Clinical Orthopaedics & Related Research最新文献

{"title":"CORR Insights®: Does the Proportion of Women in Orthopaedic Leadership Roles Reflect the Gender Composition of Specialty Societies?","authors":"M. Mulcahey","doi":"10.1097/CORR.0000000000000914","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000914","url":null,"abstract":"Although women currently comprise of approximately half of all medical students, orthopaedic surgery has the lowest percentage of women residents of all medical specialties, at 14% in 2016-2017, which is up only slightly from 11% in 2005-2006 [3]. Several factors contribute to the continued gender disparity in orthopaedics, including medical students’ perceptions that the specialty is a physically demanding male-dominated field, beset with barriers to promotion and acceptance by senior faculty [2, 9]. A separate study surveying members of the Ruth Jackson Orthopaedic Society (RJOS) found that challenges related to work-life balance and a lack of strong mentorship contributed to the reluctance of women medical students to enter the field [10]. In addition to having a low proportion of women overall, less than 9% of full professors in orthopaedic surgery are women, the lowest percentage among all surgical specialties [4]. Improving gender diversity in orthopaedics will not happen until more women move up through the ranks; that process has been perpetually stagnant [2]. In the current study, Saxena and colleagues [11] highlighted the disparities between the gender distribution in the membership of a large number of subspecialty societies, and the gender breakdowns of the boards of directors of those societies. The authors queried the executive directors in each of the 23 American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies to determine the number and percentage of women members, the number of women on each society’s board of directors, the criteria for becoming a board member, and the presence or absence of a junior board member position (those younger than 45 years of age). The authors found a strong correlation between the percentage of women in a society and the percentage of women on the society’s board of directors [11]. The Pediatric Orthopaedic Society of North America had the highest percentage of women members (26%), but did not have the highest percentage of women on its board of directors (3 out of 20). The Orthopaedic Research Society had the highest percentage of women on its board of directors (7 out of 16), but did not have the highest percentage of women members (25%). The authors found no correlation between the presence of a junior board member position and the percentage of women in an orthopaedic society or the percentage of women on the board of directors in a society [11].","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82118045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Chair Versus Chairman: Does Orthopaedics Use the Gendered Term More Than Other Specialties?","authors":"A. Abdeen","doi":"10.1097/CORR.0000000000001026","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001026","url":null,"abstract":"Here’s a riddle many of us have heard: A father and his son are in a car crash. The father is killed. The son is taken to the hospital. Just as he’s rushed to the operating room the surgeon says: “I can’t operate. That boy is my son!” How can this be? The fact that it is not immediately evident to most of us that the surgeon is the boy’s mother, underscores the enduring impact of gendered occupational terms. Surgeon is one of many genderspecific job titles (like pilot, firefighter, foreman, nurse, and midwife) that conjures up a specific gender stereotype. If the gender of an individual is not typically associated with a given profession, we use statements of exemption such as “female-surgeon” or “male-nurse”, implying an outlier, or inferior member of that profession. I’m using the terms “female-surgeon” and “male-nurse” here because they are the common parlance for those particular professions, even though language of gender would be more appropriate in light of the fact that we’re discussing social roles here, rather than anything to do with biology (that is woman and man, rather than female and male, would be the preferred words) [5]. The gendered nature of occupations is pervasive, particularly in leadership positions in academic medicine where the title “chairman” is germane. The suffix “-man” comes from the Old English word for “person”, which in present-day English has become predominantly masculine [4]. The term “chairman” is under scrutiny as a possible source of gender bias in the current article by Peck and colleagues [10]. Exclusionary language hinders diversity in the workforce and perpetuates gender disparity [6]. This paper found that the gendered term “chairman” is used more frequently in orthopaedics than in many other medical specialties. It is well established that gender diversity in medicine benefits our patients and the organizations in which we work. According to a 2018 report from the Association of American Medical Colleges, “when health care providers have life experience that more closely matches the experience of their patients, patients tend to be more satisfied with their care and to adhere to medical advice. This effect has been seen in studies ... when the