were 6% to 25%. A majority of respondents (77%) were positive about RANZCO initiatives. CONCLUSIONS: DBSH is commonly reported by RANZCO members with female ophthalmologists more than two times more likely to experience any one of the four behaviours, three times more likely to experience discrimination and six times for sexual harassment. Fear of compromising personal and career progression contribute to low levels of reporting.

Infection and periprosthetic fracture are the leading causes of failure after aseptic revision total knee arthroplasty.

AIM: The purpose of this study was to clarify the medium to long term survival of aseptic revision total knee arthroplasty (RTKAs) and identify the common modes of failure following RTKAs. MATERIALS AND METHODS: A multi-center, retrospective study included all aseptic RTKAs performed at three tertiary referral hospitals between 2003 and 2016. Patients were excluded if the revision was for prosthetic joint infection (PJI) or they had previously undergone revision surgery. Minor revisions not involving the tibial or femoral components were also excluded. Demographics, surgical data and post-operative outcomes were recorded and analyzed. Survival analysis was performed and the reasons for revision failure identified. RESULTS: Of 235 aseptic RTKAs identified, 14.8% underwent re-revision at mean follow-up of 8.3 years. Survivorship of RTKA was 93% at 2 years and 83% at 8 years. Average age at revision was 72.9 years (range 53-91.5). The most common reasons for failure following RTKA were periprosthetic joint infection (PJI) (40%), periprosthetic fracture (25.7%) and aseptic loosening (14.3%). Of those whose RTKA failed, the average survival was 3.33 years (8 days-11.4 years). No demographic or surgical factors were found to influence RTKA survival on univariate or multivariate analysis. CONCLUSION: PJI and periprosthetic fracture are the leading causes of re-revision surgery following aseptic revision TKA. Efforts to improve outcomes of aseptic revision TKA should focus on these areas, particularly prevention of PJI.

Neuro-ophthalmic evaluation and management of pituitary disease.

Neuro-ophthalmic evaluation is a crucial component of the diagnostic and prognostic assessment of pituitary disease and compressive chiasmopathy, and can inform the timing of vision-restoring tumour resection surgery. The most common disease affecting the pituitary with neuro-ophthalmic implications are pituitary adenomas. Neuro-ophthalmic manifestations include decreased vision, abnormal colour vision and impaired visual field or diplopia. The recognition of these syndromes is critical to achieve early diagnosis and treatment and to improve prognosis. The pattern of vision loss in chiasmal compression is determined by the anatomical relationship between the pituitary lesion and optic chiasm, and potential visual field defects include bitemporal deficits, junctional scotomas, monocular cecocentral defects, and incongruous homonymous hemianopias. Rarer neuro-ophthalmic manifestations of pituitary disease include ophthalmoplegia, nystagmus, and obstructive hydrocephalus. There is growing evidence that demonstrates the strong diagnostic utility of optical coherence tomography (OCT) parameters in detecting the presence of compressive chiasmopathy, as well as the prognostic ability to predict the rate and degree of visual recovery following decompression surgery. Long-term neuro-ophthalmic monitoring is critical for detecting delayed vision loss following resection surgery, which may represent tumour recurrence or secondary complications.

Days Alive and Out of Hospital as an Outcome Measure in Patients Receiving Hyperacute Stroke Intervention.

BACKGROUND: Patient outcome after stroke is frequently assessed with clinical scales such as the modified Rankin Scale score (mRS). Days alive and out of hospital at 90 days (DAOH-90), which measures survival, time spent in hospital or rehabilitation settings, readmission and institutionalization, is an objective outcome measure that can be obtained from large administrative data sets without the need for patient contact. We aimed to assess the comparability of DAOH with mRS and its relationship with other prognostic variables after acute stroke reperfusion therapy. METHODS AND RESULTS: Consecutive patients with ischemic stroke treated with intravenous thrombolysis or endovascular thrombectomy were analyzed. DAOH-90 was calculated from a national minimum data set, a mandatory nationwide administrative database. mRS score at day 90 (mRS-90) was assessed with in-person or telephone interviews. The study included 1278 patients with ischemic stroke (714 male, median age 70 [59-79], median National Institutes of Health Stroke Scale score 14 [9-20]). Median DAOH-90 was 71 [29-84] and median mRS-90 score was 3 [2-5]. DAOH-90 was correlated with admission National Institutes of Health Stroke Scale score (Spearman rho -0.44, P<0.001) and Alberta Stroke Program Early CT [Computed Tomography] Score (Spearman rho 0.24, P<0.001). There was a strong association between mRS-90 and DAOH-90 (Spearman rho correlation -0.79, P<0.001). Area under receiver operating curve for predicting mRS score >0 was 0.86 (95% CI, 0.84-0.88), mRS score >1 was 0.88 (95% CI, 0.86-0.90) and mRS score >2 was 0.90 (95% CI, 0.89-0.92). CONCLUSIONS: In patients with stroke treated with reperfusion therapies, DAOH-90 shows reasonable comparability to the more established outcome measure of mRS-90. DAOH-90 can be readily obtained from administrative databases and therefore has the potential to be used in large-scale clinical trials and comparative effectiveness studies.

Brachial artery aneurysm and bilateral posterior circulation strokes in a young child with tuberous sclerosis complex.

Although tuberous sclerosis (TS) may affect many organs, vascular manifestations involving medium- and large-size vessels are rare. We present a young child with known TS who presented with bilateral posterior circulation infarcts and subsequently was found to have right-hand ischaemia secondary to a thrombosed brachial artery aneurysm. A wound on his right middle finger failed to heal with conservative management, and digital subtraction angiography and MR angiogram demonstrated a lack of bypass target with microcollateral supply of the forearm only. The right middle digit ischaemia was initially managed with right middle finger disarticulation at the metacarpophalangeal joint, but the wound failed to heal and the patient proceeded to a thumb-sparing carpo-metacarpal amputation. Aneurysms, stenotic-occlusive disease and embolic stroke are rare but important complications of TS.

