Private Practice Research Articles

Clinical outcomes of the light adjustable lens in eyes with a history of prior corneal refractive surgery.

This study aimed to evaluate the visual and refractive outcomes in eyes with a history of laser corneal refractive surgery implanted with the second-generation light-adjustable lens (LAL). Private Practice, Sioux Falls, South Dakota, US. Retrospective, consecutive case series. Eyes with a history of prior corneal refractive surgery that underwent cataract surgery with implantation of the LAL and were targeted for plano were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and the percentage (%) of eyes within ±0.25 diopter (D), ±0.50D, and ±1.00 D of their refractive target. 76 eyes from 70 patients were included. A total of 45 eyes with a history of one prior refractive surgery and 31 eyes with a history of ≥2 refractive surgeries were included. 74% (n=56) of all eyes achieved UDVA of 20/20 or better, 88% (n=67) achieved 20/25 UDVA or better and 93% (n=71) were correctable to 20/20 or better postoperatively. For refractive outcomes, 66% of eyes (n=50) were within ±0.25 D and 86% (n=65) were within ±0.50 D of refractive target. Patients with a history of laser corneal refractive surgery achieved favorable visual and refractive outcomes with the LAL. This intraocular lens (IOL), which affords postoperative adjustability, is a promising option for patients with a history of corneal refractive surgery who maintain high expectations for functional uncorrected acuity following cataract surgery.

Results of the AABP Salary Survey

There has not previously been information available about the incomes of bovine-focused veterinarians in the United States and Canda across career stages, locations and types of employment. A survey was distributed to bovine veterinarians in late 2022 to obtain information about their employment types, incomes, demographics and satisfaction. Across career stages and employment types, men earn more income than women in bovine-focused veterinary medicine. Job satisfaction increases with higher income and decreases in private practice with more hours worked

Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis.

Does endometriosis prevalence differ in patients with obstructive Müllerian anomalies (OMA) versus those with nonobstructive Müllerian anomalies (NOMA), and in patients with NOMA versus those without Müllerian anomalies? The quantitative synthesis of published data demonstrates a substantially increased prevalence of endometriosis in patients with OMA compared with those with NOMA, and a similar prevalence in patients with NOMA and those without Müllerian anomalies. The pathogenesis of endometriosis has not been definitively clarified yet. A higher prevalence of endometriosis in patients with OMA than in those with NOMA would support the retrograde menstruation (RM)/implantation theory, whereas a higher prevalence of endometriosis in the NOMA group than in the group without Müllerian anomalies would support the embryonic remnants/celomic metaplasia hypothesis. This systematic review with meta-analysis was restricted to full-length, English-language articles published in peer-reviewed journals between 1980 and 2023. The PubMed and EMBASE databases were searched using the keyword 'endometriosis' in combination with 'Müllerian anomalies', 'obstructive Müllerian anomalies', 'female genital malformations', 'retrograde menstruation', 'infertility', 'pelvic pain', and 'classification'. References from relevant publications were screened, and PubMed's 'similar articles' and 'cited by' functions were used. Studies were selected if they reported the prevalence of surgically confirmed endometriosis in either individuals with OMA compared to those with NOMA, or patients with NOMA compared to those without Müllerian anomalies. Cohort and case-control studies and case series were deemed eligible for inclusion. Noncomparative studies, studies not reporting both the number of individuals with endometriosis and the total number of those with Müllerian anomalies or with other gynecological conditions, those including exclusively data on patients with absent or uncertain menstrual function (e.g. complete Müllerian agenesis category), or with imperforate hymen were excluded. Two reviewers independently abstracted data. The risk of bias was assessed with the Risk of Bias In Non-randomized Studies of Exposures tool. The overall certainty of the evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Seven retrospective studies were included. The overall mean estimate of endometriosis prevalence was 47% (95% CI, 36-58%) in patients with OMA, and 19% (95% CI, 15-24%) in patients with NOMA, with a common odds ratio (OR) of 4.72 (95% CI, 2.54-8.77). The overall mean estimate of endometriosis prevalence in patients with NOMA was 23% (95% CI, 20-27%), and that in patients without Müllerian anomalies was 21% (95% CI, 20-22%), with a common OR of 0.95 (95% CI, 0.57-1.58). The overall certainty of the evidence according to GRADE guidelines was judged as low for both comparisons. Some NOMA subtypes may create a partial obstacle to menstrual efflux and/or generate dysfunctional myometrial contractions that favor transtubal reflux, thus increasing the risk of endometriosis and limiting the difference between OMA and NOMA. As infertility and pelvic pain are strongly associated with endometriosis, women with these symptoms are inappropriate controls. Confounding by indication could explain the lack of difference in endometriosis prevalence between patients with NOMA and those without Müllerian anomalies. The results of this meta-analysis support the validity of the RM theory but do not definitively rule out alternative hypotheses. Thus, RM may be considered the initiator for the development of endometriotic lesions, while not excluding the contribution of both inheritable and tissue-specific genetic and epigenetic modifications as disease-promoting factors. No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynecological practice. E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest. N/A.

