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Surgical inequality

Claudia Mueller, Robert Wright, Sabine Girod
BACKGROUND: Terms such as "glass ceiling" and "sticky floor" are still commonly used to describe women's role in academic surgery. Despite continued efforts to address disparities between men and women in the field, gender inequalities persist. METHODS: In this investigation we highlight gender differences in published surgical literature by both quantity and impact. Websites for departments of surgery of three academic centers were reviewed to assess the bibliometrics of publications by gender over a two-week period...
February 14, 2017: BMC Surgery
Grace Joshy, Kay Soga, Rosemary J Korda, Manish I Patel, Emily Banks
BACKGROUND: Transurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP. METHODS: A prospective study of men aged ≥45 years participating in the 45 and Up Study, a large Australian cohort study, without prior prostatectomy and/or bowel/genital/urinary-tract cancer; questionnaire data were linked to hospitalisations and deaths...
February 8, 2017: BMJ Open
Alison Heller, Anita Hannig
Obstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated one million women in the global south. In the course of media and donor coverage on this condition, fistula sufferers have been branded as 'child brides' who, following the onset of their incontinence, become social pariahs and eventually find physical and social redemption through surgical repair. This narrative framing pits the violence of 'culture' against the potency of biomedical salvation. Based on over two years of ethnographic research at fistula repair centres in Niger and Ethiopia, this paper challenges this narrative and argues that most women with obstetric fistula remain embedded in social relations, receive continued familial support, and, unexpectedly, experience ambiguous surgical outcomes...
January 31, 2017: Anthropology & Medicine
Joseph Mendlovic, Ethel-Sherry Gordon, Ziona Haklai, Jill Meron, Arnon Afek
BACKGROUND: Medical practice variation refers to differences in health service utilization among regions in the same country. It is used as a tool for studying health inequities. In 2011, the OECD launched a Medical Practice Variation Project which examines regional differences within countries and explores the sources of the inter-regional differences. The aim of this study is to examine the patterns and trends in geographic variation for selected health services in Israel. METHODS: The analysis is based on data from the National Hospital Discharges Database (NHDD) of the Israeli Ministry of Health...
2017: Israel Journal of Health Policy Research
Hyo Seon Jeong, Kun Sei Lee, Hyun Keun Chee, Hye Mi Ahn, Sung Bo Sim
BACKGROUND: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. METHODS: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities...
December 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Mustafa Celiktas, Ozkan Kose, Adil Turan, Ferhat Guler, Cagri Ors, Emre Togrul
OBJECTIVE: The purpose of this retrospective study is to report the clinical and radiological outcome of total hip arthroplasty in patients with previous hip arthrodesis. PATIENTS AND METHODS: We retrospectively reviewed 28 (40 hips) prospectively followed patients in whom ankylosed hips were converted to total hip arthroplasty (THA) between 2010 and 2014 in our institution. The average age at the time of the conversion operation was 40.8 ± 9.8 years (range 24-62)...
January 2017: Archives of Orthopaedic and Trauma Surgery
C C Chang, C C Liao, T L Chen
"Big data", characterized by 'volume', 'velocity', 'variety', and 'veracity', being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias...
September 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
Margijske H G van Roest, Maaike A van der Aa, Lydia G M van der Geest, Koert P de Jong
The influence of socioeconomic inequalities in pancreatic cancer patients and especially its effect in patients who had a resection is not known. Hospital type in which resection is performed might also influence outcome. Patients diagnosed with pancreatic cancer from 1989 to 2011 (n = 34,757) were selected from the population-based Netherlands Cancer Registry. Postal code was used to determine SES. Multivariable survival analyses using Cox regression were conducted to discriminate independent risk factors for death...
2016: PloS One
Hassan M K Ghomrawi, Yuo-Yu Lee, Christina Herrero, Amethia Joseph, Douglas Padgett, Geoffrey Westrich, Michael Parks, Stephen Lyman
BACKGROUND: The University of California, Los Angeles (UCLA) activity scale and the Lower Extremity Activity Scale (LEAS) are the two most-widely used and rigorously developed scales for assessing activity level in patients having joint replacement. However, the two scales are not convertible, and the level of correlation between the two is not clear. Creating a crosswalk between these scales; that is, a concordance table to convert scores from one scale to the other and vice versa, will help compare results from existing studies using either scale, and pool those results for meta-analyses...
February 2017: Clinical Orthopaedics and related Research
Hamlet A Peterson, William J Shaughnessy, Anthony A Stans
Premature partial physeal arrest without the formation of an osseous bar - physeal bar equivalent (PBE) - is uncommon. Four children with a PBE had an infection near the distal femoral physis before the age of 11 months. Some growth was achieved after resection of the PBE in each case. Of two cases diagnosed and treated early, one required only contralateral physeal arrests to achieve limb-length equality at maturity. The other, currently 8 years and 4 months old, has a 1.1-cm limb-length discrepancy 6 years after PBE resection and will require observation until maturity...
