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Kobylianskii A, Murji A, Matelski JJ, Adekola AB, Shapiro J, Shirreff L. Surgeon Gender and Performance Outcomes for Hysterectomies: Retrospective Cohort Study. J Minim Invasive Gynecol 2023; 30:108-114. [PMID: 36332819 DOI: 10.1016/j.jmig.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To evaluate whether there are differences in several performance metrics between male and female surgeons for hysterectomies. DESIGN Multicenter retrospective cohort study. We matched surgeries performed by female surgeons to those by male surgeons using a propensity score and compared outcomes by gender after adjusting for years in practice and fellowship training. SETTING A total of 6 hospitals (3 academic, 3 community) in Ontario, Canada, between July 2016 and December 2019. PATIENTS All consecutive patients. INTERVENTIONS Hysterectomy. MEASUREMENTS AND MAIN RESULTS Primary outcome was a composite of any complication or return to emergency room (ER) within 30 days. Secondary outcomes were grade II or greater complications, return to ER, and operative time. We included 2664 hysterectomies performed by 77 surgeons. After propensity matching, 963 surgeries performed by females were compared with 963 performed by males. There were no differences in the primary (relative risk [RR], 0.92; 95% confidence interval [CI], 0.71-1.20; p = .56) or secondary outcomes of grade II or greater complication (RR, 1.01; 95% CI, 0.71-1.45; p = .96) or return to ER (RR, 0.81; 95% CI, 0.55-1.20; p = .30). However, surgeries performed by males were 24.72 minutes shorter (95% CI, 18.09-31.34 minutes; p <.001). Entire cohort post hoc regression analysis confirmed these findings. E-value analysis indicated that it is unlikely for an unmeasured confounder to undo the observed difference. CONCLUSION Although complication and readmission rates are similar, male surgeons may have a shorter operating time than female surgeons for hysterectomies, which may have implications for health systems and inequalities in surgeon renumeration.
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Affiliation(s)
| | - Ally Murji
- Department of Obstetrics and Gynecology, University of Toronto; Department of Obstetrics and Gynecology, Mount Sinai Hospital
| | - John J Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | | | - Jodi Shapiro
- Department of Obstetrics and Gynecology, University of Toronto; Department of Obstetrics and Gynecology, Mount Sinai Hospital
| | - Lindsay Shirreff
- Department of Obstetrics and Gynecology, University of Toronto; Department of Obstetrics and Gynecology, Mount Sinai Hospital.
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Delong A, Shirreff L, Murji A, Matelski JJ, Pudwell J, Bougie O. Individualized assessment of risk of complications following benign hysterectomy. J Minim Invasive Gynecol 2022; 29:976-983. [DOI: 10.1016/j.jmig.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
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Ratneswaran A, Rockel JS, Antflek D, Matelski JJ, Shestopaloff K, Kapoor M, Baltzer H. Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression. Front Immunol 2022; 12:794792. [PMID: 35126358 PMCID: PMC8814933 DOI: 10.3389/fimmu.2021.794792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeNon-operative management of trapeziometacarpal osteoarthritis (TMOA) demonstrates only short-term symptomatic alleviation, and no approved disease modifying drugs exist to treat this condition. A key issue in these patients is that radiographic disease severity can be discordant with patient reported pain, illustrating the need to identify molecular mediators of disease. This study characterizes the biochemical profile of TMOA patients to elucidate molecular mechanisms driving TMOA progression.MethodsPlasma from patients with symptomatic TMOA undergoing surgical (n=39) or non-surgical management (n=44) with 1-year post-surgical follow-up were compared using a targeted panel of 27 cytokines. Radiographic (Eaton-Littler), anthropometric, longitudinal pain (VAS, TASD, quick DASH) and functional (key pinch, grip strength) data were used to evaluate relationships between structure, pain, and systemic cytokine expression. Principal Component Analysis was used to identify clusters of patients.ResultsPatients undergoing surgery had greater BMI as well as higher baseline quick DASH, TASD scores. Systemically, these patients could only be distinguished by differing levels of Interleukin-7 (IL-7), with an adjusted odds ratio of 0.22 for surgery for those with increased levels of this cytokine. Interestingly, PCA analysis of all patients (regardless of surgical status) identified a subset of patients with an “inflammatory” phenotype, as defined by a unique molecular signature consisting of thirteen cytokines.ConclusionOverall, this study demonstrated that circulating cytokines are capable of distinguishing TMOA disease severity, and identified IL-7 as a target capable of differentiating disease severity with higher levels associated with a decreased likelihood of TMOA needing surgical intervention. It also identified a cluster of patients who segregate based on a molecular signature of select cytokines.
