U.S. medical school admissions and enrollment practices: status of LGBTQ inclusivity.

CONTEXT: The failure to collect information on lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity in healthcare and medical education is a part of a systemic problem that limits academic medical institutions' ability to address LGBTQ health disparities. OBJECTIVES: To determine whether accurate sexual and gender minority (SGM) demographic data is being consistently collected for all US medical schools during admissions and enrollment, and whether differences exist between collection practices at osteopathic and allopathic schools. METHODS: Secure, confidential electronic were sent via email in July 2019 to 180 osteopathic (n=42) and allopathic (n=138) medical schools identified through the American Association of Colleges of Osteopathic Medicine Student Guide to Osteopathic Medical Colleges database and the American Association of Medical Colleges Medical School Admissions Requirements database. The nine question survey remained open through October 2019 and queried for; (1) the ability of students to self report SGM status during admissions and enrollment; and (2) availability of SGM specific resources and support services for students. Chi square analysis and the test for equality of proportions were performed. RESULTS: Seventy five of 180 (41.7%) programs responded to the survey; 74 provided at least partial data. Of the 75 respondent schools, 55 (73.3%) allowed applicants to self report a gender identity other than male or female, with 49 (87.5%) of those being allopathic schools compared with 6 (31.6%) osteopathic schools. Similarly, 15 (20.0%) allowed applicants to report sexual orientation, with 14 (25.5%) of those being allopathic schools compared with one (5.3%) osteopathic school. Fifty four of 74 (73.0%) programs allowed matriculants to self report a gender identity other than male or female; 11 of 74 (14.7%) allowed matriculants to report sexual orientation. CONCLUSIONS: Demographics collection practices among American medical education programs that responded to our survey indicated that they undervalued sexual orientation and gender identity, with osteopathic programs being less likely than allopathic programs to report inclusive best practices in several areas. American medical education programs, and their supervising bodies, must update their practices with respect to the collection of sexual orientation and gender identity demographics as part of a holistic effort to address SGM health disparities.

Previous Methicillin-Resistant Staphylococcus aureus Infection Independent of Body Site Increases Odds of Surgical Site Infection after Ventral Hernia Repair.

BACKGROUND: Methicillin-resistant Staphylococcus aureus infections can be difficult to manage in ventral hernia repair (VHR). We aimed to determine whether a history of preoperative MRSA infection, regardless of site, confers increased odds of 30-day surgical site infection (SSI) after VHR. STUDY DESIGN: A retrospective cohort study of patients undergoing VHR with class I to III wounds between 2005 and 2012 was performed using Vanderbilt University Medical Center's Perioperative Data Warehouse. Preoperative MRSA status, site of infection, and 30-day SSI were determined. Univariate and multivariate analyses adjusting for confounding factors were performed to determine whether a history of MRSA infection was independently associated with SSIs. RESULTS: A total of 768 VHR patients met inclusion criteria, of which 46% were women. There were 54 (7%) preoperative MRSA infections (MRSA positive); 15 (28%) soft tissue, 9 (17%) bloodstream, 4 (7%) pulmonary, 3 (6%) urinary, and 5 (9%) other. Overall SSI rate was 10% (n = 80), SSI rate in the MRSA-positive group was 33% (n = 18), compared with 9% (n = 62) in controls (p < 0.001). Multivariate analysis demonstrated that a history of MRSA infection significantly increased odds of 30-day SSI after VHR by 2.3 times (95% CI, 1.1-4.8; p = 0.035). Other factors associated with postoperative SSI were performance of myofascial release, increasing BMI, length of operation, open repair, and clean-contaminated wound classification. CONCLUSIONS: A history of site-independent MRSA infection confers significantly increased odds of 30-day SSI after VHR. Additional investigation is needed to determine perioperative treatment regimens that might decrease odds of SSI in VHR, and optimal prosthetic types and techniques for this population.

Religiously affiliated intensive care unit patients receive more aggressive end-of-life care.

BACKGROUND: Previous studies among cancer patients have demonstrated that religious patients receive more aggressive end-of-life (EOL) care. We sought to examine the effect of religious affiliation on EOL care in the intensive care unit (ICU) setting. MATERIALS AND METHODS: We conducted a retrospective review of all patients admitted to any adult ICU at a tertiary academic center in 2010 requiring at least 2 d of mechanical ventilation. EOL patients were those who died within 30 d of admission. Hospital charges, ventilator days, hospital days, and days until death were used as proxies for intensity of care among the EOL patients. Multivariate analysis using multiple linear regression, zero-truncated negative binomial regression, and Cox proportional hazard model were used. RESULTS: A total of 2013 patients met inclusion criteria; of which, 1355 (67%) affirmed a religious affiliation. The EOL group had 334 patients, with 235 (70%) affirming a religious affiliation. The affiliated and nonaffiliated patients had similar levels of acuity. Controlling for demographic and medical confounders, religiously affiliated patients in the EOL group incurred 23% (P = 0.030) more hospital charges, 25% (P = 0.035) more ventilator days, 23% (P = 0.045) more hospital days, and 30% (P = 0.036) longer time until death than their nonaffiliated counterparts. Among all included patients, survival did not differ significantly among affiliated and nonaffiliated patients (log-rank test P = 0.317), neither was religious affiliation associated with a difference in survival on multivariate analysis (hazard ratio of death for religious versus nonreligious patients 0.95, P = 0.542). CONCLUSIONS: Compared with nonaffiliated patients, religiously affiliated patients receive more aggressive EOL care in the ICU. However, this high-intensity care does not translate into any significant difference in survival.