Effect Of Patient Sex Research Articles

The Effect of Patient Sex on Treatment Outcomes in COPD: A Post Hoc Analysis of the IMPACT Trial.

Lung physiology and COPD pathophysiology differ between sexes. This post hoc analysis investigated IMPACT trial outcomes by patient sex. IMPACT was a double-blind, 52-week trial. Patients ≥40 years with symptomatic COPD and history of exacerbations were randomised 2:2:1 to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25μg, FF/VI 100/25μg, or UMEC/VI 62.5/25μg. Annual rate and risk of moderate/severe exacerbations, change from baseline in trough FEV1 and SGRQ score, and safety were assessed. Of 10,355 patients, 66.3% were male. More females reported ≥2 moderate/severe prior exacerbations (58% vs 53%) at screening versus males. Additionally, females had worse mean (SD) SGRQ scores (52.4[15.97] vs 49.8[17.24]) at baseline. FF/UMEC/VI improved annual exacerbation rate, lung function and health status for both sexes versus dual therapy. The difference in trough FEV1 across time points with FF/UMEC/VI versus FF/VI was 103-110mL in males and 70-84mL in females. On-treatment moderate/severe exacerbation rates remained higher for females (FF/UMEC/VI: 0.99; FF/VI: 1.19; UMEC/VI: 1.35) than males (0.87; 1.01; 1.14). Females experienced fewer exacerbations with eosinophil counts <150 cells/µL (0.81[0.68,0.97], p=0.024) or <2 exacerbations in the past year (0.73[0.57,0.94],p=0.013) with FF/UMEC/VI versus UMEC/VI. More females with COPD reported exacerbations in the prior year at screening, as well as during the study, versus males, across all treatments. FF/UMEC/VI improved exacerbation rates versus UMEC/VI in females with eosinophil counts <150 cells/µL or <2 exacerbations in the prior year, suggesting inhaled corticosteroids may play an important role in exacerbation reduction for females in this patient population. Clinical Trial Registration: GSK (CTT116855/NCT02164513).

Abstract 126: Does a Difference in Bystander Cardiopulmonary Resuscitation Initiation and Continuation Exist Due to Patient Sex After Accounting for the Bystander-Patient Relationship?

Introduction/Background: Differences in bystander cardiopulmonary resuscitation (B-CPR) provision based on the patient’s sex have been reported extensively, with equivocal results. Research question: Do differences in B-CPR according to the patient’s sex exist after adjusting for the bystander-patient relationship? Aim: To explore sex differences in B-CPR initiation and continuation for out-of-hospital cardiac arrest (OHCA) patients while accounting for the bystander-patient relationship. Methods: We analysed consecutive paramedic-confirmed OHCA emergency calls, from 1 January to 30 April 2021, in Western Australia. Calls included were non-traumatic, non- emergency medical service (EMS)-witnessed OHCA, where the bystander was with the patient and CPR was not already in progress. Calls were reviewed in full, and patient and bystander characteristics were coded. Bystander relationship was categorised as either related to the patient or unrelated. We performed a logistic regression of B-CPR initiation by sex, adjusting for patient age (&lt;65 and ≥65) and location (private and public), and bystander-patient relationship. Results: Of the 295 calls included, 203 (69%) of the patients were male, and 164 (56%) were over 65 years of age. Two thirds of the bystanders (65%) were related to the patient. The majority of OHCAs were in private locations (84%). Bystander CPR was initiated in 205 (69%) calls, 69% (139 out of 201) in male patients and 70% (66 out of 94) in female patients (p=0.85). There was no difference in CPR initiation between male and female patients, unadjusted (odds ratio, OR=0.95, 95% confidence interval, 95% CI = 0.56-1.62), or when adjusted for bystander-patient relationship, location, and patient age (OR=0.92, 95% CI=0.53-1.59). Of those who started CPR (205), 175 (85%) bystanders continued performing CPR till EMS arrived. Male OHCA patients were less likely to have CPR continue to EMS arrival than female OHCA patients (OR=0.46, 95% CI=0.16-1.29). Conclusion: There was no effect of patient sex on bystander CPR, both before and after accounting for bystander-patient relationship. Bystanders were more likely to continue performing CPR on female OHCA patients.

Effect of Patient Sex on Neurocognitive Decline after Cardiac Surgery.

Neurocognitive decline (NCD) is a common complication of cardiac surgery. Understanding risk factors helps surgeons counsel patients pre- and perioperatively about risk, prevention, and treatment. Patients undergoing cardiac surgery using cardiopulmonary bypass underwent pre- and postoperative neurocognitive testing. Neurocognitive data are presented as a change from baseline to either postoperative day 4 or to 1 month. The score is standardized with respect to age. Eighty-four patients underwent surgery and completed postoperative neurocognitive testing. There was no significant difference in baseline neurocognitive function. NCD was more common in female patients (71%) than male patients (26.4%) on postoperative day 4. By 1 month, the incidence of NCD is similar between female (15.0%) and male patients (14.3%). Of note, female patients differed from male patients in preoperative hematocrit, preoperative creatinine, and type of surgery. In the acute postoperative period, female patients are both more likely to experience NCD and experience a more severe change from baseline cognitive function. This difference between male and female patients resolves by the 1 month follow-up point. Female patients had a lower preoperative hematocrit and were more likely to receive intraoperative and perioperative blood transfusion. Lower preoperative hematocrit appears to mediate the difference in NCD between male and female patients.

Effects of Male and Female Sex on the Development of Posttraumatic Osteoarthritis in the Porcine Knee After Anterior Cruciate Ligament Surgery

Background: Posttraumatic osteoarthritis (PTOA) is a common sequela of anterior cruciate ligament (ACL) injury, even when surgical treatment is selected. The effect of patient sex on cartilage health after ACL injury and surgical treatment has been less studied. Purpose/Hypothesis: The study objective was to compare the macroscopic cartilage damage that develops after ACL surgery in male and female Yucatan minipigs. It was hypothesized that after ACL surgery, the macroscopic cartilage damage of the tibiofemoral joints from female animals would be greater than that from male animals. Additionally, it was hypothesized that the effect of sex on the macroscopic cartilage damage would depend on surgical treatment. Study Design: Controlled laboratory study Methods: Twelve-month follow-up data were obtained for 55 adolescent Yucatan minipigs (22 female/33 male) that were randomized to 1 of 3 experimental groups: no treatment (ACL transection [ACLT]), ACL reconstruction, and bridge-enhanced ACL restoration. The Osteoarthritis Research Society International guidelines were used to determine a standardized macroscopic cartilage damage score on 5 surfaces of the knee joint. Results: Females had significantly worse mean total macroscopic cartilage damage scores on the surgical side (adjusted P value [P adj] = .04) and significantly better scores on the contralateral side (P adj = .01) when compared with males. The trochlear damage scores were also significantly worse in females for surgical limbs (P adj = .009) and significantly better for the contralateral limbs (P adj < .001) when compared with males. Although there were no significant differences in total macroscopic cartilage damage scores between sexes within treatment groups on the surgical limbs (ACLT, P adj = 0.45; ACL reconstruction, P adj = .56; bridge-enhanced ACL restoration, P adj = .23), the mean trochlear scores on the surgical limb of females were significantly worse than those of the males in the ACLT group (P adj = .003). Conclusion: Mean total macroscopic cartilage damage scores of Yucatan minipigs were significantly worse in females than males, regardless of treatment. These differences were predominantly found in the trochlear scores across all treatment groups. Clinical Relevance: These data suggest that patient sex could be more influential in the progression of PTOA than surgical treatment after ACL injury. Identifying factors responsible for this discrepancy may prove valuable to identify targets to slow PTOA progression in male and female ACL-injured populations.

P184 Relationship Between Patient Sex and Serum Tumor Necrosis Factor Antagonist Drug and Anti-Drug Antibody Concentrations in Inflammatory Bowel Disease; A Nationwide Cohort Study