September 29, 2016: Journal of Pediatric Orthopedics. Part B
P Niclas Broer, Hillary E Jenny, Joshua S Ng-Kamstra, Sabrina Juran
In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment...
May 2016: World Journal of Plastic Surgery
Marina R Makarov, Samuel H Dunn, Dustin E Singer, Karl E Rathjen, Brandon A Ramo, Chukwudi K Chukwunyerenwa, John G Birch
BACKGROUND: Epiphysiodesis is well-established surgical treatment for the management of leg length discrepancy (LLD) in children; however, a variety of complications may occur. This study evaluates the nature, rate, and potential risk factors of complications associated with epiphysiodesis in a large patient population treated in 1 institution. METHODS: We evaluated the medical and radiographic records of 863 children who had lower extremity epiphysiodesis to manage LLD between 1980 and 2011...
August 19, 2016: Journal of Pediatric Orthopedics
Matthew Beard, Joseph F Orlando, Saravana Kumar
INTRODUCTION: There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions...
August 17, 2016: Journal of Telemedicine and Telecare
Peter D Baade, Paramita Dasgupta, Philippa H Youl, Christopher Pyke, Joanne F Aitken
The uptake of breast conserving surgery (BCS) for early stage breast cancer varies by where women live. We investigate whether these geographical patterns have changed over time using population-based data linkage between cancer registry records and hospital inpatient episodes. The study cohort consisted of 11,631 women aged 20 years and over diagnosed with a single primary invasive localised breast cancer between 1997 and 2011 in Queensland, Australia who underwent either BCS (n = 9223, 79%) or mastectomy (n = 2408, 21%)...
2016: International Journal of Environmental Research and Public Health
S Clough, Z Shehabi, C Morgan
Background There remains significant inequality in health and healthcare in people with learning disabilities (LD). A lack of coordination and the episodic nature of care provision are contributory factors. Recognising the need to improve outcomes for this group, we evaluate a multi-disciplinary team (MDT) approach to care whereby additional medical procedures are carried out under the same episode of general anaesthesia (GA) as dental treatment for people with severe LD. This is the first published evaluation of its kind in the UK...
May 27, 2016: British Dental Journal
Ruoran Li, Rhian Daniel, Bernard Rachet
Substantial socioeconomic inequalities in breast cancer survival persist in England, possibly due to more advanced cancer at diagnosis and differential access to treatment. We aim to disentangle the contributions of differential stage at diagnosis and differential treatment to the socioeconomic inequalities in cancer survival. Information on 36,793 women diagnosed with breast cancer during 2000-2007 was routinely collected by an English population-based cancer registry. Deprivation was determined for each patient according to her area of residence at the time of diagnosis...
June 2016: European Journal of Epidemiology
Mohammed M Ahmed, Thomas J Otto, Berton R Moed
BACKGROUND: Limited-incision total hip arthroplasty (THA) preserves hip abductors, posterior capsule, and external rotators potentially diminishing dislocation risk. However, potential complications also exist, such as component malposition. Specific implants have been manufactured that enhance compatibility with this technique, while preserving metaphyseal bone; however, little data exists documenting early complications and component position. The purpose was to evaluate primary THA using a curved, bone-sparing stem inserted through the anterior approach with respect to component alignment and early complications...
April 22, 2016: Journal of Orthopaedic Surgery and Research
Bruce Rosen, Ruth Waitzberg, Sherry Merkur
Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient...
2015: Health Systems in Transition
Yao Cyril Kudjawu, Gilles Chatellier, Elsa Decool, Florence de Maria, Nathalie Beltzer, Isabelle Grémy, Guy Meyer, Daniel Eilstein
BACKGROUND: Time-to-treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays. OBJECTIVE: To describe time delays in each phase of lung cancer treatment after bronchoscopy. METHOD: Using the international classification of diseases and medical procedures codes, from national hospital discharge database we selected patients newly diagnosed for Lung cancer in 2009-2010 who had undergone treatment...
May 2016: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
A J Kuryba, N A Scott, J Hill, J H van der Meulen, K Walker
AIM: The rate of ileostomy reversal was estimated in patients undergoing an elective anterior resection for rectal cancer and factors associated with reversal were identified. METHOD: The records of 4879 rectal patients who had an ileostomy created during anterior resection between 2009 and 2012 were identified in the National Bowel Cancer Audit database and linked to administrative records of the Hospital Episode Statistics. Patients were followed from surgery...
June 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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