scholarly journals Retrospective study of the differences in patient characteristics and revenue between male and female surgeons in Taiwan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Weiming Cheng ◽  
Shu-Yi Lin ◽  
Yu-Hua Fan ◽  
Sheng-Wen Chen
Keyword(s):  
Gender Stereotypes ◽  
General Surgery ◽  
Inpatient Care ◽  
Patient Characteristics ◽  
Population Based ◽  
Similar Amount ◽  
Research Database ◽  
General Surgeons ◽  
Female Surgeons ◽  
The Difference

AbstractSurgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the condition in Asian societies. We aimed to examine the difference between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database. We identified surgeons with a clinical experience of six to thirteen years between 1995 to 2013 from the National Health Insurance Research Database. We collected patient numbers and revenue per month in outpatient and inpatient care, as well as monthly numbers of surgeries conducted by female and male surgeons in urology, general surgery, and gynecology, for analysis. Original student’s t-test and wilcoxon rank sum test was used to compare the differences between female and male surgeons, and p values less than 0.05 were considered statistically significant. Female urologists and general surgeons had a significantly higher ratio of female patients in Taiwan. Female urologists had patient numbers, revenues, and numbers of surgeries comparable to male urologists. In contrast, female general surgeons had significantly less involvement in outpatient and inpatient care and had low monthly revenues. Female general surgeons contradictorily performed more oncological surgeries per month than males. However, the difference in numbers of oncological surgeries was not significant after excluding breast cancer surgeries. Female gynecologists had a similar amount of outpatients and outpatient revenue but significantly less inpatient care and numbers of surgeries per month. A gender-based gap exists among surgeons in Taiwan. The gap between females and males appeared narrower in urology than in general surgery and gynecology. Management of diseases related to female sex organs, including breast, were more common among female surgeons. Efforts should be made to decrease gender stereotypes, to ensure that patients receive the best care regardless of the sex of the surgeons.

scholarly journals Limitations or Advantages? Gender Differences in Urologists, General Surgeons, and Gynecologists in Taiwan – A Nationwide, Population-based Study

2021 ◽  
Author(s):  
Sheng-Wen Chen ◽  
Shu-Yi Lin ◽  
Yu-Hua Fan ◽  
Weiming Cheng
Keyword(s):  
Gender Stereotypes ◽  
General Surgery ◽  
Population Based ◽  
Research Database ◽  
Outpatient Services ◽  
Population Based Study ◽  
Inpatient Services ◽  
General Surgeons ◽  
Gender Based ◽  
Student’S T

Abstract We aimed to examine the differences between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database in Taiwan. We identified surgeons with a clinical experience of 6 − 13 years, between 1995 to 2013, from the National Health Insurance Research Database. We collected patient volume and revenue per month in outpatient and inpatient services, as well as surgical volumes per month of female and male surgeons for analysis. Student’s t-test was used to compare the differences between female and male surgeons. Female urologists and general surgeons had a significantly higher ratio of female patients. Female urologists had comparable patient numbers, revenues, and surgical volumes as male urologists. In contrast, female general surgeons had significantly lesser involvement in outpatient and inpatient care and had lower monthly revenues than males; however, female general surgeons performed more oncological surgeries per month. Female gynecologists had similar outpatient services and outpatient revenue but significantly lesser inpatient services and surgical volume per month. A gender-based gap exists among surgeons in Taiwan; this gap is narrower in urology than in general surgery and gynecology. Gender stereotypes should be reduced to ensure that patients receive the best care regardless of surgeons’ gender.

Females as surgical oncologists in Taiwan: A nationwide population-based study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11042-11042
Author(s):  
Weiming Cheng ◽  
Yu-Hua Fan
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
General Surgery ◽  
Outpatient Service ◽  
Population Based ◽  
Research Database ◽  
General Surgeons ◽  
Patient Service

11042 Background: Operations for malignancy are stereotypically viewed as the field of men, especially in eastern countries. In recent decades, more and more women devoted themselves to be surgical oncologists. However, they face many challenges, especially when they treating patients with sex organ-related malignancies. In the present study, we compared the disparities between female and male surgical oncologists in urology, general surgery, and gynecology by analyzing a nationwide, population-based database in Taiwan. Methods: National Health Insurance covers more than 99.6% of population in Taiwan. The system’s claim data are released as the National Health Insurance Research Database. One of its database, the Longitudinal Health Insurance Database 2000, contains all the original data of one million randomly-selected beneficiaries enrolled in year 2000. We recruited the yearly inpatient and outpatient service volumes, oncological surgical volumes, revenue, and sex ratio of patients of each female and male attending general surgeons, gynecologists, and urologists with practice more than five years from 1995 to 2013. The differences of these factors between male and female physicians in each specialty were compared with Mann-Whitney U-test. P < 0.05 was viewed as statistically significant. Results: There are 13, 87, and 191 female urologists, general surgeons, and gynecologists included, accounting for 6.7%, 7.0%, and 51.3% of physicians in each specialty in Taiwan respectively. Female urologists and general surgeons had significantly more female patients (p = 0.004 and < 0.001 respectively). Female urologists had insignificantly less patient service numbers, oncological surgical volumes, and revenues (p = 0.285, 0.718, 0.077 respectively), while female general surgeons and gynecologists performed worse than corresponding male physicians (all p value < 0.001). Of noted, female general surgeons have significantly less patient service (66.0±57.1 vs. 94.8±98.9 patients, p < 0.001) and total surgical volumes (2.30±2.50 vs. 3.28±3.33 surgeries, p = 0.001) but more oncological surgeries (0.33±0.64 vs. 0.17±0.41 surgeries, p = 0.003); however, there is no differences after exclusion of surgeries for breast cancer (0.07±0.22 vs. 0.12±0.32 surgeries, p = 0.057). Conclusions: Patients tend to seek medical help from same-sex physicians in Taiwan. Females could have a comparable career with males in urology, while gender inequality remains significant in general surgery and gynecology. Female surgical oncologists may have advantages in breast cancer treatment.

scholarly journals Intravenous Immunoglobulin Treatment in Kawasaki Disease Decreases the Incidence of Myopia

2021 ◽  
Vol 10 (7) ◽  
pp. 1381
Author(s):  
Hun-Ju Yu ◽  
Meng-Ni Chuang ◽  
Chiao-Lun Chu ◽  
Pei-Lin Wu ◽  
Shu-Chen Ho ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Systemic Vasculitis ◽  
Age Distribution ◽  
Population Based ◽  
Research Database ◽  
Ocular Manifestations ◽  
Missing Data Treatment ◽  
The Difference ◽  
Age Range

Kawasaki disease (KD) is a systemic vasculitis that primarily affects children under the age of 5 years old. The most significant complication is coronary artery lesions, but several ocular manifestations have also been reported. Recently, one study revealed an increasing incidence of myopia among KD patients. Therefore, the aim of this study was to assess the difference in myopic incidence between Kawasaki disease (KD) patients treated with aspirin and intravenous immunoglobulin (IVIG). Materials and methods: We carried out a nationwide retrospective cohort study by analyzing the data of KD patients (ICD-9-CM code 4461) from Taiwan’s National Health Insurance Research Database (NHIRD) during the period of 1996–2013. Results: A total of 14,102 diagnosed KD were found in Taiwan during the study period. After excluded missing data, treatment strategy and age distribution, a total of 1446 KD patients were enrolled for analysis including 53 of which received aspirin (without IVIG) and 1393 of which were treated with IVIG. Patients who had myopia, astigmatism, glaucoma, cataract, etc. prior to their KD diagnosis were excluded. The age range was 0 to 6 years old. According to the cumulative curves, our results demonstrated that the myopic incidence in the IVIG group was significantly lower than the aspirin group (hazard ratio: 0.59, 95% confidence intervals: 0.36~0.96, p = 0.02). Treatment with IVIG for KD patients may have benefit for myopia control. Conclusion: Compared to aspirin, IVIG may decrease the myopic risk in KD patients. However, it needs further investigation including clinical vision survey of myopia due to the limitations of this population-based study.

scholarly journals Comparison of Total Joint Replacement Rate Between Patients With Hemophilia A and Patients With Hemophilia B: A Population-Based and Retrospective Cohort Study

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 163S-170S
Author(s):  
Wen-Ya Lin ◽  
Jiaan-Der Wang ◽  
Yu-Tse Tsan ◽  
Wei-Cheng Chan ◽  
Kwok-Man Tong ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Hemophilia A ◽  
Total Joint Replacement ◽  
Population Based ◽  
Hemophilia B ◽  
Clotting Factor ◽  
Research Database ◽  
Increased Risk ◽  
The Difference ◽  
Factor Concentrate

Recurrent hemarthrosis in patients with hemophilia (PWH) results in chronic arthropathy requiring total joint replacement (TJR). This study aimed to compare the difference in TJR rate between patients with hemophilia A (HA) and hemophilia B (HB). A final total of 935 PWH (782 HA and 153 HB) without inhibitors were collected from the Taiwan’s National Health Insurance Research Database between 1997 and 2013. Demographics, clinical characteristics, and TJR rate were compared between the 2 groups. The annual use of clotting factor concentrate was not different between HA and HB groups ( P = .116). The rate of comorbidities except for 29 PWH having HIV who were all in the HA group was also not different between the 2 groups. A total of 99 (10.6%) PWH had undergone 142 TJR procedures during the study period. All of them had received on-demand therapy. No difference was found in the cumulative incidence of TJR between HA and HB ( P = .787). After adjusting for various confounders including age, pyogenic arthritis, and HIV infection, no increased risk of TJR was found in patients with HA versus Patients with HB (hazard ratio: 0.92, 95% confidence interval 0.54-1.58). This finding suggests that the rate of TJR between patients with HA and HB is not significantly different.

Differences in prostate cancer survival between Denmark, Iceland, and Sweden: A high-resolution study.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 159-159
Author(s):  
Inga Jona Ingimarsdottir
Keyword(s):  
Prostate Cancer ◽  
High Resolution ◽  
Metastatic Disease ◽  
Excess Mortality ◽  
Relative Survival ◽  
Patient Characteristics ◽  
Mortality Rates ◽  
Population Based ◽  
The Difference ◽  
Resolution Study

159 Background: Register-based studies have demonstrated large differences in relative survival and excess mortality following the diagnosis of PC in the Nordic countries. These differences may reflect differences in patient characteristics, diagnostics (PSA-use) and treatment strategies. This high-resolution study explores the background for the differences in PC survival between Denmark, Iceland and Sweden. Methods: Patients with newly diagnosed PC in 1997 were identified through population-based national cancer registers in Denmark and Iceland. Information on clinical findings was retrieved by reviewing hospital files. In Sweden information was gathered from two regional population-based prostate cancer registers providing both time of diagnosis and clinical information. Country specific excess mortality rates were compared adjusting for available information on known prognostic factors. Results: The overall relative survival in the cohorts was comparable to population-based results previously published. Across countries significant differences in excess mortality rates were seen. These differences were largely explained by differences in patient characteristics at diagnosis, and when adjusting for differences in patient characteristics i.e. metastatic / non-metastatic disease, clinical T-stage, and PSA level at diagnosis, the differences in excess mortality diminished or disappeared. The difference in percentage of patients with metastatic disease at diagnosis was the one factor responsible for the major differences in mortality-rates across countries. Conclusions: Register-based studies on relative survival and excess mortality following a PC diagnosis may be influenced by national differences in clinical presentation at diagnosis. Differences between countries in the proportion of patients with metastatic spread at diagnosis apparently explains most of the difference in relative survival previously reported. Further studies and cross country comparisons of survival and excess mortality for PC should adjust for differences in patient characteristics, mainly TNM.

Incidence of paediatric 10-fold medication errors in Wales

2020 ◽  
pp. archdischild-2020-319130
Author(s):  
Yincent Tse ◽  
David Tuthill
Keyword(s):  
Medication Errors ◽  
Reporting System ◽  
Patient Characteristics ◽  
Population Based ◽  
Population Surveillance ◽  
Near Miss ◽  
Surveillance Study ◽  
High Resource ◽  
Improvement Strategies ◽  
Iatrogenic Harm

ObjectivesTo estimate the incidence, characteristics and outcomes of 10-fold or greater or a tenth or less medication errors in children aged <16 years in Wales.DesignPopulation-based surveillance study July 2017 to June 2019. Cases were identified by paediatricians and hospital pharmacists using monthly electronic Welsh Paediatric Surveillance Unit (WPSU) reporting system.Patients‘Definite’ incident occurred when children received all or any of the incorrect dose of medication. ‘Near miss’ was where the prescribed, prepared or dispensed medication was not administered to the child.Main outcome measuresIncidence, patient characteristics, setting, drug characteristics, outcome, harm and enabling or preventive factors.ResultsIn total, 50 10-fold errors were reported; 20 definite and 30 near miss cases. This yields a minimum annual incidence of 1 per 3797 admissions, or 4.6/100 000 children. Of these, 43 were overdoses and 7 underdoses. 33 incidents occurred in children <5 years of age. Overall, 37 different medications were involved with the majority, 31 cases, being administered enterally. Of these 31 enteral medication errors, all definite cases (10) had received liquid preparations. Temporary harm occurred in 5/20 (25%) definite cases with one requiring intensive care; all fully recovered.ConclusionsIn this first ever population surveillance study in a high-resource healthcare system, 10-fold errors in children were rare, sometimes prevented and uncommonly caused harm. We recommend country-wide improvements be made to reduce iatrogenic harm. Understanding the enabling and preventive factors may help national improvement strategies to reduce these errors.

scholarly journals A new customised placental weight standard redefines the relationship between maternal obesity and extremes of placental size and is more closely associated with pregnancy complications than an existing population standard

2019 ◽  
Vol 11 (4) ◽  
pp. 350-359
Author(s):  
Jacqueline M. Wallace ◽  
Joeleita P. Agard ◽  
Graham W. Horgan
Keyword(s):  
Pregnancy Complications ◽  
Maternal Obesity ◽  
Population Based ◽  
Multiple Regression Model ◽  
Placental Weight ◽  
Morbidly Obese ◽  
Obese Women ◽  
Entire Cohort ◽  
Multiparous Women ◽  
The Difference

AbstractPlacental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37–43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%–129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.

scholarly journals Effects of marital status on overall and cancer-specific survival in laryngeal cancer patients: a population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhao Ding ◽  
Deshun Yu ◽  
Hefeng Li ◽  
Yueming Ding
Keyword(s):  
Marital Status ◽  
Cancer Patients ◽  
Laryngeal Cancer ◽  
Cox Regression ◽  
Group Analysis ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Prognostic Effect ◽  
The Difference

AbstractMarital status has long been recognized as an important prognostic factor for many cancers, however its’ prognostic effect for patients with laryngeal cancer has not been fully examined. We retrospectively analyzed 8834 laryngeal cancer patients in the Surveillance Epidemiology and End Results database from 2004 to 2010. Patients were divided into four groups: married, widowed, single, and divorced/separated. The difference in overall survival (OS) and cancer-specific survival (CSS) of the various marital subgroups were calculated using the Kaplan–Meier curve. Multivariate Cox regression analysis screened for independent prognostic factors. Propensity score matching (PSM) was also conducted to minimize selection bias. We included 8834 eligible patients (4817 married, 894 widowed, 1732 single and 1391 divorced/separated) with laryngeal cancer. The 5-year OS and CSS of married, widowed, single, and separated/divorced patients were examined. Univariate and multivariate analyses found marital status to be an independent predictor of survival. Subgroup survival analysis showed that the OS and CSS rates in widowed patients were always the lowest in the various American Joint Committee on Cancer stages, irrespective of sex. Widowed patients demonstrated worse OS and CSS in the 1:1 matched group analysis. Among patients with laryngeal cancer, widowed patients represented the highest-risk group, with the lowest OS and CSS.

scholarly journals The Effect of Surrounding Greenness on Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort in Taiwan

2020 ◽  
Vol 18 (1) ◽  
pp. 267
Author(s):  
Hui-Ju Tsai ◽  
Chia-Ying Li ◽  
Wen-Chi Pan ◽  
Tsung-Chieh Yao ◽  
Huey-Jen Su ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Vegetation Index ◽  
Normalized Difference Vegetation Index ◽  
Population Based ◽  
Research Database ◽  
Individual Level ◽  
The Relationship

This study determines whether surrounding greenness is associated with the incidence of type 2 diabetes Mellitus (T2DM) in Taiwan. A retrospective cohort study determines the relationship between surrounding greenness and the incidence of T2DM during the study period of 2001–2012 using data from the National Health Insurance Research Database. The satellite-derived normalized difference vegetation index (NDVI) from the global MODIS database in the NASA Earth Observing System is used to assess greenness. Cox proportional hazard models are used to determine the relationship between exposure to surrounding greenness and the incidence of T2DM, with adjustment for potential confounders. A total of 429,504 subjects, including 40,479 subjects who developed T2DM, were identified during the study period. There is an inverse relationship between exposure to surrounding greenness and the incidence of T2DM after adjustment for individual-level covariates, comorbidities, and the region-level covariates (adjusted HR = 0.81, 95% CI: 0.79–0.82). For the general population of Taiwan, greater exposure to surrounding greenness is associated with a lower incidence of T2DM.

scholarly journals A “Smart” Biosensor-Enabled Intravascular Catheter and Platform for Dynamic Delivery of Propofol to “Close the Loop” for Total Intravenous Anesthesia

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 370-377
Author(s):  
Edward Chaum ◽  
Ernő Lindner
Keyword(s):  
Real Time ◽  
Drug Distribution ◽  
Population Based ◽  
Pharmacokinetic Data ◽  
Drug Infusion ◽  
Blood Concentrations ◽  
The Usa ◽  
The Difference ◽  
Automated Delivery

ABSTRACT Background Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA. Methods We conceptualized and prototyped a novel “smart” biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a “smart” biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood. Results We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop “patient” applying the known pharmacokinetics of the drug using published algorithms. Conclusions We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a “smart,” indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, “closed-loop” delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.

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