A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship.

BACKGROUND: This study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature. METHODS: Articles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012-2022) were reviewed and analyzed for first and senior authors' race and ethnicity, publication year, and citation count. RESULTS: A total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 â€‹%) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 â€‹% of senior authors were White, 29.9 â€‹% Asian, 4.6 â€‹% Hispanic, and 1.0 â€‹% Black. First authors were 59.5 â€‹% White, 32.8 â€‹% Asian, 5.2 â€‹% Hispanic, and 2.6 â€‹% Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 â€‹% CI [3.5-14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 â€‹%), while Microsurgery had the highest percentage of URiM senior authors (8.7 â€‹%). CONCLUSIONS: URiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.

Orthotic Helmet Therapy for Deformational Plagiocephaly: Stratifying Outcomes by Insurance.

OBJECTIVE: Deformational Plagiocephaly (DP) is commonly treated with cranial orthosis, or helmet therapy. A large, national study on the impact of insurance status on helmet outcomes is lacking. We assessed treatment outcomes for helmet therapy based on insurance status. DESIGN: This was a retrospective data analysis of patients referred to Cranial Technologies, Inc for helmet therapy between 2014-2020 across 21 states. PATIENTS, PARTICIPANTS: There were a total of 211,417 patients referred for helmeting, of whom 141,513 received helmet therapy. MAIN OUTCOMES MEASURES: Multivariate regression was used to assess the relationship of insurance status with post-treatment residual flattening, measured by cephalic index (CI) and cranial vault asymmetry index (CVAI), and treating provider rating of success. RESULTS: Patients with Medicaid were more likely to complete treatment with residual flattening measured by CI and CVAI when compared to patients with private insurance (OR: 1.58, CI: 1.51-1.65, p < 0.001 and OR: 1.21, CI: 1.15-1.28, p < 0.001, respectively). Providers of patients with Medicaid were more likely to give a low rating of success following treatment (OR: 3.25, CI: 2.70-3.92, p < 0.001). CONCLUSIONS: Our study investigating the impact of insurance status on helmet therapy across 21 states found that patients with Medicaid were more likely to experience residual flattening and have lower provider-rated outcomes compared to those with commercial insurance. Given significant caregiver burden posed by helmet therapy, which requires frequent visits and consistent helmet use, caregivers of patients with Medicaid may require greater support to reduce outcome disparities observed here.

Predictive Factors of Outcomes in Helmet Therapy for Deformational Plagiocephaly and Brachycephaly.

Deformational plagiocephaly and brachycephaly, or abnormal flattening of the infant skull due to external forces, are often managed with orthotic helmet therapy. Although helmet therapy is widely used, the factors that predict poor outcomes are not well characterized. In this study of over 140,000 patients who received helmet therapy, older age and greater severity at presentation, and noncompliance with treatment were each independently associated with worse craniometric and provider-reported outcomes. Each additional point of cranial vault asymmetry index or cephalic index at a presentation is associated with an increased likelihood of residual brachycephaly at completion [odds ratio (OR): 1.067; 95% Cl: 1.058-1.075; P <0.0001 and OR: 2.043; 95% CI: 2.021-2.065; P <0.0001, respectively], whereas each additional point of cranial vault asymmetry index at a presentation associated with increased likelihood of residual asymmetry at completion (OR: 2.148; 95% Cl: 2.118-2.179; P <0.0001). Patients were more likely to have residual brachycephaly or asymmetry with increasing age at treatment initiation (OR: 1.562; 95% CI: 1.524-1.600; P <0.0001 and OR: 1.673; 95% Cl: 1.634-1.713; P <0.0001, respectively, for each additional month of age at initiation). These results highlight a need for prompt referral for helmeting, especially in cases with severe features or when patients present late to care. Potentially modifiable factors are age at helmeting and compliance with treatment protocols, and consideration of these factors may be important for achieving success in some cases.

Words Matter: Stylistic Writing Strategies for Racial Health Equity in Academic Medicine.

Many racialized health inequities in the USA have been known for decades. However, academic medicine, individual clinicians, and larger healthcare systems have not yet supported action towards sufficient and meaningful solutions, as evidenced by the persistence of racialized health inequities over time. Recently, academic medicine is increasing efforts to unequivocally identify systemic racism as a public health crisis because it drives health inequity to racially minoritized groups. A health equity emphasis in clinical education, practice, and research differs from a disparities approach because it seeks to dismantle the systems of racism that create inequitable health outcomes in the first place. Therefore, medical education, practice, and research are slowly transitioning from a lens of health disparities to one of health equity. In order to support this transition, authors and journals must restructure the depiction of health inequities caused by racism. Based upon the principles of the social medicine pioneer, Dr. Rudolph Virchow, the knowledge conveyed by scientific and medical academic writing must clearly name the drivers of social disease - which is generalized to the American landscape of racialized health inequity for the purposes of this manuscript - in order to inform action capable of stopping socially mediated health inequity. Yet, the language and construction of health disparities literature perpetuates colorblind and aversive racism by stylistically omitting the driver of inequity quite frequently, which renders such knowledge unable to support action. In this article, three academicians across the spectrum of social justice education identify and classify common writing styles of health disparities research in order to demonstrate how a writing style of racial health equity better supports true progress towards equity.