Residency program factors affecting ACVS board examination pass rates from 2017 to 2021: A survey of ACVS small animal surgery residency programs.

To identify small animal surgery (SAS) residency program factors associated with board examination pass rates for the American College of Veterinary Surgeons (ACVS) board certification examinations. Online survey. Program directors of ACVS-registered SAS residency programs. An online survey was distributed to eligible 2021 ACVS SAS residency program directors. Respondents provided program information and Phase I and Phase II board examination pass rate data from 2017 to 2021. Programs were grouped based on overall combined board examination pass rates as "excellent" (≥90%) versus "adequate" (<90%). Data were analyzed using recursive partitioning. Responses from 36 ACVS SAS residency programs (18 private practice [PP], 18 academic programs [AP]) were included. Pass rates were considered "excellent" for 17/36 programs (11/17 AP, 6/17 PP). The strongest indicator of "excellent" programs was most mentors participating in rounds >75% of the time. Of those, the second indicator of "excellent" programs was a soft tissue caseload of <7 surgeries/resident/week. If the soft tissue caseload was >7 surgeries/resident/week, a high orthopedic caseload (>9 surgeries/resident/week) was indicative of "excellent" programs. If most mentors were not participating in rounds >75% of the time, APs were more likely to be "excellent." SAS APs may have higher ACVS board examination pass rates. Mentor involvement, caseload, and residency practice type may influence board examination pass rates. ACVS SAS residency programs' board examination pass rates may improve by optimizing mentor involvement and caseload regardless of practice type.

Changing industries and shifting gears

Changing from being a self-employed private practice vet­erinarian to working as a consultant for a large corporation requires self-awareness in what you like, dislike, excel at and require more training for. Audits on different facets of a dairy provide individuals the opportunity to use their brain more than their bodies; however, implementing consulting into a practice model is going to differ based on the clientele, the vet­erinarian and the interests of that veterinarian. Total mixed ration (TMR), parlor, heat, calf and data audits are all ways in which veterinarians can become more involved in a consult­ing role on the dairy and a valued team member. There are advantages and disadvantages to working in industry and an individual must weigh those options to decide what works best for them. In the end, the dairy industry and the veterinary pro­fession are changing, and we must evolve with the needs of the clients and customers we serve if we are going to continue to be a valued member of the team.

Impact of Advanced Image-Guided Systems on Correction of Corneal Astigmatism During Femtosecond Laser-Assisted Cataract Surgery

Purpose: To determine the effectiveness of the correction of corneal astigmatism utilizing the Alcon Image Guidance system (Ft. Worth, Texas) versus manual marking in the orientation of femtosecond laser-assisted astigmatic keratotomy incisions. Setting: This study was based in a private practice in Albany, New York, USA. Design: Retrospective review of patients undergoing FLACS from January 2018 to June 2022. Methods: Patients who underwent FLACS with Image Guidance (IG) and without IG were investigated. Variables including pre-operative K values, cylinder, spherical equivalent (SE), and visual acuity (VA) were collected, as well as the cyclorotation angle delta registered by IG, post- operative refractive cylinder, SE, and VA. The primary outcome was post-operative refractive cylinder in patients with IG compared to those without IG. Results: A total of 160 eyes were included, with 103 eyes who had IG and 57 eyes who did not have IG. Post-operative cylinder was similar in those with IG (0.31 +/- 0.36 D) compared to those without IG (0.31 +/- 0.37 D) (p=0.97). Average cyclorotation in the IG group was 2.82 ± 3.03 degrees. When cyclorotation was stratified into three groups (&lt;2.8 degrees, 2.8-8.5 degrees, &gt;8.5 degrees), no differences were found in post-operative refractive cylinder (p=0.35). Conclusions: Patients who underwent FLACS with Image Guidance had similar post-operative cylinder outcomes compared to those without Image Guidance. This study suggests that the accommodation of cyclotorsion using an advanced image guidance system is similar to that obtained with manual marking techniques in patients having 2 diopters or less of astigmatism corrected.

Defining practices suitable for care via teleconsultation in gynaecological and obstetrical care: a French Delphi survey

ObjectiveDelineate the scope of teleconsultation services that can be effectively performed to provide women with comprehensive gynaecological and obstetrical care.DesignBased on the literature and experts’ insights, we identified a list...

Minimally invasive non-surgical periodontal therapy of intrabony defects: A prospective multi-centre cohort study.

To assess the potential benefits of minimally invasive non-surgical therapy (MINST) in teeth with intrabony defects and to explore factors associated with the outcomes. A multi-centre trial was conducted in 100 intrabony defects in periodontitis patients in private practice. Steps 1 and 2 periodontal therapy including MINST were provided. Clinical and radiographic data were analysed at baseline and 12 months after treatment, with the primary aim being change in radiographic defect depth at 12 months. Eighty-four patients completed the 12-month follow up. The mean total radiographic defect depth reduced by 1.42 mm and the defect angle increased by 3° (both p < .05). Statistically significant improvements in probing pocket depth (PPD) and clinical attachment level (CAL) were seen at 12 months compared to baseline (p < .001). Fifty-six defects (66.7%) achieved pocket closure (PPD ≤ 4 mm) and 49 defects (58.3%) achieved the composite outcome (PPD ≤ 4 mm and CAL gain ≥3 mm). Deeper and narrower angled defects were positively correlated with radiographic and clinical improvements, respectively. Improvements in clinical and radiographic outcomes were seen after MINST. This study highlights the generalizability and wide applicability of this approach, further supporting its effectiveness in the treatment of intrabony defects. NCT03741374. https://clinicaltrials.gov/study/NCT03741374?cond=minimally%20invasive%20non%20surgical%20therapy&locStr=UK&country=United%20Kingdom&distance=50&rank=2.

A clinical audit of patient outcomes in real-world acupuncture practice.

Clinical auditing represents a valuable and cost-effective method for the collection of patient outcomes and is increasingly being used to inform clinical guidelines. The aim of this clinical audit was to assess patient outcomes across a small subset of acupuncture practitioners and private practices in the United Kingdom. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and the Patient Global Impression of Change (PGIC) scale were used as outcome measures. Additional questions assessed adverse events and patient experience with care. Clinical data were collected utilising an electronic patient-reported outcome measures (ePROMs) system. Baseline data were collected for a total of 233 health complaints (from 232 patients), of which 45.9% were musculoskeletal and 26.2% were psychological. Follow-up outcomes data were available for 144 health complaints (61.8% completion rate). For PGIC responses, >90% of health complaints were reported as at least 'minimally improved'. This was reduced to >51% when controlling for missing data. There was a gradual improvement in both mean MYMOP scores (24.5%-43.0%) and PGIC responses of 'very much improved' (12.3%-56.3%) over a 6-month period. A clinically significant improvement (>1 point change, p ⩽ 0.001) was seen in mean MYMOP scores compared to baseline from 4 to 8 weeks and symptom 1 MYMOP scores from 1 to 4 weeks. A moderately strong, negative correlation was seen between outcome measures (r = -0.507, p < 0.001). The majority of patients reported clinically meaningful improvements for their main health complaints/symptoms, which appeared to be sustained in the medium to long-term.

A clinical audit in a UK-based acupuncture private practice: assessing patient demographics, outcomes and experience.

The aim of this clinical audit was to assess patient demographics, outcomes and experience with care in patients who received acupuncture in a private practice setting in the United Kingdom. Demographic and clinical data were extracted from patients' records over a 7-year period. The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and an adapted Patient Global Impression of Change (PGIC) scale were used routinely to monitor patient outcomes over an 18-month period. Finally, a retrospective questionnaire was used to assess patient beliefs regarding treatment effectiveness, adverse events and overall experience with care. Patients not providing consent or known to be deceased were excluded. Data were collected for 306 patients presenting with 376 separate health complaints, 58% of which were musculoskeletal. Follow-up outcomes (MYMOP scores (n = 51) and PGIC scale responses (n = 50)) showed a clinically significant improvement compared to baseline for the majority of health complaints (93% of PGIC scores were 'improved' and 79% MYMOP demonstrated > 1 point change). Total mean MYMOP severity scores were reduced by almost 50% (p < 0.001) after 1-4 weeks, and this was sustained in the medium-to-long term. There was a strong negative correlation (r = -0.767, p < 0.001) between the MYMOP and PGIC scores. A total of 118 health complaints were reported by 85/255 patients who responded to a retrospective questionnaire. Over 84% of patients believed that the treatments they received were 'effective' at addressing their health complaints. Seven minor adverse events were reported and four patients experienced negative treatment outcomes. Although musculoskeletal conditions were the most common, this audit found that patients sought treatment for a wide range of predominantly chronic health complaints, for many of which there is a currently a lack of quality evidence to support the use of acupuncture. Overall, the small sample of patients who responded to outcome questionnaires reported clinically meaningful and sustained improvements.

Abstract PO1-09-12: Cancer health disparities among patients with early-stage estrogen receptor-positive (ER+) breast cancer treated in public or private practices in Brazil

Abstract Background Cancer registries in Brazil are deficient and data about patients’ profiles and cancer treatment patterns are scarce in the country. Moreover, while 30% of population has access to private insurance, almost 70% of population uses publicly health services. The objective of this work was to describe the sociodemographic and clinicopathological characteristics of women with early-stage ER+ breast cancer on adjuvant ET in different regions of Brazil, and to describe treatment patterns for this disease according public and private institutions. Methodology: We performed a real-world data analysis in different institution regions of Brazil. Women with a history of early-stage ER+ invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study in 12 centers in four different regions in Brazil. Demographic and clinicopathologic information was retrieved from medical records. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured. High education level was defined by completed high school. Data collection was done with RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. P &amp;lt; 0.05 was considered significant. Analyzes were performed in SAS 9.4; Results: From June 2021 to May 2023, a total of 461 women with ER+, early BC, were included in this analysis. A total of 233 (50.6%) came from private institutions, the mean age was 56.02 years (range 22-93), 47.69% were non-white, 61.3% were post-menopause, 61.7% lived with a partner, and 76.2% were highly educated and 66.81% had comorbidities. Tumor staging at diagnosis was classified as III, II and I respectively in 21.26%, 43.17% and 35.57% of all cases. Regarding treatment received, 62.4% of patients underwent lumpectomy, 32.2% had axillary dissection, 67.6% received (neo)adjuvant chemotherapy, 45.2% were on aromatase inhibitors and 14.19% were on ovarian function suppression plus ET . Median duration of ET use was 2.78 years (range 6 months- 9.61 years). Publicly health insurance was associated significantly associated with younger age at diagnosis (&amp;lt; 60 yo), premenopausal status, to live alone, lower educational level, more advanced tumors, prior mastectomy, prior axillary dissection, prior neo-adjuvant chemotherapy, prior radiotherapy, lower use of aromatase inhibitors, ovarian function suppression plus ET, and CDK4/6 inhibitors, while higher use of concomitant medications. Conclusion: The study shows significant health disparities among women with early-stage ER+ breast cancer treated in private versus public institutions in Brazil. Importantly, despite having more advanced tumors, women in public institution had less access to ovarian suppression, CDK4/6 inhibitors and were treated with more aggressive surgical procedures. A deep discussion involving government, lawmakers, health care providers and patients should be conducted to try to decrease the described disparities. Patient’s characteristic and patterns of treatment among patients with estrogen receptor-positive breast cancer on adjuvant therapy according to health insurance in Brazil ALND: axillary lymph node dissection; CDK4/6i: CDK4/6 inhibitors; ET: endocrine therapy; OS: ovary suppression. Citation Format: Romualdo Barroso-Sousa, Daniele Assad-Suzuki, Danielle Santos, Fernanda Moura, Sulene Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Andrea Shimada, Yuri Beckedorff, Maria Cristina Magalhães, Cristiano Souza, Carlos Paiva, Heloísa Resende, Daniela Pereira, Angelica Rodrigues, Daniela Rosa. Cancer health disparities among patients with early-stage estrogen receptor-positive (ER+) breast cancer treated in public or private practices in Brazil [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-12.

Dental hygiene students' and recent graduates' intentions, attitudes, and perceptions of academic careers.

The purpose of this study was to explore dental hygiene students' and recent graduates' awareness, attitudes, perceived barriers, motivators, and intentions to pursue a career in academia as a dental hygiene educator. Cross-sectional survey research was conducted with a non-probability sample of dental hygiene students and recent graduates (n=451). The survey included sections for familiarity regarding academic careers for dental hygienists, attitudes toward academic careers, barriers and motivating factors for this career path, and future academic career intentions. Analysis included descriptive, correlations, and regression. Of 451 surveys started, 296 were at least 80% complete for a completion rate of 66%. The most reported barrier to a career in academia was the cost to obtain the required degree to become an educator (67.6%, n=200), and for motivating factors was a sense of accomplishment (62.8%, n=186). Regression analysis of likelihood to pursue a higher education degree showed two main predictors; belief that higher education would advance the dental hygiene profession (β=0.35, p<0.001) and willingness to take a pay cut to become an educator (β=0.24, p<0.001). Overall dental hygiene students and recent graduates were familiar with and had a positive view of careers in academia. However, barriers included cost and time for obtaining a higher degree, as well as the pay differential between academia and private practice. The educator shortage in dental hygiene may be alleviated by providing educators with loan forgiveness and offering salaries comparable to clinical practice.

Assessment of Level of Awareness and Barriers to Low Vision Rehabilitation Among Optometrists in Pakistan

Introduction: Low vision rehabilitation provides strategies to substitute for visual impairment and the resultant limitations of low vision by enhancing remaining vision and other sensory or motor abilities in individuals. The purpose of this study was to evaluate the level of knowledge of and perceived barriers to providing low vision rehabilitation by optometrists in Pakistan. Methods: In this qualitative, cross-sectional study, a convenient sample of 100 participants was included and a structured, validated, self-administered questionnaire was provided to collect demographic information and to identify the level of knowledge, awareness, and perceived barriers regarding low vision rehabilitation. Data was analyzed using frequency distribution and Pearson's chi-square test to understand the significance of barriers to low vision care provision. Results: A total of 100 participants completed the study questionnaire (59 males, 41 females) with a mean age of 26 (±6.1 SD) years. Eighty-two participants (82%) had an adequate understanding of low vision as per WHO's criteria. However, 47% of participants failed to identify the steps of low vision rehabilitation. Newly graduated practicing optometrists (i.e., those with less than 3 years’ experience) had a significantly better understanding of low vision definition and low vision rehabilitation steps, as compared to more experienced optometrists ( p &lt; .05). Also, those working in private practices were more likely to consider low vision rehabilitation as less profitable ( p = .025, odds ratio = 2.56, CI = 1.1–5.8), compared to those working in hospitals. Discussion: Lack of training and unavailability of low vision devices are major barriers, as perceived by optometrists in Pakistan. Rigorous attempts are needed to educate eye care practitioners specifically optometrists about the availability and usage of low-cost, improved-quality, and up-to-date low vision devices in the country. Implications for practitioners: Continuous professional development through refresher courses is crucial to enhance knowledge of low vision rehabilitation. Educating optometrists to adopt a multidisciplinary and empathetic approach toward patient management may improve patients’ satisfaction and success with rehabilitative services.

Medical Education in Bangladesh and the United States: A Comparative Overview

This manuscript presents an overview of Bangladesh medical education system with a brief comparison to the United States. Despite differences in origins and structures, both share similarities and differences in their medical curricula and examination-driven approaches. The paper employs a non-systematic comparative review methodology, gathering information from diverse sources including government websites, educational institutions, and published articles. Medical education in Bangladesh traces its roots back to the mid-20th century, initially influenced by British educational practices. The country now boasts 76 medical colleges—23 public and 53 private—admitting approximately 7,156 students annually for the MBBS degree. The admission process is competitive, with strict eligibility criteria including completion of prerequisite courses and a minimum grade-point average. The five-year MBBS program followed by a one-year clinical internship is a standard pathway in Bangladeshi medical education, with further specialization achieved through fellowship training. In terms of structure, curriculum, and training programs, the Bangladesh medical education system aligns with a lecture-based, examination-focused approach. However, research initiatives are limited due to resource constraints, impacting the quality and quantity of publications. Financially, both public and private medical institutions in Bangladesh charge similar tuition fees ranging from $33,000 to $48,000 USD for the entire MBBS degree, with limited scholarship opportunities. Upon graduation, physicians often opt for private practice, contributing to concerns about retaining qualified medical professionals within the country, particularly in rural areas. Comparatively, the United States has a longstanding history of medical education dating back over two centuries. The American system, encompassing diverse nomenclature for medical schools and varying degrees, presents differences in the application process, structure, and postgraduate training compared to Bangladesh. This comprehensive review highlights the distinctions and commonalities between the medical education systems of the United States and Bangladesh, serving as a resource for prospective students, current practitioners, and residency program directors.

An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California.

Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.

Workplace Microaggressions: Results of a Survey of the American College of Surgeons Members

BackgroundWorkplace microaggressions are a longstanding but understudied problem in the surgical specialties. Microaggressions in healthcare are linked to negative emotional and physical health outcomes and can contribute to burnout and suboptimal delivery of patient care. They also negatively impact recruitment, retention and promotion, which often results in attrition. Further attrition at the time of an impending surgical workforce shortage risks compromising delivery of health care to the diverse US population and may jeopardize the financial stability of health care organizations. To date, studies on microaggressions have consisted of small focus groups comprised of women faculty or trainees at a single institution. There are no large, multi-organizational, gender-inclusive studies on microaggressions experienced by practicing surgeons. Objective(s)To examine the demographic and occupational characteristics of surgeons who do and do not report experiencing workplace microaggressions and whether these experiences would influence a decision to pursue a career in surgery again. Study DesignWe developed and internally validated a web-based survey to assess surgeon experiences with microaggressions and associated sequelae. The survey was distributed through a convenience sample of nine American College of Surgeons (ACS) online Communities from November 2022 to January 2023. All ACS Communities comprised members who had completed residency or fellowship training and had experience in the surgical workforce. The survey contained demographic, occupational, and validated microaggression items. Analyses include descriptive and chi-squared statistics, t-tests, and bivariable and multivariable logistic regression. ResultsThe survey was completed by 377 ACS members with the following characteristics: working as a surgeon (80.9%), non-Hispanic white (71.8%), general surgeons (71.0%), age ≥ 50 years (67.4%), fellowship-trained (61.0%), and women (58.4%). A total of 254 (67.4%) respondents reported experiencing microaggressions. Younger surgeons (p=0.002), women (p<0.001) and fellowship-trained surgeons (p=0.001) were more likely to report experiencing microaggressions than their counterparts. Surgeons working in academic medical centers or healthcare systems with teaching responsibilities were more likely to experience microaggressions than those in private practice (p<0.01). Surgeons currently working as a surgeon or those who are unable to work reported more experience with microaggressions (p=0.003). There was no difference in microaggressions experienced among respondents by surgical specialties, race/ethnicity, or for surgeons with a self-reported disability. In multivariable logistic regression, women had higher odds of experiencing microaggressions than men [aOR 15.9; 95% C.I.: 7.7-32.8] and surgeons in private practice had significantly lower odds of experiencing microaggressions compared to surgeons in academic medicine (aOR 0.3; 95% C.I. 0.1-0.8) or in healthcare systems with teaching responsibilities (aOR 0.2; 95% C.I. 0.1-0.6). Among surgeons responding to an online survey, respondents reporting microaggressions were less likely to say they would choose a career in surgery again (p<0.001). ConclusionsSurgeons reporting experience with microaggressions reflect the diversification of surgical specialties and subspecialties. With continued expansion of surgeon gender and race/ethnicity representation, deliberate efforts to address and eliminate workplace microaggressions could have broad implications for improving recruitment and retention of surgeons.

Survival Analysis up to 8 Years of 304 Anatomic-Contour Implant Zirconia Crowns Fabricated with a Fully Digital Cast-Free Workflow and Directly Screwed on External Hexagonal Implant Connections without the Interposition of a Ti-Base: A Multicentric Retrospective Study.

Data on the clinical performance of monolithic Zirconia screw-retained crowns on external hexagon implants fabricated from digital scans through a cast-free, fully digital workflow is lacking and needs to be included. This retrospective multicentric study aimed to evaluate the real-life clinical results of monolithic Zirconia screw-retained crowns without the interposition of a Ti-base on external hexagon implants fabricated from intraoral scans and a cast-free approach in private practices. Single external hex implant fixtures were restored with monolithic zirconia crowns without the interposition of a Tibase. The crowns were directly screwed on external hexagonal implant connections with a castfree, fully digital workflow. Data were analyzed using descriptive statistics and the Kaplan- Meier test. Between September 2022 and March 2023, the California Dental Association modified criteria were adopted for clinical evaluation after recalling all patients. A total of 304 single tooth restorations in the maxillary and mandibular posterior regions fabricated between July 2014 and July 2022 in 252 patients (120 males and 132 females, mean age 53.6 years, SD 23.3). Seven crowns were excluded because of patient dropout. The most common minor technical complications were screw loosening (3 crowns) and loss of the screw-access hole filling (3 crowns). Four failures included two implant failures with mobility and two fractured crowns. No screw or implant fractures were recorded. The overall cumulative survival rate was 98.6% and the average success rate (crowns experiencing no failures or complications) was 96.0%. The mean overall survival time was 101.3 months (standard error, 0.847; 95% confidence interval for the mean, 99.67-102.99). The overall survival probability was 87.9% up to 97 months. With careful case selection and comprehensive periodontal maintenance program, single crowns directly screwed onto an external hexagon platform have shown to have excellent survival and success (complication-free) rates, comparable to available data regarding single crowns with a metal implant- prosthetic interface.

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study

AimTo explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DesignA hermeneutic phenomenological approach. ParticipantsSix UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. MethodsIn-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. ResultsThree interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. ConclusionsPrivate practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. Contribution of the Paper•This research suggests that although private practice ownership brings increased freedom, flexibility, and job satisfaction, this is tempered by an array of increased pressures and responsibilities.•Practice growth was gradual, often involving luck and unexpected opportunities.•Clinic owners face challenging decisions regarding the selection, management and support of additional staff.

Does the Internet Provide Quality Information on Metoidioplasty? Using the Modified Ensuring Quality Information for Patients Tool to Evaluate Artificial Intelligence-Generated and Online Information on Metoidioplasty.

Public interest in gender affirmation surgery has surged over the last decade. This spike in interest, combined with extensive free online medical knowledge, has led many to the Internet for more information on this complicated procedure. This study aimed to evaluate the quality of online information on metoidioplasty. Google Trends in searches on "metoidioplasty" from 2004 to present were assessed. "metoidioplasty" was searched on three popular search engines (Google, Yahoo, and Bing), and the first 100 websites from each search were extracted for inclusion (Fig. 1). Exclusion criteria included duplicates, websites requiring fees, photo libraries, and irrelevant websites. Websites were assigned a score (out of 36) using the modified Ensuring Quality Information for Patients (EQIP) instrument, which grades patient materials based on content (18), identification (6), and structure (12). ChatGPT was also queried for metoidioplasty-related information and responses were analyzed using EQIP. Google Trends analysis indicated relative search interest in "metoidioplasty" has more than quadrupled since 2013(Fig. 2). Of the 93 websites included, only 2 received an EQIP score greater than 27 (6%). Website scores ranged from 7 to 33, with a mean of 18.6 ± 4.8. Mean scores were highest for websites made by health departments (22.3) and lowest for those made by encyclopedias and academic institutions (16.0). Websites with the highest frequency were research articles, web portals, hospital websites, and private practice sites, which averaged scores of 18.2, 19.7, 19.0, and 17.8, respectively. Health department sites averaged the highest content points (11.25), and academic institutions averaged the lowest (5.5). The average content point across all websites was 7.9 of 18. ChatGPT scored a total score of 29: 17 content, 2 identification, and 10 structures. The artificial intelligence chatbot scored the second highest score among all included online resources. Despite the continued use of search engines, the quality of online information on metoidioplasty remains exceptionally poor across most website developers. This study demonstrates the need to improve these resources, especially as interest in gender-affirming surgery continues to grow. ChatGPT and other artificial intelligence chatbots may be efficient and reliable alternatives for those seeking to understand complex medical information.

Agile privacy in practice: Integrating CCPA and GDPR within agile frameworks in the U.S. tech scene

Agile privacy in practice: Integrating CCPA and GDPR within agile frameworks in the U.S. tech scene