demographics of health care providers reflect those of underserved populations” [7]. Furthermore, diverse organizations are more successful—companies in the top quartile for gender diversity are 15% more likely to have returns above the industry mean [12]. Although historically a field dominated bymen, women are now entering medicine in increasing numbers. Since the 1972 enactment of Title IX, the number of women enrolled in US medical schools has drastically increased from 10% in 1970 to more than 50% today [2]. The greatest number of women in medicine are in internal medicine, pediatrics, and obstetrics and gynecology. In some specialties the percentage of women exceeds that of men such as in pediatrics and This CORR Insights is a commentary on the article “Ch","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81872574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Rates and Trends of Women Authors in Three High-Impact Orthopaedic Journals from 2006-2017?","authors":"Kathryn P Hiller, A. Boulos, Megan M. Tran, Aristides I. Cruz","doi":"10.1097/CORR.0000000000001043","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001043","url":null,"abstract":"BACKGROUND\u0000The gender gap among authors publishing research in journals is narrowing in general medicine and various medical and surgical subspecialties. However, little is known regarding the gender gap among authors publishing research in orthopaedic journals.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) What is the proportion of women first and last authors of original research articles in three high-impact orthopaedic journals from 2006 to 2017? (2) What is the proportion women first authors of original research by orthopaedic subspecialty from 2006 to 2017?\u0000\u0000\u0000METHODS\u0000A sample of original research publications from the even numbered months of issues of Clinical Orthopaedics and Related Research® (CORR®), the Journal of Bone and Joint Surgery, American volume (JBJS), and the American Journal of Sports Medicine (AJSM) were examined from 2006 to 2017. These journals were selected because of their clinical relevance, target audience, and relatively high impact factors. Over the studied period, a single author extracted and reviewed pertinent data, including the gender of the first and last authors and the primary subspecialty of the research article. The senior author refereed disputes regarding the primary subspecialty of each included article. The proportion of women first and last authors in each journal was compared between 2006 to 2017 using chi-square analysis. The proportion of women first authors according to orthopaedic subspecialty in which an article primarily focused its study was also compared between 2006 to 2017 using chi-square analysis.\u0000\u0000\u0000RESULTS\u0000Data were collected from 6292 articles, 13% (800) of which were first-authored by women and 10% (604) of which were last-authored by women. From 2006 to 2017, the overall percentage of women first authors in the examined journals increased (from 11% in 2006 to 17% in 2017; odds ratio 1.6563 [95 % CI 1.4945 to 1.8356]; p < 0.001). Overall across the period studied, the percentage of women first authors in JBJS was 14% while 12% of first authors in CORR and AJSM were women. Regarding subspecialty, the percentage of women first authorship ranged from 9% in the shoulder subspecialty to 21% in pediatric orthopaedics across all three journals.\u0000\u0000\u0000CONCLUSIONS\u0000There has been an increase in the percentage of women first authors in articles published in three high-impact orthopaedic journals from 2006 to 2017. This observed increase is encouraging in terms of promoting gender diversity in orthopaedics and may be reflective of a modest increase in the number of women entering the orthopaedic workforce.\u0000\u0000\u0000CLINICAL RELEVANCE\u0000Between 2006 and 2017, the overall number of women first authors in CORR, JBJS, and AJSM modestly increased. This may suggest a nascent narrowing of the gender gap in orthopaedics. Although this is a welcome finding in terms of promoting and encouraging gender diversity in this man-dominated field, the overall percentage of women authorship remains modest, at best. Future investigations should examin","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"37 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73963772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women.","authors":"E. Vina, D. Ran, E. Ashbeck, C. Kwoh","doi":"10.1097/CORR.0000000000001001","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001001","url":null,"abstract":"BACKGROUND\u0000When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) Does the association between widespread pain and no clinically important improvement in osteoarthritis-related pain and disability 2 years after TKA differ between men and women? (2) Does the use of pain medications 2 years after TKA differ between those with widespread pain and those without widespread pain before surgery?