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Affiliation(s)
- Anusha Ratneswaran
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jason S. Rockel
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel Antflek
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - John J. Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Konstantin Shestopaloff
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Mohit Kapoor
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Heather Baltzer
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Heather Baltzer,
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Shirreff L, Matelski JJ, Sunderji Z, Cipolla A, Bougie O, Shapiro J, Po LK, Lee S, Evans D, Murji A. Impact of Minimally Invasive Gynaecology Fellowship Training on Quality Performance Metrics for Hysterectomy. J Obstet Gynaecol Can 2021; 43:1364-1371. [PMID: 34153536 DOI: 10.1016/j.jogc.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate differences in quality metrics between hysterectomies performed by fellowship-trained surgeons and those performed by generalists. METHODS Retrospective review of 2845 consecutive hysterectomies by 75 surgeons (23 fellowship-trained, 52 generalists) at 7 hospitals in Ontario, Canada. The primary outcome was a composite of any complication or return to the emergency department (ED) within 30 days of hysterectomy. Secondary outcomes were 2 quality outcome measures (grade of complication and return to ED within 30 days) and 4 quality process measures (minimally invasive hysterectomy rate, rate of preoperative anemia, same-day discharge for laparoscopic hysterectomy [LH], and performing cystoscopy at LH). RESULTS Fellowship-trained surgeons were more likely to perform concurrent resection of endometriosis, bilateral ureterolysis, lysis of adhesions, uterine/internal iliac artery ligation, and morcellation (all P < 0.001). Generalists performed more vaginal procedures, including vaginal repair, vault suspension, and insertion of mid-urethral sling (all P < 0.001). After controlling for patient and surgical factors, there was no difference in the primary outcome (adjusted odds ratio [aOR] 1.07; 95% CI 0.79-1.45, P = 0.667). Fellowship-trained surgeons were more likely to perform minimally invasive hysterectomy (aOR 2.38; 95% CI 1.15-4.93, P = 0.020), had higher rates of same-day discharge for LH (aOR 2.23; 95% CI 1.31-3.81, P = 0.003), and were more likely to perform cystoscopy (unadjusted OR 2.94; 95% CI 2.30-3.85, P < 0.001). There were no differences in the rates of preoperative anemia, surgical complications, and ED visits. CONCLUSION Differences exist between fellowship-trained surgeons and generalists regarding case mix and process quality metrics. Postoperative complications and readmissions were comparable for both groups of surgeons.
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Affiliation(s)
- Lindsay Shirreff
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
| | - John J Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON
| | - Zahra Sunderji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
| | - Amanda Cipolla
- Department of Obstetrics and Gynaecology, Trillium Health Partners, Credit Valley Hospital, Mississauga, ON
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Center, Kingston, ON
| | - Jodi Shapiro
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
| | - Leslie K Po
- Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Center, Toronto, ON
| | - Sabrina Lee
- Department of Obstetrics and Gynaecology, North York General Hospital, Toronto, ON
| | - Devon Evans
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON
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Sawka AM, Ghai S, Tomlinson G, Baxter NN, Corsten M, Imran SA, Bissada E, Lebouef R, Audet N, Brassard M, Zhang H, Gupta M, Nichols AC, Morrison D, Johnson-Obeski S, Prisman E, Anderson D, Chandarana SP, Ghaznavi S, Jones J, Gafni A, Matelski JJ, Xu W, Goldstein DP. A Protocol for a Pan-Canadian Prospective Observational Study on Active Surveillance or Surgery for Very Low Risk Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:686996. [PMID: 34194396 PMCID: PMC8237853 DOI: 10.3389/fendo.2021.686996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background The traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference. Methods This is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient's choice. Our primary objective is to determine the rate of 'failure' of disease management in respective AS and surgical arms as defined by: i) AS arm - surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes. Discussion The results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer. Registration details This prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.
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Affiliation(s)
- Anna M. Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nancy N. Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Syed Ali Imran
- Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Eric Bissada
- Department of Otolaryngology-Head and Neck Surgery, l’Université de Montréal, Montreal, QC, Canada
| | - Rebecca Lebouef
- Division of Endocrinology, Department of Medicine, l’Université de Montréal, Montreal, QC, Canada
| | - Nathalie Audet
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Han Zhang
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Gupta
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Deric Morrison
- Division of Endocrinology, Department of Medicine, Western University, London, ON, Canada
| | | | - Eitan Prisman
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Don Anderson
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Shamir P. Chandarana
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Sana Ghaznavi
- Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Jones
- Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John J. Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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Zakhari A, Edwards D, Ryu M, Matelski JJ, Bougie O, Murji A. Dienogest and the Risk of Endometriosis Recurrence Following Surgery: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1503-1510. [PMID: 32428571 DOI: 10.1016/j.jmig.2020.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine whether dienogest therapy after endometriosis surgery reduces the risk of endometriosis recurrence compared with expectant management. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, clinicaltrials.gov, and International Standard Randomized Controlled Trial Number Registry were searched from inception to March 2019 for observational and randomized controlled trials. METHODS OF STUDY SELECTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Medical Subject Heading terms and keywords such as "dienogest," "endometriosis," and "recurrence" were used to identify relevant studies. TABULATION, INTEGRATION, AND RESULTS The search yielded 328 studies, 10 of which were eligible for inclusion, representing 1184 patients treated with dienogest and 846 expectantly managed controls. Among these studies, 9 looked exclusively at endometrioma recurrence, whereas 1 used reappearance of symptoms as evidence of disease recurrence. Data on both incidence of and time to recurrence of endometriosis were extracted. The incidence rate of endometriosis recurrence in patients treated with dienogest was 2 per 100 women over a mean follow-up of 29 months (95% confidence interval [CI], 1.43-3.11) versus 29 per 100 women managed expectantly over a mean follow-up of 36 months (95% CI, 25.66-31.74). The likelihood of recurrence was significantly reduced with postoperative dienogest (log odds -1.96, CI, -2.53 to -1.38, p <.001). CONCLUSION Patients receiving dienogest after conservative surgery for endometriosis had significantly lower risk of postoperative disease recurrence than those who were expectantly managed.
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Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Darl Edwards
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji)
| | - Michelle Ryu
- Department of Mount Sinai Hospital, Sidney Liswood Health Sciences Library, Toronto, ON, Canada (Ms. Ryu)
| | - John J Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, Canada (Mr. Matelski)
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston General Hospital, Kingston (Dr. Bougie), Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynecology, McGill University Health Center, Montreal, QC, Canada (Drs. Zakhari, Edwards, and Murji).
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Jeyalingam T, Matelski JJ, Alam AQ, Liu JJ, Goldberg H, Klemensberg J, Bell CM. The Characteristics of Physicians Who are Re-Disciplined by Medical Boards: A Retrospective Cohort Study. Jt Comm J Qual Patient Saf 2018; 44:361-365. [PMID: 29793887 DOI: 10.1016/j.jcjq.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physician misconduct adversely affects patient safety and is therefore of societal importance. Little work has specifically examined re-disciplined physicians. A study was conducted to compare the characteristics of re-disciplined to first-time disciplined physicians. METHODS A retrospective review of Canadian physicians disciplined by medical boards between 2000 and 2015 was conducted. Physicians were divided into those disciplined once and those disciplined more than once. Differences in demographics, transgressions, and penalties were evaluated. RESULTS There were 938 disciplinary events for 810 disciplined physicians with 1 in 8 (n = 101, 12.5%) being re-disciplined. Re-disciplined physicians had up to six disciplinary events in the study period and 4 (4.0%) had events in more than one jurisdiction. Among those re-disciplined, 94 (93.1%) were male, 34 (33.7%) were international medical graduates, and 88 (87.1%) practiced family medicine (n = 59, 58.4%), psychiatry (n = 11, 10.9%), surgery (n = 9, 8.9%), or obstetrics/gynecology (n = 9, 8.9%). The proportion of obstetrician/gynecologists was higher among re-disciplined physicians (8.9% vs. 4.2%, p = 0.048). Re-disciplined physicians had more mental illness (1.7% vs. 0.1%, p = 0.01), unlicensed activity (19.2% vs. 7.2%, p <0.01), and less sexual misconduct (20.1% vs. 27.9%, p = 0.02). License suspension occurred more frequently among those re-disciplined (56.8% vs. 48.0%, p = 0.02) as did license restriction (38.4% vs. 26.7%, p <0.01). License revocation was not different between cohorts (10.9% vs. 13.5%, p = 0.36). CONCLUSION Re-discipline is not uncommon and underscores the need for better identification of at-risk individuals and optimization of remediation and penalties. The distribution of transgression argues for a national disciplinary database that could improve communication between jurisdictional medical boards.
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Liu JJ, Bell CM, Matelski JJ, Detsky AS, Cram P. Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study. BMJ 2017; 359:j4619. [PMID: 29074628 PMCID: PMC5655612 DOI: 10.1136/bmj.j4619] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective To estimate financial payments from industry to US journal editors.Design Retrospective observational study.Setting 52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014.Participants 713 editors at the associate level and above identified from each journal's online masthead.Main outcome measures All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible.Results Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals.Conclusions Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research.
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Affiliation(s)
- Jessica J Liu
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - John J Matelski
- Department of Medicine, Division of General Internal Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Allan S Detsky
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of General Internal Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
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Alam A, Matelski JJ, Goldberg HR, Liu JJ, Klemensberg J, Bell CM. The Characteristics of International Medical Graduates Who Have Been Disciplined by Professional Regulatory Colleges in Canada: A Retrospective Cohort Study. Acad Med 2017; 92:244-249. [PMID: 27603039 DOI: 10.1097/acm.0000000000001356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE This study evaluated the proportion and characteristics of international medical graduates (IMGs) who have been disciplined by professional regulatory colleges in Canada in comparison with disciplined North American medical graduates (NAMGs). METHOD The authors compiled a database of the nature of professional misconduct and penalties incurred by disciplined physicians from January 2000 to May 2015 using public records. They compared discipline data for IMGs versus those for NAMGs, and calculated risk ratios (RRs) and 95% confidence intervals (CIs) for select outcomes. RESULTS There were 794 physicians disciplined; 922 disciplinary cases during the 15-year study period. IMGs composed an average of 23.4% (standard deviation = 1.1%) of the total physician population and represented one-third of disciplined physicians and discipline cases. The overall disciplinary rate for all Canadian physicians was 8.52 cases per 10,000 physician years (95% CI [7.77, 9.31]). This rate per group was higher for IMGs than for NAMGs (12.91 [95% CI (11.50, 14.43)] vs. 8.16 [95% CI (7.53, 8.82)] cases per 10,000 physician years, P < .01, and RR 1.58 (95% CI [1.38, 1.82]). IMGs were disciplined at significantly higher rates than NAMGs if they were trained in South Africa (RR 1.73 [95% CI (1.14, 2.51), P < .01), Egypt (RR 3.59 [95% CI (2.18, 5.52)], P < .01), or India (RR 1.66 [95% CI (1.01, 2.55)], P = .03). CONCLUSIONS IMGs are disciplined at a higher rate than NAMGs. Future initiatives should be focused to delineate the exact cause of this observation.
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Affiliation(s)
- Asim Alam
- A. Alam is staff anesthesiologist and transfusion medicine specialist, Department of Anesthesia, Sunnybrook Health Sciences Centre and Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. J.J. Matelski is a biostatistician, Division of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada. H.R. Goldberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. J.J. Liu is a general medical internist, Division of General Internal Medicine, University Health Network and Department of Medicine, University of Toronto, Ontario, Canada. J. Klemensberg is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C.M. Bell is a general medical internist, Division of Internal Medicine, Mt. Sinai Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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