Women's interest in surgery as a career in the early postgraduate period: a national longitudinal study.

BACKGROUND: Women remain underrepresented in Surgery in Aotearoa New Zealand (AoNZ). This study described interest in surgical careers by gender in the early postgraduate period and associated influencing factors. METHODS: AoNZ medical graduates between 2012 and 2016 responding to an Exit Questionnaire (EQ) at graduation and 3 years later (PGY3) as part of the Medical Schools Outcomes Database and Longitudinal Tracking Project (MSOD) were included. Analyses of specialty preferences and influences by gender were performed. RESULTS: Of 992 participants, 58% were women. At EQ, 158 participants (16%) had a surgical preference: 21% of men and 14% of women (P < 0.01). By PGY3, this was 20% of men and 10% of women (P < 0.01). A logistic regression found women were half as likely as men to have a surgical preference at PGY3. Those with a surgical preference at EQ were over 23 times more likely to have a surgical preference at PGY3, irrespective of gender. There were significant differences in self-reported career influencing factors between women and men at EQ and PGY3, as well as between PGY3 women with a surgical and those with a non-surgical preference. These included nature of the specialty, training requirements, lifestyle, family and personal factors. CONCLUSIONS: Increasing the proportion of women in Surgery requires a multifaceted approach starting during medical school and continuing through early postgraduate years. More needs to be done to make surgical experiences as an undergraduate and junior doctor appealing to women.

Racial and ethnic differences in abdominal soft tissue sarcoma incidence in New Zealand: a retrospective audit.

BACKGROUND: Soft tissue sarcomas are a rare and heterogenous group of tumours. Anecdotally there seems to be an over representation of patients of Maori ethnicity presented at the Auckland Regional Sarcoma Multidisciplinary Meeting (MDM). To date no study has reported on ethnicity demographics of abdominal and retroperitoneal sarcoma in New Zealand. The aim of this study is to characterize the ethnicity distribution of patients discussed at the regional MDM. METHODS: A retrospective audit was performed of patients presented at the Auckland Regional Sarcoma MDM between January 2015 and December 2020 with abdominal sarcoma. Ethnicity documentation for these patients was reviewed. RESULTS: One hundred and twenty-four patients with intra-abdominal and retroperitoneal tumours were discussed at MDM with 61 proceeding for resection, of those 43 (70.5%) were primary tumours, 10 (16.4%) were recurrent tumours and 8 (13.1%) had metastatic disease. Liposarcoma made up 56 (45.2%) cases, Leiomyosarcoma 33 (26.6%), Other 35 (28.2%). Ethnicities for this group specifically were European 64 (51.6%), Maori 31 (25.0%), Pacific Peoples 17 (13.7%), Asian 6 (4.8%) and Other/unknown 3(2.4%). This was found to be statistically significantly different to the expected ethnicity distribution based on 2018 census data from North Island DHBs (χ2  = 19.55, p = 0.00), with Maori and Pacific Peoples being over-represented and Asian patients being under-represented. Recommendation for surgery did not appear to be related to ethnicity. CONCLUSION: Our descriptive data shows a higher proportion of patients of Maori ethnicity discussed through the North Island regional sarcoma MDM than we would expect comparted to ethnicity distribution in the general population. It is unclear whether this represents a true difference in incidence based on ethnicity.

Professional and Personal Development After Psychoanalytic Training: Interviews with Early Career Analysts.

After analytic training, graduates position their newly acquired identity as "psychoanalyst" in the context of their broader career, contemplating whether to start new analytic cases, adapting their new knowledge base to psychotherapy practice, and deciding how to focus their professional and personal interests going forward. Using questionnaires and interviews, the Columbia Postgraduate Analytic Practice Study (CPAPS) has prospectively tracked the career trajectory of 69 of 76 graduates (91%) from the Columbia University Center for Psychoanalytic Training and Research since 2003. In this paper grounded theory is used to identify developmental themes in interviews with analysts who have been followed for at least ten years. Recent graduates are negotiating the following challenges: developing a sense of competence, navigating relationships with colleagues and former supervisors as situations change and roles shift, transitioning into becoming mentors, and balancing the competing responsibilities of professional and personal life. Disillusionment about aspects of training, analytic practice, analysis as a treatment, institute politics, and the field in general emerges as a stark reality, despite a high level of career satisfaction. Educational recommendations include making career development opportunities available and providing a realistic view of both practice realities and expectations of analytic treatment outcome.

A prospective study of psychoanalytic practice and professional development: early career interviews.

In 2003 the Columbia Center for Psychoanalytic Training and Research began a prospective study of graduates designed to both describe and understand their professional trajectory. The study has two components: a quantitative component based on an anonymous comprehensive questionnaire given analysts yearly starting with their graduation, and a qualitative component comprising analyst interviews beginning at the end of the first postgraduate year and repeated every two years. Analysis of the first six years of the qualitative study shows that analysts will talk openly about their practice and careers and that when they do, practical issues are a dominant concern. Analysts both immersed and not immersed in four-times-weekly analytic cases experiment with adapting skills developed in training to treat cases in analysis seen less frequently. Analysts without four-times-weekly case immersion are engaged in analytic careers, participate as faculty at the institute, and report a high degree of career satisfaction. The major findings of this study compel changes in psychoanalytic training programs. The field would do well to address actual clinical practice experience in institute curricula and training programs, thus making analytic training more relevant.