ABSTRACT
INTRODUCTION: Older adults are at high risk of adverse health outcomes in the post-emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta-analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self-care, routine follow-up, and return precautions. METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers sourced evidence from databases including Medline (PubMed), EMBASE, Web of Science, CINAHL, and Google Scholar (for gray literature). Publications or preprints appearing before April 2024 were included if they focused on geriatric ED discharge instructions and reported a proportion of patients with comprehension of at least one of five predefined discharge components. Meta-analysis of eligible studies for each component was executed using random-effects modeling to describe the proportion of geriatric ED cases understanding the discharge instructions; where appropriate we calculated pooled estimates, reported as percentages with 95% confidence interval (CI). RESULTS: Of initial records returned (N = 2898), exclusions based on title or abstract assessment left 51 studies for full-text review; of these, seven constituted the study set. Acceptable heterogeneity and absence of indication of publication bias supported pooled estimates for proportions comprehending instructions on medications (41%, 95% CI 31%-50%, I2 = 43%), self-care (81%, 95% CI 76%-85%, I2 = 43%), and routine follow-up (76%, 95% CI 72%-79%, I2 = 25%). Key findings included marked heterogeneity with respect to comprehending two discharge parameters: diagnosis (I2 = 73%) and return precautions (I2 = 95%). CONCLUSIONS: Older patients discharged from the ED had greater comprehension of self-care and follow-up instructions than about their medications. These findings suggest that medication instructions may be a priority domain for future interventions.
ABSTRACT
Socioeconomic disparities remain prevalent among those who undergo breast reconstruction. At our institution, patients must meet certain criteria to become eligible for breast reconstruction. The purpose of this study was to determine the impact of socioeconomic factors on breast reconstruction eligibility, enrollment, choice, and completion at our large safety-net institution. Methods: A retrospective chart review of patients who underwent partial or total mastectomy at a large safety-net hospital from 2016 to 2019 was completed. Surgical and demographic data were compared across varying socioeconomic factors. Results: A total of 645 patients were included in the study. More patients of a racial minority had government-based insurance than White patients (89% versus 81%; P = 0.01). Those with government-based insurance had higher average hemoglobin A1c values (6.26 versus 6.0; P = 0.03), proportion of American Society of Anesthesiologists scores greater than III (46% versus 40%; P = 0.01), and smokers (23% versus 9%; P = 0.02) than those with private insurance. Diabetic patients, patients with an American Society of Anesthesiologists greater than III, and active smokers were significantly less likely to receive a plastic surgery consult. Patients with government-based insurance underwent immediate tissue expander placement at mastectomy at rates lower than those with private insurance (57% versus 69%; P = 0.01). Conclusions: Barriers remain for socioeconomically disadvantaged patients to be eligible for, undergo, and complete breast reconstruction. Obesity, diabetes, smoking, and poor overall health were identified as the main barriers and were associated with racial minorities, government-based insurance, and lower incomes. Concerted effort through multidisciplinary teams is needed to maximize eligibility of socioeconomically disadvantaged breast cancer patients for reconstruction.
ABSTRACT
BACKGROUND: The type of content that influences plastic and reconstructive surgery (PRS) residency program selection and attracts applicants is continually changing and not clearly understood. Further, the COVID-19 pandemic has had a major yet undetermined impact on residency selection. OBJECTIVES: The purpose of this study was to determine the type of PRS social media (SM) content that drives prospective applicants' interest in a residency program, and the degree of SM influence on applicants, especially in the context of COVID-19. METHODS: Prospective PRS residency applicants were surveyed anonymously. RESULTS: An average of 60% of respondents reported that PRS SM content influenced their perception of a program. Fifty-eight percent reported that resident lifestyle content made them more interested in a program. Separately, 32% reported that resident lifestyle content influenced them to rank a program higher. Seventy-two percent of respondents claimed SM content did not make them lose interest in a program. Rarely posting, outdated content, and lack of engagement were cited as factors for loss of interest in a program. A majority of respondents (53%) reported wanting to see more resident life and culture content on SM. Of the existing PRS SM content, respondents were most interested in resident lifestyle, followed by clinical and program-specific content. CONCLUSIONS: The COVID-19 pandemic amplified the importance of SM PRS residency selection. Resident lifestyle content was consistently indicated as more likely to make respondents gain interest in a program, rank a program higher, and as the most desired content. PRS programs will benefit from highlighting resident camaraderie, quality of life, hobbies, and lifestyle to attract applicants.