Assessment of patient-centered approaches to collect sexual orientation and gender identity information in the emergency department: The equality Study

Importance: Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.Objective: To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting.Design, setting, and participants: This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to assess whether either SOGI collection method was associated with higher patient satisfaction with their ED experience. Eligible adults older than 18 years who identified as a sexual or gender minority (SGM) were enrolled and then matched 1 to 1 by age (aged ≥5 years) and illness severity (Emergency Severity Index score ±1) to patients who identified as heterosexual and cisgender (non-SGM), and to patients whose SOGI information was missing (blank field). Patients who identified as SGM, non-SGM, or had a blank field were invited to complete surveys about their ED visit. Data analysis was conducted from April 2017 to November 2017.Interventions: Two SOGI collection approaches were tested: nurse verbal collection during the clinical encounter vs nonverbal collection during patient registration. The ED physicians, physician assistants, nurses, and registrars received education and training on sexual or gender minority health disparities and terminology prior to and throughout the intervention period.Main outcomes and measures: A detailed survey, developed with input of a stakeholder advisory board, which included a modified Communication Climate Assessment Toolkit score and additional patient satisfaction measures.Results: A total of 540 enrolled patients were analyzed; the mean age was 36.4 years and 66.5% of those who identified their gender were female. Sexual or gender minority patients had significantly better Communication Climate Assessment Toolkit scores with nonverbal registrar form collection compared with nurse verbal collection (mean [SD], 95.6 [11.9] vs 89.5 [20.5]; P = .03). No significant differences between the 2 approaches were found among non-SGM patients (mean [SD], 91.8 [18.9] vs 93.2 [13.6]; P = .59) or those with a blank field (92.7 [15.9] vs 93.6 [14.7]; P = .70). After adjusting for age, race, illness severity, and site, SGM patients had 2.57 (95% CI, 1.13-5.82) increased odds of a better Communication Climate Assessment Toolkit score category during form collection compared with verbal collection.Conclusions and relevance: Sexual or gender minority patients reported greater comfort and improved communication when SOGI was collected via nonverbal self-report. Registrar form collection was the optimal patient-centered method for collecting SOGI information in the ED

ACC/AHA Guideline Authors Self-Disclosed Relationships Compared to the Open Payments Database: Do Discrepancies Represent Undisclosed Conflicts of Interest?

Background: In order to identify true conflicts of interest, accurate physician disclosures in clinical guidelines and research are necessary to characterize relationships with industry (RWI). The Patient Protection and Affordable Care Act’s “Sunshine Act” requires the Center for Medicare and Medicaid Services to display payment information made by pharmaceutical manufacturers and group purchasing organizations to physicians and teaching hospitals. We tested the hypothesis that there would be discrepancies between industry-reported payments and author disclosures. Methods: Authors of the fifteen ACC and AHA guidelines published in 2013 and 2014 were matched to payments made during the same time period in the government database, Open Payments. Duplicate authors across guidelines were assessed independently. In the guidelines, a significant payment is ≥$10,000 within 12 months; a modest payment is \u3c$10,000. Percent agreement was calculated; a chi square test was used to detect statistical significance. Results: Of the 203 guideline authors, 159 authors had relationships with industry. 65.4% of these relationships were disclosed representing a total of 575 disclosures. Of those disclosed relationships: 45.2% were for consulting, 39.7% were for related to research, and 5.2% were for speaking services. Industry reported 1,016 payments to these authors: 60.3% in the Other category (travel, meals, gifts, royalties), 20.5% for consulting, and 13.0% for research. These authors received a total of $16,540,202 in payments with research having the highest mean payment (Research$97,019 ± 297,923) and other having the lowest mean payment (Other $1,777 ± 9,720). Overall, mean payments were$78,888 ± 66,416 in cases of agreement and $10,775 ± 17,193 in cases of author error (P\u3c0.0001). In a multivariate regression, agreement was more likely if the payment was significant or in consulting and research categories. Disagreement was higher than agreement in every category (P\u3c0.0001). Conclusions: Our analysis shows extensive industry relationships among ACC and AHA guideline authors. There is significant disagreement in every category between author disclosures and company payments, regardless of category. The two parties are more likely to agree if the payment is significant or made for research or consulting. Although RWIs are rampant, it is impossible to discern true conflicts of interest, given the difficulty in discerning the exact nature of a relationship in the current reporting system. As such, caution is advised in interpreting RWIs as COIs

Immediate Response to Chemotherapy in an Adult Neuroblastoma Patient Presenting with Cord Compression

We report a case of a 31-year-old female patient with high-risk neuroblastoma (NBL) who presented with a history of static back pain and bilateral lower limb weakness for almost a month. Her primary tumor was located in the right paraspinal region, causing spinal cord compression (SCC). Chemotherapy was administered with an immediate clinical improvement noted after 24 hours of starting treatment. We herein report the efficacy of chemotherapy in an adult neuroblastoma (aNBL) patient presenting with spinal cord compression

Temporal trends in gender-affirming surgery among transgender patients in the United States

Importance: Little is known about the incidence of gender-affirming surgical procedures for transgender patients in the United States.Objectives: To investigate the incidence and trends over time of gender-affirming surgical procedures and to analyze characteristics and payer status of transgender patients seeking these operations.Design, setting, and participants: In this descriptive observational study from 2000 to 2014, data were analyzed from the National Inpatient Sample, a representative pool of inpatient visits across the United States. The initial analyses were done from June to August 2015. Patients of interest were identified by International Classification of Diseases, Ninth Revision, diagnosis codes for transsexualism or gender identity disorder. Subanalysis focused on patients with procedure codes for surgery related to gender affirmation.Main outcomes and measures: Demographics, health insurance plan, and type of surgery for patients who sought gender-affirming surgery were compared between 2000-2005 and 2006-2011, as well as annually from 2012 to 2014.Results: This study included 37 827 encounters (median [interquartile range] patient age, 38 [26-49] years) identified by a diagnosis code of transsexualism or gender identity disorder. Of all encounters, 4118 (10.9%) involved gender-affirming surgery. The incidence of genital surgery increased over time: in 2000-2005, 72.0% of patients who underwent gender-affirming procedures had genital surgery; in 2006-2011, 83.9% of patients who underwent gender-affirming procedures had genital surgery. Most patients (2319 of 4118 [56.3%]) undergoing these procedures were not covered by any health insurance plan. The number of patients seeking these procedures who were covered by Medicare or Medicaid increased by 3-fold in 2014 (to 70) compared with 2012-2013 (from 25). No patients who underwent inpatient gender-affirming surgery died in the hospital.Conclusions and relevance: Most transgender patients in this national sample undergoing inpatient gender-affirming surgery were classified as self-pay; however, an increasing number of transgender patients are being covered by private insurance, Medicare, or Medicaid. As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them

A comprehensive health effects assessment of the use of sanitizers and disinfectants during COVID-19 pandemic: a global survey

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87-2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74-1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90-2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92-2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused