Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System.

BACKGROUND: Professional roles within a hospital system may influence attitudes behind clinical decisions. OBJECTIVE: To determine participants' preferences about clinical decisions that either value equal health care access or efficiency. DESIGN: Deidentified survey asking participants to choose between offering a low-cost screening test to a whole population ("equal access") or a more sensitive, expensive test that could be given to only half of the population but resulting in 10% more avoided deaths ("efficient"). Data collection took place from August 18, 2021, to January 24, 2022. Study 1644 was determined to be exempt by Tufts Health Sciences Institutional Review Board (IRB). SETTING: Tufts Medicine Healthcare System. PARTICIPANTS: Approximately 15,000 hospital employees received an e-mail from the Tufts Medicine Senior Vice President of Academic Integration. MEASUREMENTS: Analysis of survey responses with chi-square and 1-sample t tests to determine the proportion who chose each option. Logistic regression models fit to examine relationships between professional role and test choice. RESULTS: A total of 1,346 participants completed the survey (∼9.0% response rate). Overall, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%). However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice. For example, among those in nonclinical roles, women were more likely than men to choose equal health care access. In multivariable analyses, having clinical roles was significantly associated with 1.73 times the likelihood of choosing equal access (95% confidence interval = 1.33-2.25). LIMITATIONS: Generalizability concerns and survey question wording limit the study results. CONCLUSION: Clinicians were more likely than nonclinicians to choose the equal health care access option, and health care administrators were more likely to choose efficiency. These differing attitudes can affect patient care and health care quality. HIGHLIGHTS: Divergent preferences of valuing equal health care access and efficiency may be in conflict during clinical decision making.In this cross-sectional study that included 1,346 participants, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%), a nonsignificant difference. However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choiceSince clinicians were more likely than nonclinicians to choose the equal health care access option and health care administrators were more likely to choose efficiency, these differing attitudes can affect patient care and health care quality.

Carotid Endarterectomy Versus Stenting for the Treatment of Patients With Carotid Artery Stenosis: An Updated Systematic Review and Meta-Analysis.

Carotid endarterectomy (CEA) is a surgical procedure that treats the narrowed carotid arteries, which may be narrowed by atherosclerosis. Stenting is the insertion of a wire mesh scaffold into the narrowed portion of the carotid artery to keep it open by preventing blood from clotting. Using the study done over 10 years back as a point of reference, this study will seek an update on an assessment comparing CEA and stenting in studies carried out between 2015 and to date. The PICOS (population, intervention, control, outcome, and study designs) criteria were used to construct a set of inclusion and exclusion guidelines. This meta-analysis and systematic review used two forms of investigative analysis; both quantitative and qualitative assessments. From the studies, stroke (95% CI: 0.51-0.71, P < 0.001), myocardial infarction (95% CI: 1.49-3.42, P = 0.001), and stroke or death analysis (95% CI: 0.53-0.77, P < 0.001) were noted to be significant. From the analysis, CEA was observed as having better treatment results in terms of stroke events and stroke or death incidences when compared to stenting. Carotid stenting was observed as having lower cases of myocardial infarctions when compared to endarterectomy.

Post-operative quadriparesis following posterior cervical laminectomy and fusion: A case-series of incidence, risk factors, and management.

OBJECTIVE: Post-operative quadriparesis following posterior cervical decompression and fusion is a rare but devastating complication. Unless rapidly identified and treated, it can cause permanent injury and disability. Given the sparse literature on this topic we intend to report on its incidence, to identify potential predisposing risk factors, and to discuss management considerations. METHODS: We retrospectively reviewed a series of 301 patients who underwent posterior cervical decompressive laminectomies and instrumented fusion performed by the senior author between 2006 and 2020. We describe the clinical courses and interventions for the seven of these 301 patients who developed post-operative quadriparesis. RESULTS: The incidence of post-operative quadriparesis following cervical spine decompressive laminectomies and instrumented fusion was 2.3% (7/301) in our study. The mean time-to-onset was 2 days, and the most common pathology was post-operative hematoma. We did not identify any statistically significant risk factors that predispose patients to post-operative quadriparesis. In our series, the patients with post-operative quadriparesis without profound hypotension who underwent emergent surgical decompression demonstrated improved neurologic outcomes compared to those who underwent interval imaging prior to decompression. CONCLUSION: Post-operative quadriparesis following cervical spine surgery is a catastrophic complication that is poorly reported and under-studied in current literature. In this study, we found a 2.3% incidence of post-operative quadriparesis with no obvious risk factors predisposing patients to this adverse outcome. We advocate that post-operative quadriparesis following cervical spine surgery, in the absence of profound hypotension, warrants emergent surgical site exploration without delay for interval imaging.

General Surgery Going Viral: Current Trends in Social Media Utilization by General Surgery Residency Programs.

OBJECTIVE: This study examined the current and changing trends in utilization of social media platforms by general surgery residency programs. DESIGN: US general surgery residency programs were identified. Facebook, Instagram, and Twitter were surveyed for active accounts specific to an institution's general surgery residency program. Metrics for these accounts included: Date of first post/date of account creation, total number of posts, number of followers, number of posts categorized per year for 2017, 2018, 2019, 2020, and 2021. Active accounts were categorized into university based, university affiliated, or independent programs. Number of followers and the number of posts were compared among those categories. Data collection took place from 7/21/2021 - 8/2/2021. RESULTS: 295 social media accounts were identified. 55% of all programs have at least one social media account. Instagram (47.8%) and Twitter (36.3%) make up the majority of the social media accounts. The majority of all social media accounts (51.2%) were created in 2020. Instagram saw the largest increase in activity in 2020 with posting increasing by 403.7% compared to 2019. Twitter accounts had the highest amount of posts in 2020 (9940). Instagram accounts have the highest follower base (113,499). Facebook also saw increased posting in 2020 but its overall account creation has remained stagnant. University based program accounts have higher on average followers and posts when compared to independent program accounts. CONCLUSION: Social media accounts specific to general surgery residency programs have grown steadily in the past few years, with a dramatic rise of account creation and activity in 2020. Instagram and Twitter serve as the dominant platforms for new account creation and activity. University based programs attract more followers than independent programs on Instagram and Twitter.

Pain Therapy Guided by Purpose and Perspective in Light of the Opioid Epidemic.

Prescription opioid misuse is an ongoing and escalating epidemic. Although these pharmacological agents are highly effective analgesics prescribed for different types of pain, opioids also induce euphoria, leading to increasing diversion and misuse. Opioid use and related mortalities have developed in spite of initial claims that OxyContin, one of the first opioids prescribed in the USA, was not addictive in the presence of pain. These claims allayed the fears of clinicians and contributed to an increase in the number of prescriptions, quantity of drugs manufactured, and the unforeseen diversion of these drugs for non-medical uses. Understanding the history of opioid drug development, the widespread marketing campaign for opioids, the immense financial incentive behind the treatment of pain, and vulnerable socioeconomic and physical demographics for opioid misuse give perspective on the current epidemic as an American-born problem that has expanded to global significance. In light of the current worldwide opioid epidemic, it is imperative that novel opioids are developed to treat pain without inducing the euphoria that fosters physical dependence and addiction. We describe insights from preclinical findings on the properties of opioid drugs that offer insights into improving abuse-deterrent formulations. One finding is that the ability of some agonists to activate one pathway over another, or agonist bias, can predict whether several novel opioid compounds bear promise in treating pain without causing reward among other off-target effects. In addition, we outline how the pharmacokinetic profile of each opioid contributes to their potential for misuse and discuss the emergence of mixed agonists as a promising pipeline of opioid-based analgesics. These insights from preclinical findings can be used to more effectively identify opioids that treat pain without causing physical dependence and subsequent opioid abuse.

CerebraLux: a low-cost, open-source, wireless probe for optogenetic stimulation.

The use of optogenetics to activate or inhibit neurons is an important toolbox for neuroscientists. Several optogenetic devices are in use. These range from wired systems where the optoprobe is physically connected to the light source by a tether, to wireless systems that are remotely controlled. There are advantages and disadvantages of both; the wired systems are lightweight but limit movement due to the tether, and wireless systems allow unrestricted movement but may be heavier than wired systems. Both systems can be expensive to install and use. We have developed a low cost, wireless optogenetic probe, CerebraLux, built from off-the-shelf components. CerebraLux consists of two separable units; an optical component consisting of the baseplate holding the fiber-optic in place and an electronic component consisting of a light-emitting diode, custom-printed circuit board, an infrared receiver, microcontroller, and a rechargeable, lightweight lithium polymer battery. The optical component (0.5 g) is mounted on the head permanently, whereas the electronic component (2.3 g) is removable and is applied for each experiment. We describe the device, provide all designs and specifications, the methods to manufacture and use the device in vivo, and demonstrate feasibility in a mouse behavioral paradigm.