Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis.

Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.

Facilitators and barriers to learning faced by female students with disability in higher education.

This study was aimed to investigate the learning experiences' facilitators and barriers that is encountered by the physically disabled female students during their higher education. Twenty semi-structured interviews were conducted with female students with physical disabilities aged between 19 and 33 years. Interviews were transcribed, confirmed, and analyzed after being recorded. The average age of the sample was 22.15 ± 3.48 years and one-fourth of the participants' disability was due to cerebral palsy and 35% participants used wheelchairs. All the factors promoted inclusive education and equal opportunities for both disabled and nondisabled students. This study reveals that in order to improve the learning experiences of students with disabilities (SwD) and to give them more opportunities for success, it is important to consider all the barriers discussed in this study. It can be concluded that high effort is required to transform the higher educational institutions to be more accommodating for students with disabilities.

Levels of Awareness Regarding Pediatric Eye Diseases Among Saudi Parents From the Hail and Al-Qassim Regions, Saudi Arabia.

BACKGROUND: The importance of children's eye health cannot be overstated as it has significant implications for personal life, education, career, health, financial status, and overall satisfaction. This study aims to assess the awareness of parents regarding pediatric eye diseases to identify potential gaps in knowledge. By understanding parental awareness, we can develop targeted educational initiatives to promote early detection, timely intervention, and overall improved eye health in children. This research seeks to contribute valuable insights for enhancing preventive measures and fostering healthier eyesight in younger generations. METHODOLOGY:  A descriptive cross-sectional study was conducted in the Hail and Al-Qassim regions, of Saudi Arabia. Parents with children aged less than 15 years were included. Targeted parents were selected consecutively using an online questionnaire for data collection. Data included parents' data, children's eye diseases, and parents' knowledge, practice, and attitude toward pediatric eye diseases.  Results: A total of 618 eligible parents were included, 429 (69.4%) from Al-Qassim and 189 (30.6%) from Hail. Parents' ages ranged from 20 to 59 years with a mean age of 35.4 ± 11.5 years. A total of 510 (82.5%) respondents were females. A total of 442 (71.5%) of the study parents had poor knowledge about their pediatric eye problems, 154 (24.9%) had a good knowledge level, and only 22 (3.6%) had excellent knowledge. As for their practice, 458 (74.1%) of the parents arranged for their children to undergo an eye or visual test; 254 (55.5%) did so when the child was six to ten years of age. CONCLUSION:  The current study showed poor awareness levels about pediatric eye diseases among parents, mainly regarding cataracts and glaucoma. On the other hand, parents demonstrated a high level of engagement in visually assessing their children. The primary hindrance to conducting assessments was the absence of symptoms and signs or active complaints, leading to a lack of proactive seeking of visual evaluations.

Transparency in Artificial Intelligence Reporting in Ophthalmology-A Scoping Review.

Topic: This scoping review summarizes artificial intelligence (AI) reporting in ophthalmology literature in respect to model development and validation. We characterize the state of transparency in reporting of studies prospectively validating models for disease classification. Clinical Relevance: Understanding what elements authors currently describe regarding their AI models may aid in the future standardization of reporting. This review highlights the need for transparency to facilitate the critical appraisal of models prior to clinical implementation, to minimize bias and inappropriate use. Transparent reporting can improve effective and equitable use in clinical settings. Methods: Eligible articles (as of January 2022) from PubMed, Embase, Web of Science, and CINAHL were independently screened by 2 reviewers. All observational and clinical trial studies evaluating the performance of an AI model for disease classification of ophthalmic conditions were included. Studies were evaluated for reporting of parameters derived from reporting guidelines (CONSORT-AI, MI-CLAIM) and our previously published editorial on model cards. The reporting of these factors, which included basic model and dataset details (source, demographics), and prospective validation outcomes, were summarized. Results: Thirty-seven prospective validation studies were included in the scoping review. Eleven additional associated training and/or retrospective validation studies were included if this information could not be determined from the primary articles. These 37 studies validated 27 unique AI models; multiple studies evaluated the same algorithms (EyeArt, IDx-DR, and Medios AI). Details of model development were variably reported; 18 of 27 models described training dataset annotation and 10 of 27 studies reported training data distribution. Demographic information of training data was rarely reported; 7 of the 27 unique models reported age and gender and only 2 reported race and/or ethnicity. At the level of prospective clinical validation, age and gender of populations was more consistently reported (29 and 28 of 37 studies, respectively), but only 9 studies reported race and/or ethnicity data. Scope of use was difficult to discern for the majority of models. Fifteen studies did not state or imply primary users. Conclusion: Our scoping review demonstrates variable reporting of information related to both model development and validation. The intention of our study was not to assess the quality of the factors we examined, but to characterize what information is, and is not, regularly reported. Our results suggest the need for greater transparency in the reporting of information necessary to determine the appropriateness and fairness of these tools prior to clinical use. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Targeting liver and adipose tissue in obese mice: Effects of a N-acylethanolamine mixture on insulin resistance and adipocyte reprogramming.

N-acylethanolamines (NAEs) are endogenous lipid-signalling molecules involved in inflammation and energy metabolism. The potential pharmacological effect of NAE association in managing inflammation-based metabolic disorders is unexplored. To date, targeting liver-adipose axis can be considered a therapeutic approach for the treatment of obesity and related dysfunctions. Here, we investigated the metabolic effect of OLALIAMID® (OLA), an olive oil-derived NAE mixture, in limiting liver and adipose tissue (AT) dysfunction of high-fat diet (HFD)-fed mice. OLA reduced body weight and fat mass in obese mice, decreasing insulin resistance (IR), as shown by homeostasis model assessment index, and leptin/adiponectin ratio, a marker of adipocyte dysfunction. OLA improved serum lipid and hepatic profile and the immune/inflammatory pattern of metainflammation. In liver of HFD mice, OLA treatment counteracted glucose and lipid dysmetabolism, restoring insulin signalling (phosphorylation of AKT and AMPK), and reducing mRNAs of key markers of fatty acid accumulation. Furthermore, OLA positively affected AT function deeply altered by HFD by reprogramming of genes involved in thermogenesis of interscapular brown AT (iBAT) and subcutaneous white AT (scWAT), and inducing the beigeing of scWAT. Notably, the NAE mixture reduced inflammation in iBAT and promoted M1-to-M2 macrophage shift in scWAT of obese mice. The tissue and systemic anti-inflammatory effects of OLA and the increased expression of glucose transporter 4 in scWAT contributed to the improvement of gluco-lipid toxicity and insulin sensitivity. In conclusion, we demonstrated that this olive oil-derived NAE mixture is a valid nutritional strategy to counteract IR and obesity acting on liver-AT crosstalk, restoring both hepatic and AT function and metabolism.

A Comparison of Knowledge, Attitude, and Practice (KAP) Between Private- and Government-Sector Pharmacists With Regard to Psychotropic Medications in Riyadh City.

Background Pharmacists play a significant role in patient care, and many patients consider them to be their primary source of information regarding medications. Therefore, pharmacists must have an adequate level of knowledge about psychotropic medications. This study aims to assess and compare the levels of knowledge, attitudes, and practices regarding psychotropic medications in governmental and private-sector pharmacists in Riyadh, Saudi Arabia. Methods An observational cross-sectional study was conducted, which included 355 pharmacists (governmental and private sector pharmacists). Each pharmacist was interviewed and asked to answer a structured questionnaire that consisted of four sections: demographic data, knowledge, attitude, and practice regarding psychotropic medications. Results Our findings indicate that the overall knowledge regarding psychotropic medications among private and government-sector pharmacists is insufficient. While 282 (79.4%) had insufficient knowledge, 20.6% of pharmacists had adequate knowledge regarding psychotropic medications, and good knowledge was detected among 29.1% of government-sector pharmacists compared to 18.1% of private-sector pharmacists (P = .033). Our results also revealed that 31.5% of the pharmacists felt comfortable with their knowledge of psychotropic agents. In addition, 18.9% of the pharmacists reported that they received adequate training on psychotropic medications (12.7% of the governmental group versus 20.7% of the private-sector group; P =.048). Conclusion The insufficient knowledge among pharmacists regarding psychotropic medications highlights the importance of providing more training programs and educational courses to improve pharmacists' knowledge about psychotropic medications in Saudi Arabia.

Liraglutide Attenuates Diabetic Cardiomyopathy via the ILK/PI3K/AKT/PTEN Signaling Pathway in Rats with Streptozotocin-Induced Type 2 Diabetes Mellitus.