\u0000\u0000\u0000METHODS\u0000Osteoarthritis Initiative (https://nda.nih.gov/oai/) study participants were followed annually from March 2005 until October 2015. Participants who underwent TKA up to the 7-year follow-up visit with pain/disability assessment at the protocol-planned visit before TKA and at the second planned annual visit after surgery were included in the analysis. Among 4796 study participants, 391 had a confirmed TKA, including 315 with pain/disability assessment at the protocol-planned visit before TKA. Overall, 95% of participants (298) had the required follow-up assessment; 5% (17) did not have follow-up data. Widespread pain was defined based on the modified American College of Rheumatology criteria. Symptoms were assessed using the WOMAC pain (range 0 to 20; higher score, more pain) and disability (range 0 to 68; higher score, more disability) scores, and the Knee Injury and Osteoarthritis Outcome Score for pain (range 0 to 100; higher score, less pain). Improvements in pain and disability were classified based on improvement from established clinically important differences (decrease in WOMAC pain ≥ 1.5; decrease in WOMAC disability ≥ 6.0; increase in Knee Injury and Osteoarthritis Outcome Score for pain ≥ 9). At baseline, more women presented with widespread pain than men (45% [84 of 184] versus 32% [36 of 114]). Probability and the relative risk (RR) of no clinically important improvement were estimated using a logistic regression analysis in which participants with widespread pain and those without were compared. The analyses were done for men and women separately, then adjusted for depression and baseline outcome scores.\u0000\u0000\u0000RESULTS\u0000Among women, preoperative widespread pain was associated with an increased risk of no clinically important improvement 2 years after TKA, based on WOMAC pain scores (13.5% versus 4.6%; RR 2.93 [95% CI 1.18 to 7.30]; p = 0.02) and the Knee Injury and Osteoarthritis Outcome Score for pain (16.5% versus 4.9%; RR 3.39 [95% CI 1.34 to 8.59]; p = 0.02). Given the lower and upper limits of the confidence intervals, our data are compatib","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91429720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chair Versus Chairman: Does Orthopaedics use the Gendered Term More Than Other Specialties?","authors":"C. Peck, Soren J Schmidt, Darin Latimore, M. O’Connor","doi":"10.1097/CORR.0000000000000964","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000964","url":null,"abstract":"BACKGROUND\u0000Orthopaedics is the least gender-diverse medical specialty. Research suggests that the use of gendered language can contribute to workforce disparity and that gender-neutral language supports the inclusion and advancement of women, but the degree to which gender-neutral language is used by academic departments in what typically is a department's highest position (department chair) has not been characterized.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) Is the proportion of department websites that use the term chairman (as opposed to chair) greater in orthopaedics than in five other surgical and medical specialties? (2) Are departments led by chairs who are women less likely to use \"chairman\" than those led by men, and does this vary by specialty?\u0000\u0000\u0000METHODS\u0000Seven hundred fourteen official websites of orthopaedic, neurosurgery, general surgery, internal medicine, pediatrics, and obstetrics and gynecology departments affiliated with 129 allopathic medical schools were screened. Any use of the term chairman on title pages, welcome messages, and faculty profile pages was identified using a Boyer-Moore string-search algorithm and terms were classified based on their location on the site. The overall use of the term chairman was compared by specialty and gender of the chair.\u0000\u0000\u0000RESULTS\u0000Sixty percent of orthopaedic department websites (71 of 119) used the term chairman at least once, a proportion higher than that of pediatrics (36% [46 of 128]; OR 0.38; 95% CI, 0.23 to 0.63; p < 0.001), internal medicine (31% [38 of 122]; OR 0.030; 95% CI, 0.18 to 0.53; p < 0.001), and obstetrics and gynecology (29% [37 of 126]; OR 0.28; 95% CI, 0.17 to 0.48; p < 0.001), but no different than that of neurosurgery (57% [54 of 94]; OR 0.91; 95% CI, 0.52 to 1.6; p = 0.74) and general surgery (55% [69 of 125]; OR 0.83; 95% CI, 0.50 to 1.4; p = 0.48). Across disciplines, departments whose chairs were women were much less likely to use the term chairman than departments whose chairs were men (14% [17 of 122] versus 50% [297 of 592]; OR 0.16; 95% CI, 0.09 to 0.28; p < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000The frequent use of the term chairman in orthopaedics, coupled with the preference of women to use the term chair, suggests considerable room for growth in the use of gender-equal language in orthopaedics.\u0000\u0000\u0000CLINICAL RELEVANCE\u0000Our current efforts to increase the number of women in orthopaedics may be undermined by gendered language, which can create and reinforce gendered culture in the field. Electing to use gender-neutral leadership titles, while a relatively small step in the pursuit of a more gender-equal environment, presents an immediate and no-cost way to support a more inclusive culture and counteract unconscious gender bias. Future studies should explore the individual attitudes of chairs regarding the use of gendered titles and identify additional ways in which biases may manifest; for example, the use of gendered language in interpersonal communications and the presence of unconscious bias ","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89619007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Geographic Distribution of Women Orthopaedic Surgeons Throughout the United States?","authors":"Talia Chapman, Benjamin M. Zmistowski, Sky Prestowitz, J. Purtill, Antonia F. Chen","doi":"10.1097/CORR.0000000000000868","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000868","url":null,"abstract":"BACKGROUND\u0000Orthopaedic surgery has a shortage of women surgeons. An even geographic distribution of women orthopaedic surgeons may provide more uniform care to patients. However, little is known about the geographical distribution of women orthopaedic surgeons.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) Is there substantial geographic variation in the distribution of orthopaedic surgeons who are women? (2) How does the geographic distribution of women orthopaedic surgeons compare with that of other physicians? (3) What are the variables associated with increased region-based proportions of orthopaedic surgeons who are women?\u0000\u0000\u0000METHODS\u0000To obtain a national snapshot of orthopaedic providers, two Medicare databases were used (Medicare Provider Utilization and Payment Data and Medicare's current and archived Physician Compare Data). These databases were used to identify physicians with self-reported specialties of \"Orthopedic Surgeon,\" \"Hand Surgeon,\" or \"Sports Medicine\" with at least 11 Medicare claims in 1 year for a single procedure type between 2012 and 2014. These databases are the only databases known to specifically report surgeon gender on a national scale and include physician demographics and education. The Dartmouth Atlas's hospital referral regions and United States Census Bureau divisions were used to group physicians by geographic region. The Gini coefficient, a measure of statistical dispersion, was used to quantify the regional distribution of orthopaedic surgeons. This was compared with the dispersion of non-orthopaedic physicians within the same Medicare databases. Surgeon and regional characteristics were correlated with the proportion of women orthopaedic surgeons in the region.\u0000\u0000\u0000RESULTS\u0000There is substantial geographic variation in the distribution of orthopaedic surgeons who are women, ranging from 0% to 15%. There was a greater prevalence of women orthopaedic surgeons in New England (7.3%, 107 of 1469 surgeons) and the Pacific region (6.5%, 208 of 3196 surgeons) than in the South Atlantic (4.5%, 210 of 4618 surgeons) and East South Central regions (3.5%, 50 of 1442 surgeons). This represents a greater level of variation (Gini coefficient = 0.37) compared with other specialties (0.30 and 0.37) and compared with men orthopaedic surgeons (0.16). Variables independently associated with an increased prevalence of women orthopaedic surgeons based on hospital referral region were an increased proportion of currently practicing women physicians who graduated from medical schools in that region (beta = 0.03; p = 0.01), increased proportion of Medicaid-eligible patients (beta = 0.12; p = 0.002), increased proportion of regional population is black (beta = -0.06; p = 0.03), and increased regional supply of women physicians (beta = 0.26; p < 0.0001).\u0000\u0000\u0000CONCLUSIONS\u0000Despite the recent increase in women orthopaedic surgeons nationally, gains have not been equally distributed throughout the United States.\u0000\u0000\u0000CLINICAL RELEVANCE\u0000In other medical fields, gender di","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84538543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What is the Geographic Distribution of Women Orthopaedic Surgeons Throughout the United States?","authors":"Anthony E Johnson","doi":"10.1097/CORR.0000000000000931","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000931","url":null,"abstract":"It is estimated that by 2050, there will no longer be any clear racial and ethnic majority in the United States. Indeed, Americans of Hispanic and Asian descent comprise of the fastest-growing population segments [5]. As the US population becomes more diverse, the need for diversity and multi-culturalism in medicine will become ever-more essential. The characteristics of many clinical encounters today, including time pressure, cognitive complexity, and cost-containment measures, increase the likelihood of care poorly matched to minority patients’ needs [14]. Additionally, minority patients may experience a range of other obstacles to accessing care, including barriers of language, geography, and cultural familiarity [14]. In addition to race and gender, workplace diversity includes variation in age, ethnicity, physical attributes, educational background, sexual orientation, geographical location, socioeconomic status, marital and parental status, spiritual practice, and previous work experience. Any organization’s growth and success depend upon its ability to understand and effectively meet the needs of an increasingly diverse customer-patient population. Diverse organizations also benefit from enhanced: (1) Adaptability to fluctuating conditions and patient demands, (2) skillsets and competencies extending the range of potential customers-patients, and (3) idea pools and innovative solutions [6, 7, 19]. The Council on Graduate Medical Education first expressed concern about the growing disparity between the physician specialty and geographic maldistribution in 1988, despite an increasing aggregate supply of physicians within the United States. It found that “the composition of the Nation’s physicians [did] not reflect the general population” contributing to a “crisis in health care delivery” [9]. In 2011, the Association of American Medical Colleges (AAMC) reported a continued maldistribution of physicians by specialty and geography [1]. Men far outnumber women in nearly all surgical subspecialties, and surgeons of color are underrepresented across the board in medicine—a disparity that is even more severe in surgery [11, 12]. This is problematic for many reasons, not least of which is that patient-physician raceconcordance has been demonstrated to have higher patient satisfaction ratings; the same has been shown for patientphysician gender concordance [22]. Definite signs of progress are visible in medical schools and in some subspecialties during residency for women and under-represented minorities. For instance, women have increased from 48% to 51% of medical school matriculants since 2002. Women also account for the majority of graduate medical education trainees in obstetrics and gynecology, pediatrics, dermatology, internal medicine/ pediatrics, familymedicine, pathology, and psychiatry [2, 12]. Moreover, from 1995 to 2010, the percentage of women faculty members in orthopaedic departments has nearly doubled (from 4.9% to 8.1%), as did bla","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72780705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Musculoskeletal Urgent Care Centers in Connecticut Restrict Patients with Medicaid Insurance Based on Policy and Location.","authors":"R. Blasier","doi":"10.1097/CORR.0000000000001024","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001024","url":null,"abstract":"The United States continues to struggle with its ability to provide health care for all of its residents and citizens. Healthcare costs for the government, employers, and individuals continue to rise quickly. Because medical care, drugs, and medical supplies generally are provided on a for-profit basis, it has been difficult to find efficiencies. As there is no universal coverage in the United States, individual coverage is necessary, and providing this for those who cannot afford it has been a real challenge. Enacted in 2010, the Patient Protection and Affordable Care Act (sometimes called Obamacare) sought to provide care for more of the US population. Much of this new coverage has occurred through Medicaid expansion, by extending Medicaid eligibility to individuals with annual incomes below 133 percent of the federal poverty level (USD 15,880 for an individual or USD 32,319 for a family of four in 2016) who are under 65 years of age [3, 8]. In June 2012, the Supreme Court ruled to make Medicaid expansion voluntary for states. Most but not all states have expanded their Medicaid program. While this coverage now includes more people, it has not been a panacea; reimbursement for providers is low, and there is considerable administrative burden [4]. As a result, while more lives are covered, actual access to care may not be increased as providers are not as likely to see and treat patients with Medicaid coverage as they are patients with commercial insurance. Increased coverage does not necessarily lead to increased access to care. A relatively new concept in the provision of musculoskeletal care is the musculoskeletal urgent care center which, of course is of interest to orthopaedic surgeons. Will these centers help to increase access to care and result in efficiencies that benefit all? Wiznia and colleagues [10] interviewed owners of musculoskeletal urgent care centers throughout Connecticut. They found that most musculoskeletal urgent care centers in Connecticut do not accept patients with Medicaid insurance and have similar or stricter Medicaid policies to those of the groups that own them. Additionally, musculoskeletal urgent care centers generally were located in more-affluent neighborhoods. The authors felt that private practices are using musculoskeletal urgent care centers to capture patients with more favorable insurance. A major causative factor seems to be the relatively low Medicaid reimbursement rates in Connecticut (as well as other states). At first glance, musculoskeletal urgent care centers appear to offer marked benefits compared to services offered at primary care offices and emergency rooms in the provision of acute care for musculoskeletal conditions. These include shorter patient wait times, potentially increased patient satisfaction and more cost-effective and specialized care [1, 7]. While urgent care centers have This CORR Insights is a commentary on the article “Musculoskeletal Urgent Care Centers in Connecticut Restrict","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85889492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse.","authors":"D. Ling, Jennifer Cheng, Kristen A Santiago, Brittany Ammerman, B. Jivanelli, J. Hannafin, E. Casey","doi":"10.1097/CORR.0000000000000995","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000995","url":null,"abstract":"BACKGROUND\u0000There is ample evidence to suggest sex- and gender-based differences in the incidence of sports-related concussions. The mechanisms of concussion may vary between male and female athletes and contribute to this observed difference. Understanding the underlying etiology by pooling data from primary studies across different settings and sport types will inform interventions that can reduce concussion rates.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000Specifically, we asked: (1) In which sports are female athletes less likely to experience concussions from player contact? (2) In which sports are female athletes more likely to experience concussions because of ball or equipment contact?\u0000\u0000\u0000METHODS\u0000PubMed, EMBASE, and Cochrane Library databases were searched to identify articles published from January 2000 to December 2018. Ten studies met the inclusion criteria, which were studies that reported concussion incidence by mechanism for both male and female athletes. Exclusion criteria included non-English studies, conference abstracts, and studies on non-sports related concussions. The sports represented by the 10 studies included ice hockey (n = 4), soccer (n = 5), basketball (n = 4), baseball/softball (n = 4), and lacrosse (n = 5). The rate ratio was calculated as the incidence rate in female athletes/male athletes for each concussion mechanism or activity. Data were pooled using the DerSimonian-Laird random-effects model. Study quality was assessed with the Newcastle-Ottawa Scale.\u0000\u0000\u0000RESULTS\u0000Female athletes were at lower risk of player-contact-induced concussions in lacrosse (pooled rate ratio 0.33 [95% CI 0.25 to 0.43]; p < 0.001), basketball (pooled rate ratio 0.86 [95% CI 0.76 to 0.97]; p = 0.01), ice hockey (pooled rate ratio 0.64 [95% CI 0.56 to 0.73]; p < 0.001), soccer (pooled rate ratio 0.70 [95% CI 0.66 to 0.75]; p < 0.001), and soccer heading (pooled rate ratio 0.80 [95% CI 0.72 to 0.90]; p < 0.001); in these sports, men were at higher risk of concussions from player contact. Female athletes were more likely to experience concussions because of ball or equipment contact in lacrosse (pooled rate ratio 3.24 [95% CI 2.10 to 4.99]; p < 0.001), soccer (pooled rate ratio 2.04 [95% CI 1.67 to 2.49]; p < 0.001), and soccer heading (pooled rate ratio 2.63 [95% CI 1.84 to 3.77]; p < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000The mechanism or activity underlying concussions differs between male and female athletes across different sports. This finding remains the same regardless of whether there are rule differences between the men's and women's games. The implementation of other interventions are required to further ensure player safety, including protective head equipment, concussion prevention training, or rules limiting player contact in the men's game.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level III, retrospective study.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82168314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Is There an Association Between Prophylactic Femur Stabilization and Survival in Patients with Metastatic Bone Disease?","authors":"T. Damron","doi":"10.1097/CORR.0000000000000880","DOIUrl":"https://doi.org/10.1097/CORR.0000000000000880","url":null,"abstract":"Prophylactic stabilization is a topic of interest both to general orthopaedic surgeons and orthopaedic oncologists. The benefits of prophylactic stabilization compared to treatment after the pathologic fracture occurs remain poorly substantiated. Yet, it is widely assumed that “orthopaedic surgeons know it is best to stabilize lesions in the femoral neck prior to fracture.” Unfortunately, this presumption is largely unsupported by evidence. Indeed, few articles speak to this topic, and robust data supporting prophylactic fixation are sparse. According to the Nationwide Inpatient Sample (NIS), pathologic fractures have been associated with increased morbidity and mortality [2]. Decreasing that morbidity and mortality would obviously be desirable. As such, a comparison using the NIS database between patients treated with pathologic bone lesions before and after fracture suggests advantages for prophylactic stabilization in terms of blood transfusion, risk of urinary tract infection, and discharge to home. However, these advantages come at the expense of a higher likelihood of venous thromboembolic disease in the group that received prophylactic surgery [1]. According to the National Surgical Quality Improvement Program, prophylactic stabilization is associated with a lower rate of blood transfusion compared to pathologic fracture treatment after controlling for patient differences [10]. Additionally, compared to pathologic fracture treatment, prophylactic stabilization resulted in less blood loss, shorter hospital stay, higher percentage discharge to home, higher resumption of supportfree ambulation, and greater ability to avoid endoprosthetic reconstruction [16]. One study showed reduced direct costs and length of stay in those treated prophylactically compared to after fracture [4]. The current paper by Phillip and colleagues [17] may now be added to the knowledge base purporting a benefit to prophylactic stabilization. In this case, the purported benefit is survival.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84655878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}