Common Specialty Research Articles

Impact of parallel planning on residency match rate success

BackgroundMedical students targeting competitive specialties or those with lower competitiveness for their preferred specialty are encouraged to parallel apply to a less competitive field. The AAMC provides data on the number of applicants who parallel apply but little information exists on their match success.ObjectiveOur objective is to describe the success rates for students who parallel apply to more than one specialty.MethodsFollowing IRB exemption, a retrospective cohort study of Indiana University School of Medicine graduates from the 2021–2024 residency match cycles was conducted. ERAS data and match reports were reviewed to identify students who parallel applied to more than one specialty, determining their match outcomes. Subgroup analyses were performed based on specialty type, and descriptive statistics were reported.ResultsBetween 2021 and 2024, 1,411 IUSM students applied for the match, with 225 (16%) having a parallel plan; 39% of these students matched into their preferred specialty, 56% into their parallel specialty, and 5% did not match. The most common parallel plan specialties were Anesthesiology, Orthopaedic Surgery, and OBGYN. There were no statistically significant differences in parallel application rates among surgical, hospital-based, and primary care specialties.ConclusionsOur study shows that 1 in 6 students will apply to a parallel specialty, with more than half matching into their parallel plan, making it a viable strategy for those targeting competitive specialties or with lower competitiveness. We found no difference in application rates between surgical, hospital-based, and primary care specialties, emphasizing the need for individualized competitiveness guidance.

Association of Social Determinants of Health With Genetic Test Request and Completion Rates in Children With Neurologic Disorders.

Genetic testing is critical for optimal diagnosis and management of pediatric neurology patients, but access is challenging. We investigated whether social determinants of health (SDOH) were associated with genetic testing among pediatric neurology patients in a retrospective observational study. Electronic health record data were extracted from pediatric outpatients (0-18 years) evaluated at a single tertiary care institution between July 2018 and January 2020. Genetic testing requests, insurance denials, and test completion rates were compared among non-Hispanic single-racial or multiracial Black (Black) vs non-Hispanic single-racial White (White) patients. SDOH and clinical variables including ethnoracial identity, insurance type, Area Deprivation Index, rural urban commuting area, sex, age, diagnoses, and number of neurology visits were evaluated to identify associations with chromosomal microarray (CMA), multigene panel (MGP), and exome/genome sequencing (ES/GS) test completion. Of 11,371 patients (mean age 9.25 years; 46.1% female), 554 (4.9%) completed ≥1 genetic test in the study interval, with White patients nearly twice as likely to have completed ≥1 genetic test compared with Black patients (aOR 1.88, 95% CI 1.41-2.51). Outpatient pediatric neurology was the most common specialty through which testing was completed. Neurology provider request rates for genetic testing did not differ by patient ethnoracial identity, but insurance denial rates after neurology request were lower for White vs Black patients (relative rate ratio [RR] 0.44, 95% CI 0.27-0.73), and those with public insurance were less likely to complete genetic testing after it was requested through neurology (aOR 0.59, 95% CI 0.35-0.97). However, when considering individual genetic test types completed through any specialty, insurance type was significantly associated only with MGP completion (public vs private OR 0.56, 95% CI 0.40-0.77), not CMA or ES/GS. Marked ethnoracial disparities in genetic testing completion were identified despite equivalent rates of genetic testing requests by neurologists. While Black patients had higher rates of insurance denials, insurance type itself accounted for the disparity in MGP but not CMA or ES/GS completion. Other unmeasured barriers stemming from systemic racism likely affected genetic testing among Black patients.

Baseline disease characteristics by surgery history among patients with chronic rhinosinusitis with nasal polyps (CRSwNP) in the global AROMA registry.

Baseline disease characteristics by surgery history among patients with chronic rhinosinusitis with nasal polyps (CRSwNP) in the global AROMA registry.