One of the possible candidates for the treatment of diabetic cardiomyopathy is liraglutide, a glucagon-like peptide-1 receptor (GLP1R) agonist. In this study, the impacts of liraglutide on the integrin-linked kinase (ILK)-related PI3K/AKT axis in rats with type 2 diabetes induced via streptozotocin were examined. Twenty-four Wistar albino rats were distributed in four different groups, and a high-fat diet and streptozotocin were used to induce type 2 in two groups. Rats in the untreated control groups were administered 0.9% NaCl solution over a 6-week period, and those in the treatment groups were administered 0.9% NaCl for 3 weeks, followed by subcutaneous injection of liraglutide (150 µg/kg) for an additional 3 weeks. In the liraglutide-treated diabetic group, the heart-to-body weight ratio was significantly reduced, levels of cardiac biomarkers, troponin I and creatine-kinase-MB, were improved; activities of antioxidant enzymes, glutathione peroxidase and superoxide dismutase, were increased; and levels of malondialdehyde were decreased. Western blotting and immunohistochemical studies revealed increased levels of ILK, P-PI3K, P-AKT, and BCL2, as well as those of caspase 3, BAX, and P-PTEN, indicating mitigation of cardiomyocyte apoptosis. Our results show that liraglutide, by targeting GLP1Rs, enhances the expression of proteins in the ILK/PI3K/AKT/PTEN pathway and thereby exerts its cardioprotective effects in rats with DCM.

Examining the Quality of Life and Discrimination Impact on Parents of Children With Autism Spectrum Disorder in Aseer Region, Saudi Arabia: A WHO-QOL Survey.

Background Autism spectrum disorder (ASD) is a neurodevelopmental disease marked by social and repetitive or restricted behaviors, as well as communication difficulty. Objectives This survey aimed to assess the quality of life (QoL) of parents with ASDs in the Aseer region of Saudi Arabia using the brief form of the World Health Organization (WHO-QOL) questionnaire. Furthermore, we sought to measure the severity of discrimination experienced by parents of children with ASDs and their impact on QoL. Methodology Using a Google form, a cross-sectional study was carried out online between March and April 2023. The patient records from four different regions of Saudi Arabia were used to recruit study participants. The survey was distributed through well-known social media channels (Instagram, Telegram, Facebook). Results A total of 99 parents were included in this study. The Southern region accounted for the bulk of participants (81.8%, n=81), nearly three-fourths of the children were boys (70.7%), mothers were more common among respondents (65.7%, n=65) than fathers, 66.7% of respondents reported being married, and 78.8% fall into the middle economic class category. The main source of information among the studied population was the Internet (39.4%, n=39), followed by relatives (23.0%, n=23), physicians (8.1%, n=9), and finally books (4%, n=4). The mean scores for the various domains are as follows: physical (58.48 ± 13.84), psychological (62.04 ± 18.08), social relations (61.20 ± 23.24), environment (24.12 ± 14.62), general QoL (72.93 ± 4.30), and general health (73.94 ± 4.63). Nearly half (46.5%) of parents have encountered stigma or discrimination toward their child or family. Individuals who reported experiencing discrimination exhibited significantly lower mean scores in multiple QoL domains than those who did not report discrimination for physical (54.11, ± 14.36vs, 62.26±12.28, p=0.003), psychological (55.80 ± 20.33 vs 67.45 ± 13.94, p=0.002), and social relations (55.43± 24.17 vs 66.20 ± 21.40, p=0.022). Multivariate analysis revealed that discrimination was the only significant predictor of QoL (p < 0.001). Conclusions The QoL of parents having a child with autism is low, moreover, the coincidence of discrimination and stigma significantly lowered QoL.

Assessment of Knowledge and Awareness Regarding Coronary Artery Disease Risk Factors Among the Saudi Arabian Population: A Cross-Sectional Study.

Background Coronary artery disease constitutes a critical public health issue due to its widespread prevalence, placing a significant burden on healthcare systems and posing considerable challenges to the well-being of the population. Limited recent data on coronary artery disease awareness in Saudi Arabia underscores the need for updated information to inform preventive programs. Methodology A cross-sectional questionnaire survey was conducted from August 2021 to October 2022, targeting individuals aged 18 and above in Saudi Arabia. The online survey collected demographic data and assessed knowledge and awareness of coronary artery disease risk factors. A scoring system categorized participants as possessing high, medium, or low levels of awareness and knowledge. Data analysis involved a multivariable regression approach to explore associations. Results The study included a total of 1,409 participants, representing a diverse demographic distribution. Knowledge scores revealed 70.3% high, 27.4% medium, and 2.3% low levels, while awareness scores showed 59.9% high, 32.9% medium, and 7.2% low levels. The study identified significant associations between knowledge scores and gender (p = 0.003) and age (p = 0.001). Similarly, awareness scores demonstrated associations with gender (p = 0.001), age (p = 0.001), marital status (p = 0.003), educational qualification (p = 0.036), and occupation (p = 0.001). These findings underscore the multifaceted nature of factors influencing awareness and knowledge levels. Conclusions The study highlights a strong foundation of knowledge and awareness among the Saudi population regarding coronary artery disease risk factors, indicating a positive starting point for preventive initiatives. However, targeted programs addressing regional variations and enhancing knowledge are recommended to improve early detection and treatment of coronary artery disease risk factors.