Abstract Background Anti-drug antibodies to infliximab (ATI) and adalimumab (ATA) are associated with loss of response to tumor necrosis factor antagonist (anti-TNF) therapy in inflammatory bowel disease (IBD). We evaluated the relationship between patient sex and serum TNF antagonist drug and antibody concentrations in inflammatory bowel disease Methods A nationwide multicenter retrospective cohort study was conducted by evaluating patients’ charts from July 2018 until September 2021. The effect of patient sex on anti-drug antibodies and serum drug concentration in patients with IBD across 7 hospitals was investigated. A subgroup analysis also investigated the effect of anti-TNF combination therapy. Geometric means were calculated, and multiple linear regression was used to estimate the adjusted ratio of geometric means (RoGM) and their 95% confidence intervals (CI). Results In the total study sample (n = 1093), males receiving infliximab had higher anti-drug antibody concentrations (38.3 vs. 22.3 AU/ml; aRoGM = 1.72, 95% CI: 1.30–2.27, p-value &amp;lt;0.001) compared to females. Additionally, infliximab serum drug concentrations among males were lower compared to females (2.6 vs. 4.1 ug/ml; aRoGM = 0.62, 95% CI: 0.44–0.88, p-value = 0.007). In the subgroup analysis (n = 359), male compared to female patients on combination therapy with infliximab and immunomodulators had similar anti-drug antibody concentrations (30.2 vs. 21.9 AU/ml; aRoGM = 1.38, 95% CI: 0.79–2.40, p-value = 0.254). There was no difference in the anti-drug antibody and serum drug concentrations among males and females on adalimumab. Conclusion In patients receiving infliximab, anti-drug antibodies were higher in males than females. Consistent with this, serum drug concentrations were lower in males than females on infliximab. There was no difference in anti-drug antibody and serum drug concentrations among males and females on adalimumab. In addition, no difference in anti-drug antibodies between males and females receiving anti-TNF combination therapy was observed

Relationship Between Patient Sex and Serum Tumor Necrosis Factor Antagonist Drug and Anti-drug Antibody Concentrations in Inflammatory Bowel Disease; A Nationwide Cohort Study.

Background: Anti-drug antibodies to infliximab (ATI) and adalimumab (ATA) are associated with loss of response to tumor necrosis factor antagonist (anti-TNF) therapy in inflammatory bowel disease (IBD). We evaluated the relationship between patient sex and serum TNF antagonist drug and antibody concentrations in inflammatory bowel disease.Methods: A nationwide multicenter retrospective cohort study was conducted by evaluating patients' charts from July 2018 until September 2021. The effect of patient sex on anti-drug antibodies and serum drug concentration in patients with IBD across seven hospitals was investigated. A subgroup analysis also investigated the effect of anti-TNF combination therapy. Geometric means were calculated, and multiple linear regression was used to estimate the adjusted ratio of geometric means (RoGM) and their 95% confidence intervals (CI).Results: In the total study sample (n = 1093), males receiving infliximab had higher anti-drug antibody concentrations (38.3 vs. 22.3 AU/ml; aRoGM = 1.72, 95% CI: 1.30–2.27, p < 0.001) compared to females. Additionally, infliximab serum drug concentrations among males were lower compared to females (2.6 vs. 4.1 ug/ml; aRoGM = 0.62, 95% CI: 0.44–0.88, p = 0.007). In the subgroup analysis (n = 359), male compared to female patients on combination therapy with infliximab and immunomodulators had similar anti-drug antibody concentrations (30.2 vs. 21.9 AU/ml; aRoGM = 1.38, 95% CI: 0.79–2.40, p = 0.254). There was no difference in the anti-drug antibody and serum drug concentrations among males and females on adalimumab.Conclusion: In patients receiving infliximab, anti-drug antibodies were higher in males than females. Consistent with this, serum drug concentrations were lower in males than females on infliximab. There was no difference in anti-drug antibody and serum drug concentrations among males and females on adalimumab. In addition, no difference in anti-drug antibodies between males and females receiving anti-TNF combination therapy was observed.

The effect of patient sex on the efficacy and safety of anticancer immunotherapy

ABSTRACT Introduction: Immune checkpoint inhibitors (ICIs) have improved the prognosis of patients with several types of cancer. A sex-based dimorphism in efficacy and toxicity of chemotherapies is well known and was recently described for anticancer immunotherapy. Areas covered: This review presents an overview of existing biological differences between males and females, including the immune system dimorphism, which represent the rationale for a sexual dimorphism in activity and toxicity of anticancer immunotherapies. Expert opinion: Clinical and preclinical research focused its efforts on the characterization of cancer molecular background and the complexity of tumoral microenvironment. Host factors, such as sex of a patient, and their potential roles in modulating cancer behavior as well as sensitivity and toxicity to anticancer treatments have been under-evaluated and poorly studied. Differences between males and females have been reported in studies with chemotherapy, both in activity and toxicity. Sex-based dimorphism is well known and relies on a complex interplay between immune functions, hormones, genes, and microbioma. With the extensive use of new drugs such as ICIs that lead to an immune system activation, the role of sex in modulating responses and immune-related toxicities needs to be taken into account to further tailor therapeutic approaches for males and females.

Sex differences in continuous-flow ventricular assist device therapy for advanced heart failure.

The effect of patient sex in continuous-flow ventricular assist device (c-VAD) therapy has not been well described. We investigated sex-specific differences in clinical outcomes related to c-VAD therapy for Japanese patients. We retrospectively analyzed 153 patients, including 41 (27%) female patients who underwent c-VAD implantation over the last 13years in our institution for a mean follow-up of 766 ± 446days. Clinical outcomes were compared between male and female patients RESULTS: There was no significant difference in mortality, cerebral vascular accidents, the severity of heart failure, or driveline infection in patients who underwent c-VAD implantation, regardless of sex. While male patients tended to have more bleeding at the time of surgery, female patients had significantly higher rates of non-surgical bleeding during subsequent c-VAD therapy, mainly from gynecological origins. Female patients treated with c-VAD had a significantly higher incidence of non-surgical bleeding events. Careful attention to gynecological complications and sex-specific care is required in female patients with c-VAD.

Sex differences in immune responses to influenza vaccine in healthcare workers during the 2019–2020 influenza season

Abstract Seasonal influenza epidemics affect 5–15% of the world population with an estimated 290,000–650,000 annual respiratory deaths due to influenza. The Center for Disease Control recommends annual influenza vaccination for healthcare workers (HCWs) because not only does their occupation increase their risk of contracting influenza, but HCWs care for people at higher risk for developing influenza-related complications. Studies have shown immune responses, such as seroconversion, differ between male and female vaccine recipients, but few have focused on HCWs and their influenza vaccine responses by sex. To understand sex differences in immune responses to the influenza vaccine in the HCW population, 50 male and 50 female were recruited during the 2019–2020 influenza season as part of the Johns Hopkins Center for Excellence in Influenza Research and Surveillance (JH-CEIRS) annual serological surveys among Johns Hopkins Hospital HCWs that takes part in the annual hospital-wide vaccination campaigns. Participants were recruited just prior to receiving their annual quadrivalent influenza vaccine (QIV), which targets influenza strains A/Brisbane/H1N1, A/Kansas/H3N2, B/Colorado (Victoria lineage), and B/Phuket (Yamagata lineage). Whole blood was collected at 0, 7 and 28 days post-vaccination. Neutralizing antibody assays will be used to measure pre and post antibody titers against the H1N1 and H3N2 vaccine components. We will also analyze vaccine-specific B cell responses from peripheral blood mononuclear cells (PBMCs) at 7 and 28 days post-vaccination via flow-cytometry. This study will provide extensive data on the effects of patient sex on influenza vaccine-induced antibody responses and B cell phenotypes in the HCW.

Effect of Patient Sex on the Severity of Coronary Artery Disease in Patients with Newly Diagnosis of Obstructive Sleep Apnoea Admitted by an Acute Coronary Syndrome.

BackgroundThe cardiovascular consequences of obstructive sleep apnoea (OSA) differ by sex. We hypothesized that sex influences the severity of acute coronary syndrome (ACS) in patients with OSA. OSA was defined as an apnoea–hypopnoea index (AHI)>15 events·h-1. We evaluated the severity of ACS according to the ejection fraction, Killip class, number of diseased vessels, number of stents implanted and plasma peak troponin level.MethodsWe included 663 men (mean±SD, AHI 37±18 events·h-1) and 133 women (AHI 35±18 events·h-1) with OSA.ResultsThe men were younger than the women (59±11 versus 66±11 years, p<0.0001), exhibited a higher neck circumference (p<0.0001), and were more likely to be smokers and alcohol users than women (p<0.0001, p = 0.0005, respectively). Body mass index and percentage of hypertensive patients or diabetics were similar between sexes. We observed a slight tendency for a higher Killip classification in women, although it was not statistically significant (p = 0.055). For men, we observed that the number of diseased vessels and the number of stents implanted were higher (p = 0.02, p = 0.001, respectively), and a decrease in the ejection fraction (p = 0.002).ConclusionsThis study shows that sex in OSA influences the severity of ACS. Men show a lower ejection fraction and an increased number of diseased vessels and number of stents implanted.

Do patient race and sex change surgeon recommendations for TKA?

Prior investigations have suggested that physician-related factors may contribute to differential use of TKA among women and ethnic minorities. We sought to evaluate the effect of surgeon bias on recommendations for TKA. Using an experimental approach with standardized patient scenarios, we sought to evaluate surgeon recommendations regarding TKA, specifically to determine whether recommendations for TKA are influenced by (1) patient race, and (2) patient sex. We developed four computerized scenarios for all combinations of race (white or black) and sex (male or female) for otherwise similar patients with end-stage knee osteoarthritis. Patients gave an orthopaedic history of 2years worsening pain with decreased functional status and failure of oral antiinflammatory medications and corticosteroid intraarticular injections. Orthopaedic surgeons attending the 2012 annual meetings of the New York State Society of Orthopaedic Surgeons and American Association of Hip and Knee Surgeons were recruited for the study. Surgeons passing an open recruitment table at each meeting were asked to participate. Of the 1111 surgeons in attendance at either meeting, 113 (10.2%) participated in the study. All participants viewed the "control" patient's story (white male) and were randomized to view one of the three "experimental" scenarios (white female, black male, black female). After viewing each scenario, the participants were anonymously asked whether they would recommend TKA. An a priori power analysis showed that 112 participants were needed to detect a 15% difference in the likelihood of recommending surgery for white versus nonwhite patients in the test scenarios evaluated with 90% power at a level of significance of 0.05. Of the 39 surgeons who viewed the white male plus black female scenario, there were 33 (85%) concordant responses (TKA offered to both patients) and six discordant responses (TKA offered to only one of the patients), with no effect of patient race and sex (p=0.99). Of the 37 surgeons who viewed the white male plus black male scenario, there were 33 (89%) concordant responses and four discordant responses, with no effect of patient race (p=0.32). Of the 37 surgeons who viewed the white male plus white female scenario, there were 30 (77%) concordant responses and seven discordant responses, with no effect of patient sex (p=0.71). After orthopaedic surgeons viewed video scenarios of patients with end-stage knee osteoarthritis, patient race and sex were not associated with a different likelihood of a surgical recommendation. Our findings support the notion that patient race and sex may be less influential on decision making when there are strong clinical data to support a decision. Physician bias may have a greater effect on decision making in situations where the indications for surgery are less clear.

The effect of patient sex on the incidence of early adverse effects in a population of elderly patients.

Patient sex is known to influence the response to general and regional anaesthesia and recovery after surgery. However, most studies come from analyses carried out on middle-aged patients. As most of the patients admitted to the post-anaesthesia recovery room in our institution are elderly, we took the opportunity to investigate the association between sex and incidence of early adverse events in this older population of patients after major surgery. Consecutive patients undergoing general, orthopaedic, urological and gynaecological surgery, admitted to the recovery room of our institution over a 15-month period, were retrospectively studied. The following adverse events were considered in the analysis: shivering, postoperative nausea and vomiting, hypotension and hypertensive responses, new arrhythmias requiring treatment, acute respiratory failure and desaturation. A total of 1347 patients (mean age 73.3±15.1 years, 61.4% women) were included. Women showed a higher incidence of shivering (relative difference +48%, P=0.0003), postoperative nausea and vomiting (+91%, P<0.0001), hypotension (+32%, P=0.044) and desaturation (+60%, P=0.0030) than men. The incidence of hypertensive response, arrhythmias and acute respiratory failure were not statistically significantly different. The findings of this exploratory study suggest that women have a higher risk of early postoperative adverse events even in a more elderly population.

Re: The effect of patient sex on survival in patients undergoing isolated coronary artery bypass surgery receiving a radial artery

Re: The effect of patient sex on survival in patients undergoing isolated coronary artery bypass surgery receiving a radial artery

The effect of patient sex on survival in patients undergoing isolated coronary artery bypass surgery receiving a radial artery

To determine whether patient sex makes a difference to in-hospital mortality and survival in patients undergoing isolated coronary artery bypass graft surgery (CABG) receiving a radial artery graft. Analysis of consecutive patients on a validated prospective cardiac surgery database was performed for patients undergoing isolated CABG. Uni- and multivariate analyses were performed for in-hospital mortality and long-term survival. A propensity analysis was also performed. Overall mortality was 2.1% (n = 284) for all cases, n = 13 369. Median follow-up was 7.0 (interquartile range 4.1-10.1) years. Of the cases 28.2% of males (n = 384) and 29.7% of females (n = 764) had a radial artery utilized. Univariate analysis demonstrated that in-hospital mortality was significantly lower in male patients, P < 0.001, and radial artery use was associated with increased survival in males, P < 0.0001, but not in females, P = 0.82. In male patients, multivariate analysis failed to identify the radial artery as a risk factor for in-hospital death. The radial artery was identified as a significant prognostic factor, associated with improved long-term survival (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.69-0.88, P = 0.0001). Propensity analysis confirmed this finding (HR 0.76, 95% CI 0.67-0.86, P < 0.0001). In female patients, multivariate analysis failed to identify the radial artery as a significant factor determining in-hospital mortality or long-term survival. Propensity analysis confirmed these findings. Males derive a significant survival advantage if they receive a radial artery graft when undergoing isolated CABG. The radial artery makes no difference to long-term survival in female patients. Radial artery use does not affect in-hospital mortality regardless of patient sex.

Effect of patient sex on triage for ischaemic heart disease and treatment onset times: A retrospective analysis of Australian emergency department data

Time between emergency department (ED) presentation and treatment onset is an important, but little-researched phase within the revascularization process for ischaemic heart disease (IHD). ObjectiveTo determine if sex influences triage score allocation and treatment onset for patients with IHD in the ED. MethodsRetrospective data for patients 18–85years presenting to EDs from 2005 to 2010 for acute myocardial infarction (AMI), unstable and stable angina, and chest pain were analysed collectively and separately for AMI. ResultsProportionately more men (61% of males) were triaged correctly for AMI than women (51.4% of females; P<0.001). Across all triage categories, average treatment time was faster for men than women with AMI (P<0.001). When incorrectly triaged for AMI, treatment time for men was faster than for women (P=0.04). When correctly triaged for AMI, there was no difference in mean treatment time between men and women (P=0.538). ConclusionsSubstantial undertriage of AMI occurred for both sexes, but was worse in women. Incorrect triage led to prolonged treatment times for AMI, with women’s treatment delays longer than men’s. When triaged correctly, both sexes were treated early for AMI, emphasising the need for all patients to be accurately triaged for this time-sensitive disease.

Effect of Patient Sex on White Matter Alterations in Unilateral Medial Temporal Lobe Epilepsy with Hippocampal Sclerosis Assessed by Diffusion Tensor Imaging

Studies shows ictal behavior and symptoms are affected by patient sex in temporal lobe epilepsy. The purpose of our study was to determine whether alterations in the WM as assessed by DTI display different patterns in male and female patients with unilateral HS. Patients with unilateral HS were categorized as women with right HS (n=12), men with right HS (n=10), women with left HS (n=12), and men with left HS (n=10). DTI of the brain along 64 noncollinear directions was obtained from 44 patients and 37 sex-matched control participants. We used TBSS to analyze whole-brain WM. Regions with significant changes of FA and MD, and their mean FA, MD, total number of significant voxels, and asymmetry indices were determined for each group. All groups showed bilateral and extensive reductions of FA and elevated MD in the WM, more prominent ipsilateral to the affected hippocampus. The total number of voxels with decreased FA in patients compared with that of control participants was higher in women with right HS (24,727 vs 5,459) and in men with left HS (27,332 vs 14,013) than in their counterparts. Changes in MD associated with right HS were more extensive in both men and women (right vs left HS, women: 16,926 vs 5,458; men: 5,389 vs 4,764) than in those with left HS. In patients with right HS, the ipsilateral cingulum, uncinate fasciculus, internal and external capsules, and right acoustic radiation were involved extensively in women. Women and men showed different patterns in extent of WM alterations associated with HS.

Effect of patient sex on general anaesthesia and recovery

Numerous studies have shown that women emerge faster from general anaesthesia than men, and differ in their postoperative recovery profile. The extent and underlying mechanisms for these sex-related differences in general anaesthesia are unclear. In a multicentre, prospective, matched cohort study, 500 ASA physical status I or II patients of either sex undergoing general anaesthesia for elective surgery were recruited. All subjects received a general anaesthetic through inhalation. Anaesthetic drugs and doses used, bispectral index (BIS) scores, recovery times, pain scores, and 40-item quality of recovery (QoR-40) scores for 3 days after general anaesthesia were recorded. Women had higher BIS scores at similar concentrations of anaesthesia (P<0.05). Time to eye-opening (P<0.01) and time to obeying commands (P<0.01) were shorter in women. Duration of recovery room stay was longer in women, who also had higher pain scores and need for treatment of nausea and vomiting (all P<0.001). QoR-40 scores for the first 3 days after general anaesthesia were lower in women (P<0.001). Plasma progesterone concentrations in women negatively correlated with the time to eye-opening (ρ=-0.53, P=0.01). Patient sex is an independent factor influencing the response to anaesthesia and recovery after surgery. Women emerged faster from general anaesthesia but their overall quality of recovery was poorer. Female sex hormones, particularly progesterone, might be involved, with premenopausal women having faster recovery time but poor overall recovery.

The effect of patient sex on recurrence of atrial fibrillation following successful direct current cardioversion

The effect of patient sex on recurrence of atrial fibrillation after a successful direct current cardioversion is unknown. This prospective study included 773 patients (486 [63%] men and 287 [37%] women) undergoing successful direct current cardioversion of atrial fibrillation between May 2000 and July 2003. Patient characteristics at presentation were recorded. The primary end point was the time between cardioversion and the first documented recurrence of arrhythmia. At presentation, women were older and had a higher prevalence of hypertension and valvular disease compared with men. In addition, women had worse mechanical left atrial appendage function. Arrhythmia recurrence was more prevalent in women (50.0% at 1 year compared with 43.4% in men, and 75.8% at 2 years compared with 67.0% in men; P = .03). On the basis of multivariate analysis, patient sex was a significant predictor of arrhythmia recurrence. There was no significant difference in overall mortality between men and women. Women were more likely than men to have recurrence of atrial fibrillation after successful direct current cardioversion. Patient sex should be taken into account with other clinical factors when making the decision about cardioversion for atrial fibrillation.

Effect of patient sex, clinician sex, and sex role on the diagnosis of Antisocial Personality Disorder: Models of underpathologizing and overpathologizing biases

This study examined the influence of patient sex and clinician sex and sex role for a case, meeting minimum diagnostic criteria for Antisocial Personality Disorder, in which patient sex was varied. The purpose was to provide an in-depth evaluation of the process by which patient sex and characteristics of clinicians may contribute to bias in personality disorder diagnoses. Psychologists (N = 167) read two cases, including the target case, and provided symptom ratings and diagnoses. A sex-unspecified condition served as a baseline to assess for over- and underpathologizing bias, and diagnoses based on the symptom ratings were compared to assigned diagnoses. Clinician sex role was assessed using the Bem Sex Role Inventory-Short Form. Results revealed that bias occurred when the patient's sex (female) was inconsistent with the gender weighting of the symptoms in the case (masculine), but the direction of the bias was consistent with sex roles (underdiagnosis of sex-role-inconsistent diagnoses, overdiagnosis of sex-role-consistent diagnoses). Path models of over- and underdiagnostic bias were developed using structural equation modeling. Patient sex had a direct effect on diagnostic ratings whereas clinician sex role had an indirect effect through symptom ratings.

Sex differences in injury severity and outcome measures after traumatic brain injury

Slewa-Younan S, Green AM, Baguley IJ, Gurka JA, Marosszeky JE. Sex differences in injury severity and outcome measures after traumatic brain injury. Arch Phys Med Rehabil 2004;85:376–9. Objective To investigate the effect of a patient’s sex on various measures of injury severity and outcome after rehabilitation in a matched sample of patients with traumatic brain injury (TBI). Design Retrospective data were retrieved from a database that contains information routinely collected on all patients admitted for inpatient rehabilitation. Setting Inpatient rehabilitation unit of major teaching hospital in Australia. Participants Fifty-four women with TBI after a motor vehicle crash (MVC) were identified from the Brain Injury Rehabilitation Database. An equal number of men were then matched for age and years of education. All subjects met the study admission criteria of having being involved in a high-speed MVC. Exclusion criteria included history of a previous head injury, chronic amnesia, psychiatric disturbance, and significant alcohol and/or substance abuse. Interventions Not applicable. Main outcome measures Differences, by sex, in patient scores on measures of injury severity and outcome after TBI. Results Men had significantly greater levels of injury severity as indicated by the Glasgow Coma Scale scores ( U=994.0, P=.002) and length of posttraumatic amnesia ( U=880.0, P=.016) when compared with women. No significant sex differences existed in the outcome measures or in injuries not associated with the central nervous system. Conclusions Few investigations exist on the effect of patient sex on measures of injury severity and outcome after a TBI. In the present study, men’s levels of injury severity were greater than women’s despite the same admission criteria (high-speed MVC) being applied to both sexes.