Survey on Kampo formulas frequently prescribed by physicians belonging to the Japanese Society for Oriental Medicine

AbstractAimWe conducted a web‐based survey of physician members of the Japan Society for Oriental Medicine (JSOM) to investigate trends in Kampo formulas prescribed by Kampo specialists.MethodsJSOM physician members were surveyed using Microsoft Forms from December 1, 2022 to January 27, 2023. Respondents subjectively ranked their top five Kampo formulas, commenting on each formula.ResultsThere were 475 respondents, representing 6.4% of all JSOM members. The respondents had similar sex and age distributions and affiliation regions to all JSOM members. The most common Western medicine specialty of the respondents was internal medicine (13.3%), followed by obstetrics and gynecology (12.2%) and gastroenterology (6.9%). In total, 284 (59.8%) respondents were licensed as board‐certified physicians of the JSOM and 107 (22.5%) had more than 30 years of experience in prescribing Kampo formulas. The Kampo formulas were prescribed as extracts by 360 (75.8%) respondents, whereas only 115 (24.2%) prescribed decoctions. The most frequently used Kampo formula was goreisan, followed by hochuekkito, keishibukuryogan, kamishoyosan, and hachimijiogan. Several commonly used Kampo formulas supported by scientific evidence, including daikenchuto, goshajinkigan, and bofutsushosan, were ranked low in our survey. In addition, differences among respondents in sex, age distribution, affiliated regions, Western medicine specialties, and proficiency in Kampo medicine influenced the trends in frequently prescribed Kampo formulas.ConclusionOur study identified the most frequently prescribed Kampo formulas among physician members of the JSOM. They selected Kampo formulas with diverse pharmacological properties to treat imbalances in qi, blood, and fluids. Kampo decoctions were rarely used, even by specialists.

The Early Landscape of Gender Affirmation Surgery in the United States.

Gender affirmation surgeries (GASs) are procedures that help patients align their body and gender identity. European surgeons are widely credited with pioneering GAS surgical techniques in the 1930s, whereas knowledge of GAS in the United States (US) prior to the 1960s is sparser. This study explores the early leaders, techniques, and obstacles encountered by physicians performing GAS in the US in the 1950s to 1970s. Archives from the Harry Benjamin Collection and Elmer Belt Papers were reviewed for patient, physician, and operative details. A total of 39 physician and academic collaborators and 72 patients were identified. Most physicians and academic collaborators were from the US (28/39, 71.8%) or Germany (3/39, 7.7%). Urology was the most common specialty (8/36, 22.2%), followed by plastic surgery (7/36, 19.4%) and psychiatry (5/36, 13.9%). Forty patients underwent GAS, of which the majority underwent vaginoplasty (31/40, 77.5%), orchiectomy (7/40, 17.5%), and penectomy without vaginoplasty (4/40, 10.0%). Belt preferred to implant testicles into the retroperitoneum rather than perform orchiectomies during his vaginoplasties, and vaginoplasty complications were commonly reported (13/31, 41.9%). Patients and providers faced challenges obtaining and providing GAS due to the indeterminate legal status of the procedures, shifting hospital policies, and discouragement from family and colleagues. Despite records of professional, familial, and even legal censure, the legacy of these early physicians and patients persists in the continued practice and refinement of GAS surgical techniques, often through the same organizations that housed these early practitioners. This article seeks to deepen our understanding of the lives and professional struggles of these medical innovators, upon whose work the contemporary American practice of GAS is built.

Led By Vascular Surgery, Vascular Interventions Are Increasingly Performed By Women.

Led By Vascular Surgery, Vascular Interventions Are Increasingly Performed By Women.

Abstract TP141: Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.

Introduction: Informed consent (IC) plays a central role in medical care and research. Practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the clinical roles and medical specialties of individuals who obtain IC for EVT, aiming to provide insights for enhancing the process in contemporary stroke care. Methods: We conducted a survey from July to December 2023 among clinicians involved in acute stroke care. Utilizing Qualtrics, we disseminated a structured questionnaire through various national and international platforms including the American Academy of Neurology and StrokeNet. This analysis summarizes findings pertaining to the characteristics of those who obtain EVT IC at the respondents’ institution. Results: Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%) ( Table 1 ). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%) ( Table 2 ). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p<0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p<0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p<0.001) and fellows (52% vs. 18%, p<0.001). Conclusion: This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT, with neurologists and staff physicians being the most frequently utilized. These variations likely reflect availability and capacity of certain providers in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses issues such as ischemic core volume, outcome expectations and diversity.

P-1748. Reducing Inappropriate Post-Operative Antibiotics in Pediatrics: The Optimizing PERioperative AnTibiotics In Children (OPERATIC) Trial

Abstract Background Prolonged ( > 24 hours) post operative antibiotic (abx) use is the most common reason for inappropriate abx use in hospitalized children occurring in 40% of cases. Effective strategies are needed to reduce inappropriate post operative abx use. One strategy, facilitation, helps people develop the skills to change the structure and processes within a system to reduce the gap between evidence and practice. This study evaluated the best strategy, order set change vs order set change + facilitation, to deimplement unnecessary post operative abxs.Figure 1:Operatic Stepped-Wedge Trial Design Stepped-wedge trial design comparing order set change only (control) versus order set change plus a facilitation workshop (intervention) attended by the ASP team at the beginning of step. Nine children’s hospitals were randomized to 1 of 3 clusters to begin the intervention at either steps 1, 2, or 3. All hospitals were in the intervention in steps 3-5. Each cluster included 3 hospitals and each step was 6 months in duration. Methods A stepped-wedge trial was conducted at 9 US children’s hospitals from 11/1/20-10/31/23 (Fig 1). After 6 months of all hospitals starting in control of changing order sets, 3 hospital antimicrobial stewardship teams in steps 1-3 participated in the intervention (int), a virtual facilitation workshop to help change order sets. The primary outcome was the rate of inappropriate post operative abxs ( > 24 hours) in clean and clean contaminated cases. Hospital data were collected through the National Surgical Quality Improvement Project Pediatrics. Secondary outcomes were rate of surgical site infection (SSI) and C. difficile infection (CDI). Generalized estimating equations (GEE) with logit link function were utilized to investigate the outcome changes across steps.Figure 2.All Cases All NSQIP-P clean and clean-contaminated cases inappropriate rate of post-operative antibiotic use (>24 hours) by step and group (control and intervention). The GEE model of inappropriate antibiotic rate is presented as the least square means with 95% Confidence intervals. Results The study included 17202 cases, 5913 control and 11289 int. Demographics included mean age of 8.4 years (sd 5.9); 51% female; 71% White, 14% Unknown, 9% Black race; and 14% Hispanic ethnicity. The common surgical specialties were orthopedics (31%), general (21%), and neurosurgery (17%). The overall post operative inappropriate rate was 10%, 11% control v. 10% int. 4 hospitals targeted spine cases (n 2733); the inappropriate rate was 28%, 33% control v. 26% int. Controlling for time and hospital, the GEE model showed a significant decrease in inappropriate post operative abx use for all cases and spine cases for the int across steps (Fig 2&3 p< 0.001). SSI and CDI rates were not significantly increased or decreased.Figure 3.Spine CasesSpine cases inappropriate rate of post-operative antibiotic use (>24 hours) by step and group (control and intervention). The GEE model of inappropriate antibiotic rate is presented as the least square means with 95% Confidence intervals. Conclusion Order set change plus facilitation resulted in a significant reduction in inappropriate post operative abx use. This study is the first deimplementation trial to show the impact of a facilitation workshop on inappropriate abx use. Disclosures Jason G. Newland, MD, MEd, Moderna: Grant/Research Support|Pfizer: Grant/Research Support

Evaluation of Surgical Antimicrobial Prophylaxis Compliance: A Multicentre Point Prevalence Study.

Evaluation of Surgical Antimicrobial Prophylaxis Compliance: A Multicentre Point Prevalence Study.

Practice Intention: Addressing the Needs of Diverse Underserved Communities in Medical Education.

The US physician workforce is at a critical juncture, with a projected shortage and misdistribution of primary care physicians. Culturally and linguistically diverse states, such as California, are challenged to search for innovative approaches in medical education to address the physician needs of diverse underserved communities. The University of California recognizes this imperative and supports Programs in Medical Education (PRIME), including PRIME Leadership and Advocacy (PRIME-LA) at University of California Los Angeles (UCLA). This study examines medical education outcomes for PRIME-LA graduates versus a comparator group. We conducted a secondary data analysis of the graduation questionnaire responses from UCLA graduates between 2018 and 2023. Our study included 97 PRIME-LA graduates and 811 comparator graduates. Primary outcomes included intentions to practice in underserved areas and intentions to care for underserved populations. Secondary outcomes included participation in experiences related to health disparities, health education, providing mentorship, and specialty of interest. A higher proportion of PRIME-LA graduates reported an intention to practice in underserved areas than the comparator group (89% vs 32%, P<.001). Intentions to care for underserved populations were higher among PRIME-LA graduates than those in the comparator group (93% vs 44%, P<.001). Family medicine is the most common specialty among PRIME-LA graduates in contrast to graduates of the comparator group (26.4% vs 6.3%, P<.001). Mission-based medical education programs play a critical role in addressing the physician workforce gap in underserved communities. The PRIME-LA program may equip students with additional skills and training to address California's physician workforce needs.

Buprenorphine prescribing practices for older adults in 2019 and 2020.

Opioid use disorder (OUD) prevalence has increased threefold among Medicare beneficiaries 65 years and older (hereafter "older adults") since 2013, with a prevalence of 15.7 per 1000 Medicare beneficiaries in 2018. Yet, access to treatment that addresses the needs of older adults with OUD is limited, including patterns of buprenorphine prescribing to older adults. Therefore, we sought to describe buprenorphine treatment patterns among older adults and prescribing clinician specialties. We conducted a retrospective observational study using 2019-2020 IQVIA Real World Data-Longitudinal Prescriptions. High-prescribing clinicians are those who prescribed buprenorphine to >15 unique older adults within a calendar year. We used T-test and chi-square tests to compare characteristics associated with differences in prescribing. Among 26,202 clinicians prescribing buprenorphine to 67,921 unique older adults, 1232 (5%) prescribed to more than 15 older adults (mean 28.1, SD = 23.6), corresponding to buprenorphine prescribing for 24,672 (36%) older adults. Among older adults dispensed buprenorphine, the majority (58%) were 66-70 years of age and male (54%). Individuals older than 70 years (44%) and males (51%) were slightly more common among high prescribers than non-high-prescribing clinicians (41% and 49%, respectively). Primary care clinicians (42%) and advance practice providers (APPs) (29%) were the most common specialties prescribing buprenorphine. Most (87%) buprenorphine prescribers were in urban counties; with a slightly higher percentage of high-prescribing clinicians in urban counties (91%). A relatively small subset of clinicians prescribes most buprenorphine to older adults. This work provides evidence of gaps in care delivery. Scalable systems-level interventions should be developed and tested to improve treatment availability mindful of existing clinical infrastructure.

Use of Multiplex Molecular Panels to Diagnose Urinary Tract Infection in Older Adults

Multiplex molecular syndromic panels for diagnosis of urinary tract infection (UTI) lack clinical data supporting their use in routine clinical care. They also have the potential to exacerbate inappropriate antibiotic prescribing. To describe the frequency of unspecified multiplex testing in administrative claims with a primary diagnosis of UTI in the Medicare population over time, to assess costs, and to characterize the health care professionals (eg, clinicians, laboratories, physician assistants, and nurse practitioners) and patient populations using these tests. This cohort study used Centers for Medicare & Medicaid Services (CMS) claims data for Medicare beneficiaries. The study included older community-dwelling adults and nursing home residents with fee-for-service Medicare Part A and Part B benefits from January 1, 2016, to December 31, 2023. Multiplex syndromic panels were identified using carrier claims (ie, claims for clinician office or laboratory services). The annual rate of claims was measured for multiplex syndromic panels with a primary diagnosis of UTI per 10 000 eligible Medicare beneficiaries. The performing and referring specialties of health care professionals listed on claims of interest and the proportion of claims that occurred among beneficiaries residing in a nursing home were described. Between 31 110 656 and 36 175 559 Medicare beneficiaries with fee-for-service coverage annually (2016-2023) were included in this study. In this period, 1 679 328 claims for UTI multiplex testing were identified. The median age of beneficiaries was 77 (IQR, 70-84) years; 34% of claims were from male beneficiaries and 66% were from female beneficiaries. From 2016 to 2023, the observed rate of UTI multiplex testing increased from 2.4 to 148.1 claims per 10 000 fee-for-service beneficiaries annually, and the proportion of claims that occurred among beneficiaries residing in a nursing home ranged from 1% in 2016 to 12% in 2020. In addition to laboratories or pathologists, urology was the most common clinician specialty conducting this testing. The CMS-assigned referring clinician specialty was most frequently urology or advanced practice clinician for claims among community-dwelling beneficiaries compared with internal medicine or family medicine for claims among nursing home residents. In 2023, the median cost of a multiplex test in the US was $585 (IQR, $516-$695 for Q1-Q3), which was more than 70 times higher than the median cost of $8 for a urine culture (IQR, $8-$16 for Q1-Q3). This cohort study of Medicare beneficiaries with fee-for-service coverage from 2016 to 2023 found increasing use of emerging multiplex testing for UTI coupled with high costs to the Medicare program. Monitoring and research are needed to determine the effects of multiplex testing on antimicrobial use and whether there are clinical situations in which this testing may benefit patients.

Duties, tasks, knowledge and skills of an obesity medicine physician: A practice analysis

Duties, tasks, knowledge and skills of an obesity medicine physician: A practice analysis

Deprescribing in Older Adults: Attitudes, Awareness, Training, and Clinical Practice Among Portuguese Physicians.

The importance of deprescribing in clinical practice is growing, particularly in aging populations with polypharmacy scenarios, making it a crucial matter in Portugal, one of Europe's most aged nations. The aim of this study was to investigate deprescribing awareness, training, attitudes, and practices among Portuguese physicians to inform future healthcare strategies. A cross-sectional study using an anonymous online questionnaire was disseminated through the Portuguese Medical Association. It gathered sociodemographic and professional data, and insights into deprescribing awareness, attitudes, training, and practices. Descriptive statistics were summarized as frequencies, percentages, medians, and interquartile ranges. For inferential analysis, the Chi-square test and Fisher's exact test were used to evaluate categorical variables, and the Mann-Whitney U test was used for continuous variables. The significance level was set at p < 0.05. A total of 425 valid questionnaires were included. The participants were mostly women (61.6%), with a median age of 45 (IQR 34 - 42). General practice/family medicine (34.1%) and internal medicine (16.2%) were the most common medical specialties. While 81.2% of the respondents were familiar with the term 'deprescribing', 55.4% reported no training. A vast majority (91.9%) reported practicing deprescribing, but a smaller fraction employed specific methodologies to deprescribe (39.8%) and criteria for identifying potentially inappropriate medications (38.7%). Training in deprescribing was significantly associated with higher deprescribing awareness (p < 0.001), the use of specific deprescribing methods (p < 0.001), the use of criteria to identify potentially inappropriate medications (p < 0.001) and having certification in geriatrics by the Portuguese Medical Association (p = 0.006). Family physicians showed higher familiarity with and training in deprescribing than hospital-based specialists (p < 0.001). Deprescribing methodologies were adopted more often by family physicians than by hospital-based specialists (p = 0.004). This study highlights widespread deprescribing awareness among Portuguese physicians, while simultaneously uncovering considerable gaps in training and inconsistencies in its application. These findings highlight the pressing need for targeted educational initiatives that could contribute to medication optimization for older adults in the national healthcare system. Furthermore, these findings emphasize the importance of policy development and medical education in promoting safe deprescribing.

Implementation and Evaluation Strategies for Pharmacogenetic Testing in Hospital Settings: A Scoping Review.

Pharmacogenetic testing in clinical settings has improved the safety and efficacy of drug treatment. There is a growing number of studies evaluating pharmacogenetic implementation and identifying barriers and facilitators. However, no review has focused on bridging the gap between identifying barriers and facilitators of testing and the clinical strategies adopted in response. This review was conducted to understand the implementation and evaluation strategies of pharmacogenetic testing programs. A PRISMA-compliant scoping review was conducted. The included studies discussed pharmacogenetic testing programs implemented in a hospital setting. Quantitative, qualitative, and mixed design methods were included. A total of 232 of the 7043 articles that described clinical pharmacogenetic programs were included. The most common specialties that described pharmacogenetic implementation were psychiatry (26%) and oncology (16%), although many studies described institutional programs implemented across multiple specialties (19%). Different specialties reported different clinical outcomes, but all reported similar program performance indicators, such as test uptake and the number of times the test recommendations were followed. There were benefits and drawbacks to delivering test results through research personnel, pharmacists, and electronic alerts, but active engagement of physicians was necessary for the incorporation of pharmacogenetic results into clinical decision making. Further research is required on the maintenance and sustainability of pharmacogenetic testing initiatives. These findings provide an overview of the implementation and evaluation strategies of different specialties that can be used to improve pharmacogenetic testing.

The psychological burden of major surgical complications in visceral surgery

BackgroundComplications are common after major visceral surgery. Besides the patients, also surgeons may experience negative feelings by the patients suffering. Some studies have evaluated the mental burden caused by complications, mainly focusing on residents in different surgical specialties. No evidence exists on the mental burden of board-qualified visceral surgeons in Germany.Materials and MethodsA point prevalence study was conducted using an online questionnaire. For the inclusion of participants, all departments of visceral surgery at German university hospitals were addressed. The objective of the online questionnaire was to elaborate the perception of complications and the coping mechanisms used by the surgeons with the aim to characterize the mental burden and possible improvement strategies.ResultsA total of 113 questionnaires were answered, 98 being complete. 73.2% of the participants were male, 46.9% were consultants and had a working experience of 11–20 years. Most common specialties were colorectal and general surgery and 91.7% claimed to have caused complications Clavien-Dindo grade IV or V. Subsequently, predominant feelings were anger, grief, self-doubt and guilt. The fear of being blamed by colleagues or to lose reputation were high. Especially female and younger surgeons showed those fears. Coping mechanisms used to overcome those negative feelings were interaction with friends and family (60.6%) or proactive training (59.6%). Only 17.2% of the institutions offered professional support. In institutions where no support was offered, 71.6% of the surgeons asked for support.ConclusionSurgical complications cause major psychological burden in surgeons in German university hospitals. Main coping mechanisms are communication with friends and families and professional education. Vulnerable subgroups, such as younger surgeons, may be at risk of suffering more from perceived mental distress. Nonetheless, the majority did not receive but asked for professional counselling. Thus, structured institutional support may ameliorate care for both surgeon and patient.

Current situation and future issues with Kampo medicine: A survey of Japanese physicians

AbstractAimWe aimed to elucidate the present clinical situation, future challenges, and potential need for diagnostic support software in Kampo medicine.MethodsWe conducted an online survey (comprising 28 questions) of Japanese physicians from the 23 to 24 January 2024 via MedPeer. The participants' responses were stratified according to their age distribution.ResultsWe evaluated data for 652 respondents. The most common respondent age groups were those in their 30s and 40s. The most common specialty of respondents was internal medicine (43.7%). Only 33.7% of respondents had received education on Kampo medicine at university. Most respondents (90.0%) were not licensed as certified physicians or members of the Japan Society for Oriental Medicine. Most respondents (86.7%) currently prescribed Kampo formulas (current users); only 3.8% had no experience in prescribing Kampo formulas. The conditions for which Kampo formulas were frequently prescribed were muscle cramps, constipation, medically unexplained symptoms/menopausal syndrome, appetite loss/malnutrition, and fatigue. However, 48.3% of current users did not use traditional Kampo patterns (sho). The most frequent issues reported by respondents were the lack of scientific evidence and standardization of diagnostic methods in Kampo medicine. Respondents indicated the need for postgraduate education and implementation of diagnostic support software for using Kampo patterns by non‐specialists in Kampo medicine.ConclusionThere was a discrepancy between the high frequency of Kampo formula prescriptions and the low use of traditional Kampo patterns in Japan. Diagnostic support software is likely to become a useful method of improving appropriate Kampo formula prescriptions by non‐specialists.

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center

Survey results of COVID-19 pandemic on female surgical trainees: New normal work environment

Survey results of COVID-19 pandemic on female surgical trainees: New normal work environment

Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States.

Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States.