Exploring Integrative Approaches: Insights Into Complementary Medicine Practices Among Breast Cancer Survivors in Saudi Arabia.

OBJECTIVES: Complementary and integrative medicine (CAM) is a prevalent approach often used with conventional medical practices The study aims to understand the factors influencing breast cancer (BC) survivors' decisions regarding CAM therapy and the drivers behind their use. SETTING: This research was conducted at an academic hospital in Saudi Arabia. The study used cross-sectional research with a questionnaire. Participants were enrolled in the study through BC survivors' groups on WhatsApp. Individuals who were actively following up at the clinic were also interviewed. Informed consent was obtained. RESULTS: The study surveyed 211 BC survivors, aged 34-49 (50.2%), who had undergone surgery (93.4%), hormonal therapy (66.4%), and chemotherapy (87.7%). Less than half (44.5%) had chronic conditions such as diabetes and hypertension. CAM users were 43.6%. The most used CAM modalities were Zamzam water, honey, and water read-upon Quran. A significant motivator for CAM use was to boost the immune system. More than half of patients used less than 100 SAR per month on CAM modalities. Exactly 80.4% of CAM users perceived benefits from CAM use. Predictors of CAM use included higher family monthly income, radiation therapy, and being diagnosed from 1 to 5 years. BC survivors without medical conditions after diagnosis were less likely to use CAM. CONCLUSION: The study highlights the prevalence, predictive factors, motivations, and perceived benefits of CAM use among BC survivors in Saudi Arabia, emphasizing the need for understanding and integration into cancer care plans and the need for further research on CAM safety and efficacy.

Rates of Laser Trabeculoplasty by Ophthalmologists and Optometrists: A Comparative Analysis of the CMS Medicare Public Use File.

Purpose: To provide a comparative analysis of rates of laser trabeculoplasty (LTP) among eye care providers in the USA. Methods: This retrospective cohort analysis utilized the Centers for Medicare and Medicaid Services (CMS) Public Use File (PUF), 2015-2018. We used CPT code 65855 to select eye care providers who performed LTP in three key US states (KY, LA, and OK). Primary outcomes were eye provider differences in provider count, service count, unique beneficiary count, and Medicare-allowed payments. Asymptotic two-sided chi-squared tests were executed. Statistical significance was achieved at p<0.05. Results: The sum of Medicare-allowed payments for LTP in all three states in 2018 was roughly 26% lower than in 2015. The proportion of Medicare-allowed payments furnished by optometrists increased from 11.3% to 17.9% between 2015 and 2018 (p<0.001). Relative to ophthalmologists, we observed significant increases in optometric Medicare-allowed payments in KY, LA, OK, and the all-inclusive tri-state cohort (all p<0.001). Furthermore, significant optometric increases in number of providers performing LTP (p=0.007), number of unique Medicare beneficiaries seen (p<0.001), and number of LTP services billed (p<0.001) were observed relative to ophthalmologists. Conclusion: The recent expansion of surgical authority by optometrists in key US states is creating a tangible impact on ophthalmologic and optometric practice patterns. The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.

The Level of Empathy Among Medical Students at the University of Tabuk, Saudi Arabia.

Background and objective Empathy plays an important role in patient-provider relationships. It is a key aspect of therapy, ensuring accurate diagnosis, and improving compliance and outcomes, all of which contribute to clinician satisfaction. This study aimed to assess the level of empathy among medical students at the University of Tabuk. Methods A cross-sectional study was conducted among medical students at Tabuk University. Data were collected using a self-administered online questionnaire based on the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). Results A total of 230 medical students participated in this study. The students' total empathy scores ranged between 55 and 131, with a mean of 99.05 ± 13.75. The highest item score was obtained for the question "Patients feel better when their physicians understand their feelings" (6.34 ± 0.99). Female students had a significantly (p=0.002) higher mean score (100.67 ± 13.06) than males (94.36 ± 14.70). Students from the clinical phase had a significantly higher mean total score compared to those from preclinical phases (100.26 ± 14.34 vs. 96.78 ± 12.33, p=0.043). Students choosing people-oriented specialties had significantly higher mean total scores than those selecting procedure-oriented specialties (100.59 ± 13.72 vs. 95.67 ± 14.46, p=0.033). Conclusion The degree of students' empathy with the patients at the Faculty of Medicine, University of Tabuk was found to be highest among females, students in the clinical phase, and students intending to select people-oriented specialties. These findings have implications for medical education programs, highlighting the importance of fostering empathy skills and addressing potential gender differences in empathy development.

Students' perception of the educational environment at King Saud bin Abdulaziz University for health sciences using DREEM tool.

BACKGROUND: Students' learning results are influenced by the educational environment. The best learning environment is created when students are involved in the evaluation process of their education. The purpose of this study was to evaluate students' perceptions of their learning environment at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh using the Dundee Ready Education Environment Measure (DREEM) instrument. METHODS: This observational cross-sectional study was conducted through an online questionnaire using the Arabic version of the DREEM tool. Students from six colleges at KSAU-HS Riyadh campus were asked to complete the questionnaire through emails. The study was carried out between November 2021 and April 2022. Descriptive statistics and inferential statistics were performed for DREEM as both a continuous (two-way ANOVA test) and categorical variable (Chi-squared and Monte-Carlo test). RESULTS: A total of 370 students completed the questionnaire. The overall DREEM score for the study was 125.88/200, with a standard deviation of 58.79. SSP items received the highest scores, while SAP items earned the lowest scores. The college and the academic level showed statistically significant differences in the DREEM overall score and the five subscales, whereas gender showed no significant difference. The college of pharmacy scored the highest total DREEM score (140.35 ± 27.75), and scored higher among the five subscales than both colleges of dentistry (114.13 ± 29.74) and medicine (113.87 ± 33.03). Students in their third year had the greatest overall DREEM score (132.23 ± 29.76), and scored higher in SPL, SPA and SSP compared to students in their sixth year, in which the total DREEM score was (111.65 ± 27.58). CONCLUSIONS: Students of KSAU-HS generally perceived the educational environment as having more positive than negative. The educational level and college differed significantly in the overall DREEM score and the five subscales. Junior students had better perception of the educational environment and they differed significantly in the SPL and SPA subscales. The faculty of pharmacy had higher scores in the overall DREEM and the five subsequent scales than colleges of dentistry and medicine. Further research is needed in order to optimize the educational environment by investigating different solutions.

Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening.

PRCIS: Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms. PURPOSE: To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies. PARTICIPANTS AND METHODS: From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not. RESULTS: As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P -value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months. CONCLUSIONS: Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.

The Relevance of Arterial Blood Pressure in the Management of Glaucoma Progression: A Systematic Review.

BACKGROUND: Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood. OBJECTIVES: This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients. METHODS: A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles. RESULTS: 80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h. CONCLUSIONS: We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.

Salary Negotiations: Gender Differences in Attitudes, Priorities, and Behaviors of Ophthalmologists.

PURPOSE: To investigate attitudes, priorities, and behaviors of ophthalmologists in salary negotiations. DESIGN: Cross-sectional study. METHODS: A Qualtrics survey was disseminated to U.S.-based practicing ophthalmologists between November 1, 2021 and March 31, 2022 and assessed attitudes, behaviors, and priorities surrounding salary negotiation during the respondents' first negotiation as a practicing physician and currently. Optional case-based scenarios were also included. RESULTS: Of 424 respondents, 155 (36.5%) identified as male (M) and 269 (63.3%) identified as female (F). Men were more likely to negotiate salary for their first position as an independent ophthalmologist (M 78.3%, F 68.2%; P = .04). Respondents of both genders assessed their success similarly; 85.0% of men and 75.7% of women (P = .07) felt that their negotiation was very successful or somewhat successful. Women were more likely to select "flexibility in clinic/OR schedule for personal commitments" as a priority during salary negation for their first position (M 14.8%, F 23.1%; P = .04). Women ophthalmologists reported feeling more uncomfortable (M 36.1%, F 49.1%; P = .01), intimidated (M 20.0%, F 43.5%; P < .01), and were less likely to feel well-trained (M 24.5%, F 13.0%; P < .01). Most respondents never received formal training in negotiation. CONCLUSIONS: We found significant gender differences among ophthalmologists in attitudes, priorities and behaviors surrounding salary negotiation. There were low reported levels of formal negotiation training, which appears to disadvantage women more than men. These gender disparities suggest that incorporating education about negotiation skills and career development early in training may be impactful.

Top 50 Highly Cited Publications in Facelift Surgery: A 50-Year Bibliometric Analysis Review.

INTRODUCTION: Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023). METHODS: The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed. RESULTS: The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author. CONCLUSION: Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .