Academic Affiliation (academic + affiliation)

Distribution by Scientific Domains
Medical Sciences80%

Selected Abstracts

Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States,

HEPATOLOGY, Issue 1 2010
Jessica A. Davila
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended but may not be performed. The extent and determinants of HCC surveillance are unknown. We conducted a population-based United States cohort study of patients over 65 years of age to examine use and determinants of prediagnosis surveillance in patients with HCC who were previously diagnosed with cirrhosis. Patients diagnosed with HCC during 1994-2002 were identified from the linked Surveillance, Epidemiology, and End-Results registry,Medicare databases. We identified alpha-fetoprotein (AFP) and ultrasound tests performed for HCC surveillance, and examined factors associated with surveillance. We identified 1,873 HCC patients with a prior diagnosis of cirrhosis. In the 3 years before HCC, 17% received regular surveillance and 38% received inconsistent surveillance. In a subset of 541 patients in whom cirrhosis was recorded for 3 or more years prior to HCC, only 29% received routine surveillance and 33% received inconsistent surveillance. Among all patients who received regular surveillance, approximately 52% received both AFP and ultrasound, 46% received AFP only, and 2% received ultrasound only. Patients receiving regular surveillance were more likely to have lived in urban areas and had higher incomes than those who did not receive surveillance. Before diagnosis, approximately 48% of patients were seen by a gastroenterologist/hepatologist or by a physician with an academic affiliation; they were approximately 4.5-fold and 2.8-fold, respectively, more likely to receive regular surveillance than those seen by a primary care physician only. Geographic variation in surveillance was observed and explained by patient and physician factors. Conclusion: Less than 20% of patients with cirrhosis who developed HCC received regular surveillance. Gastroenterologists/hepatologists or physicians with an academic affiliation are more likely to perform surveillance. HEPATOLOGY 2010 [source]

Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancer

JOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003
David W. Petrik MD
Abstract Background and Objectives Axillary lymph node dissection (ALND) in patients with breast cancer is crucial for accurate staging, provides excellent regional tumor control, and is included in the standard of care for the surgical treatment of breast cancer. However, the extent of ALND varies, and the extent of dissection and the number of lymph nodes that comprise an optimal axillary dissection are under debate. Despite conflicting evidence, several studies have shown that improved survival is correlated with more lymph nodes removed in both node-negative and node-positive patients. The purpose of this study is to determine which patient, tumor, surgeon, and hospital characteristics are associated with the number of nodes excised in early breast cancer patients. Methods A random sample of 938 women with node-negative breast cancer was drawn from the Ontario Cancer Registry and the data supplemented with chart reviews. The extent of axillary dissection was studied by examining the number of nodes examined in relation to the patient, tumor, surgeon, and hospital factors. Results The mean number of lymph nodes excised was 9.8 (SD = 4.8; range, 1,31), and 49% of patients had ,10 nodes excised. Lower patient age was associated with the excision of more lymph nodes (,10 nodes: 63% of patients <40 years vs. 38% of patients ,80 years). Surgeon academic affiliation and surgery in a teaching hospital were highly correlated with each other and were significantly associated with the excision of ,10 nodes. The number of nodes excised was not associated with any tumor factors, nor with the breast operation performed. These results were confirmed with multivariable models. Conclusions Even though the number of lymph nodes found in the pathologic specimen can be influenced by factors other than surgical technique (e.g., number of nodes present, specimen handling, and pathologic examination), this study shows significant variation of this variable and an association with several patient and surgeon/hospital factors. This variation and the association with survival warrant further study and effort at greater consistency. J. Surg. Oncol. 2003;82:84,90. © 2003 Wiley-Liss, Inc. [source]

Combined Residency Training in Emergency Medicine and Internal Medicine: An Update on Career Outcomes and Job Satisfaction

ACADEMIC EMERGENCY MEDICINE, Issue 9 2009
Chad S. Kessler MD
Abstract Objectives:, This study was designed to provide an update on the career outcomes and experiences of graduates of combined emergency medicine-internal medicine (EM-IM) residency programs. Methods:, The graduates of the American Board of Emergency Medicine (ABEM) and American Board of Internal Medicine (ABIM)-accredited EM-IM residencies from 1998 to 2008 were contacted and asked to complete a survey concerning demographics, board certification, fellowships completed, practice setting, academic affiliation, and perceptions about EM-IM training and careers. Results:, There were 127 respondents of a possible 163 total graduates for a response rate of 78%. Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Thirty-one graduates (24%) pursued formal fellowship training in either EM or IM. Graduates spend the majority of their time practicing clinical EM in an urban (72%) and academic (60%) environment. Eighty-seven graduates (69%) spend at least 10% of their time in an academic setting. Most graduates (64%) believe it practical to practice both EM and IM. A total of 112 graduates (88%) would complete EM-IM training again. Conclusions:, Dual training in EM-IM affords a great deal of career opportunities, particularly in academics and clinical practice, in a number of environments. Graduates hold their training in high esteem and would do it again if given the opportunity. [source]

Work Hours and Caseload as Predictors of Physician Burnout: The Mediating Effects by Perceived Workload and by Autonomy

APPLIED PSYCHOLOGY, Issue 4 2010
Arie Shirom
We tested a model in which perceived workload and autonomy were hypothesised to mediate the effects of work hours and caseload on physician burnout. The study was based on data provided by 890 specialists representing six medical specialties. We used structural equation modeling to test our hypotheses. Controlling for the effects of gender, seniority, and the specialists' academic affiliation, we found that the study data fit the hypothesised model,reflecting these hypotheses,quite well. As expected, workload predicted higher levels of global burnout and physical fatigue, while autonomy predicted lower levels of global burnout. Work hours and caseload predicted global burnout only indirectly, via their effects on either perceived workload or autonomy. These findings suggest that public policies, designed to reduce physician work hours in order to reduce burnout and improve patients' safety, should take into account physician perceived workload and autonomy. Nous avons mis à l'épreuve un modèle centré sur l'hypothèse selon laquelle la charge de travail perçue et l'autonomie régulaient l'impact de la durée du travail médical et administratif sur le burnout des médecins. La recherche a exploité des données fournies par 890 spécialistes relevant de six spécialités médicales. On a fait appel à une modélisation en équations structurales pour valider nos hypothèses. En contrôlant l'action du genre, de l'âge et du type de spécialité, il est apparu que les données correspondaient parfaitement au modèle hypothétique. Comme prévu, la charge de travail prédisait des niveaux plus élevés de burnout global et de fatigue physique, alors que l'autonomie débouchait sur des niveaux plus faibles de burnout global. La durée du travail ne prédisait qu'indirectement le burnout global, par l'entremise des retombées sur la charge de travail perçue et l'autonomie. Ces résultats montrent que la réglementation publique qui envisage de réduire le temps de travail des médecins dans le souci d'atténuer le burnout et d'améliorer la sécurité des malades devrait prendre en considération la charge de travail perçue et l'autonomie des médecins. [source]

Factors associated with surgical options for breast carcinoma,

CANCER, Issue 7 2006
Anees B. Chagpar M.D., M.Sc.
Abstract BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1,9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1,11.0 cm) in patients undergoing mastectomy (P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27,100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27,96 yrs [P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247,1.699 [P < 0.001]), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524,0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021,1.393 [P = 0.026]), and geographic location (P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision-making. Cancer 2006. © 2006 American Cancer Society. [source]