Healthcare disparities in quality represent one of the greatest challenges in achieving uniformly high-quality care (1). Research reporting disparities in surgical outcomes are abundant (2-6). The cornerstone of delivering high quality healthcare is ensuring optimal access for all patients. A relative lack of access to surgical services may be a contributing factor to disparities in surgical outcomes.Access is "the timely use of personal health services to achieve the best possible outcomes" (7). Utilization of services, the process of entering and staying in the system, and the actual quality of care received are all involved. Disparities in access arise when the system disproportionately under-performs for a specific group of patients relative to the historically

Key Points Question Can a risk score for sustained prescription opioid use after surgery be developed for a working-age population using readily available clinical information? Findings In this case-control study of 86 356 patients undergoing 1 of 10 common surgical procedures, prior opioid exposure was the factor most strongly associated with sustained opioid use. The group with the lowest Stopping Opioids After Surgery scores (<31) had a mean 4.1% risk of sustained opioid use; the group with intermediate scores (31-50) had a mean risk of 14.9%; and the group with the highest scores (>50) had a mean risk of 35.8%. Meaning The scoring system developed in this study may inform the risk of sustained prescription opioid use after surgery and be scalable to clinical practice.

BackgroundWith limited health care resources, bibliometric studies can help guide researchers and research funding agencies towards areas where reallocation or increase in research activity is warranted. Bibliometric analyses have been published in many specialties and sub-specialties but our literature search did not reveal a bibliometric analysis on Cardiovascular Magnetic Resonance (CMR). The main objective of the study was to identify the trends of the top 100 cited articles on CMR research.MethodsWeb of Science (WOS) search was used to create a database of all English language scientific journals. This search was then cross-referenced with a similar search term query of Scopus® to identify articles that may have been missed on the initial search. Articles were ranked by citation count and screened by two independent reviewers.ResultsCitations for the top 100 articles ranged from 178 to 1925 with a median of 319.5. Only 17 articles were cited more than 500 times, and the vast majority (n = 72) were cited between 200–499 times. More than half of the articles (n = 52) were from the United States of America, and more than one quarter (n = 21) from the United Kingdom. More than four fifth (n = 86) of the articles were published between the time period 2000–2014 with only 1 article published before 1990. Circulation and Journal of the American College of Cardiology made up more than half (n = 62) of the list. We found 10 authors who had greater than 5 publications in the list.ConclusionOur study provides an insight on the characteristics and quality of the most highly cited CMR literature, and a list of the most influential references related to CMR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0303-9) contains supplementary material, which is available to authorized users.

Background: Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma. Materials and methods: This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury. Results: Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission. Conclusions: Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in

In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.

Background Despite the number of female medical-school applicants reaching an all-time high and the increasing number of females in surgical training, males retain an overwhelming majority in senior surgical academic positions and formal leadership positions. This study aims to better understand the extent of and influences for gender disparity in general surgical societies throughout North America, Europe, and Oceania. Methods Data collection for this retrospective cross-sectional study took place between June and December 2017. Committee and subcommittee members from the eight selected general surgical societies that met the inclusion criteria (n = 311) were compiled into an Excel spreadsheet in which the data was recorded. Analyzed metrics included university academic ranking, surgical society leadership position, h-index, number of citations, and total publications. SCOPUS database (Elsevier, Amsterdam, Netherlands) was used to generate author metrics, and STATA version 14.0 (StataCorp, College Station, TX) was used for statistical analysis. Results Overall, 83.28% of members of the entities we studied were male and 16.72% were females. Males had significantly higher representation than females in all societies (Pearson chi 2 = 29.081; p-value = 0.010). Females were underrepresented in all society leadership positions and university academic rankings. Male members had a higher median h-index, more number of citations, and more total publications. Conclusions The composition of the general surgical societies included in this study demonstrated significant gender disparity. Female inclusivity initiatives and policies must be initiated to promote greater research productivity and early career opportunities for female surgeons in the specialty of general surgery.

Using bibliometric knowledge, authors can craft a title, abstract, and text that may enhance visibility and citation count over what they would otherwise experience.

Purpose The feasibility of using physical activity monitors (PAMs) to measure functional status in patients with cancer is unclear. We aimed to determine the feasibility of using PAMs to longitudinally assess physical activity and performance status (PS) in patients with cancer. Methods Patients with cancer who had Eastern Cooperative Oncology Group (ECOG) PS of 0 to 2 and were receiving systemic therapy were enrolled in a prospective pilot trial of PAM use. Feasibility was defined as patients using the PAM for > 50% of the observation period. We correlated PAM-reported measures with scores from ECOG PS and quality-of-life tools (Functional Assessment of Cancer Therapy–General [FACT-G], Quick Inventory of Depressive Symptoms–Self-Rated 16 [QIDS-SR16], and Brief Fatigue Inventory [BFI]) using Pearson’s correlation test. Patients were surveyed regarding their experience with PAMs at study completion. Results In all, 24 patients were enrolled; mean age was 54 years, 16 (67%) were women, and 19 (79%) were white. Twenty-three patients (96%) met the primary end point of feasibility. The median duration of follow-up was 69 days. Mean PAM-measured steps for ECOG PS of 0, 1, and 2 were 5,911, 1,890, and 845 steps per day, respectively ( P = .002). Minimum steps per day correlated with BFI ( r = –0.53; P < .01), FACT-G ( r = 0.45; P = .02), and QIDS-SR16 ( r = –0.57; P < .01). Eighteen patients (75%) reported a positive experience with the PAM. Conclusion PAMs are a feasible tool for measuring long-term physical activity in patients with cancer who are receiving systemic therapy. PAM-derived measures correlated with clinician-assessed PS.