Guthrie Foundation

About half of medical residents report experiencing bullying behaviors in training settings, and these negative acts adversely impact the work environment in a variety of ways. Understanding perceptions of how often others report bullying behavior (descriptive norms) and how approving others are of these behaviors (injunctive norms) lays important groundwork for potential intervention studies in medical education. The primary aims of our study were to (a) examine the accuracy of descriptive and injunctive norms related to reporting bullying behaviors, and (b) determine whether individuals with larger self-other differences would be more likely to report bullying behaviors. We conducted exploratory analyses to examine associations between self-valuation (eg, self-compassion) and perceived risk of consequences of reporting bullying behavior. Our analyses also explored differences in perceptions of risk related to experiencing retaliation among women and those who identified as underrepresented in medicine. Data were gathered and analyzed as part of the 2024 Council of Academic Family Medicine Educational Research Alliance survey of family medicine educators and practicing physicians. Faculty and staff working in family medicine education (N = 1,096) tended to be inaccurate when estimating others' behaviors and beliefs about reporting behavior. Self-other differences predicted one's tendency to engage in reporting bullying behavior. Our study expanded on previous findings that suggested that those in medical education have inaccurate peer perceptions of attitudes and behaviors related to reporting bullying behavior. Further, our study provided additional support for studying the use of social norms interventions as a strategy to modify maladaptive perspectives and behaviors in this setting.

Abstract Background While current evidence suggests that the clinical outcomes of ST-elevation myocardial infarction (STEMI) are worse among patients with cancer, it is unknown what role the quality of care received during admission plays. We aimed to evaluate the association between care quality and patient survival after discharge. Methods A nationally-linked cohort of STEMI patients (January 2005-March 2019) were obtained from the UK Myocardial Infarction National Audit Project (MINAP) and UK national Hospital Episode Statistics Admitted Patient Care (HES APC) registries. We used the composite opportunity-based quality indicator (OBQI) to measure overall care quality. Survival outcomes were assessed using Cox proportional hazard models and Kaplan-Meier and cumulative survival curves. Results In total, 6,787 STEMI indexed admissions with cancer were identified. Of those, 4,340 (63.9%) patients received optimum care, 1,320 (19.5%) intermediate care, and 1,127(25.2%) low care quality. Patients with low care quality were older (optimum quality median (IQR)=72.8 (65.1, 79.6), intermediate quality 75.5 (67.9, 82.1), low quality 78.2 (69.2, 84.7)) and more frequently women (optimum quality 21.6%, intermediate quality 27.3%, low quality 35.5%). Compared to patients with optimum care, patients with low care quality had a higher risk of death at 30 days (HR 7.0, 95% CI 5.7-8.7), 1 year (HR 4.0, 95% CI 3.6-4.4), and 5 years (HR 2.6, 95% CI 2.4-2.8). Relative survival analysis revealed that the number of patients who would survive nationally if they received optimal care is 84 (95% CI 67-102), 508 (95% CI 468-548), and 1096 (95% CI 1034-1158) at 30 days, one year, and five years respectively. The association between care quality and survival was more profound in the Northwest and Northeast regions. Conclusion Quality of care is closely associated with short- and long-term survival among STEMI patients with cancer. Improving quality of care may save hundreds to thousands of lives in the shorter and longer term.

Burnout and declining fulfillment are prevalent among facial plastic surgeons (FPS), yet the organizational drivers of these challenges remain underexplored. Ownership structure, workplace autonomy, and collective representation may influence surgeon well-being and workforce sustainability.To assess how autonomy, ownership, and unionization relate to satisfaction and stress among FPS. We hypothesized that private practitioners would report greater autonomy and satisfaction, that academic and hospital-employed surgeons would experience more stress and diminished control, and that prior union exposure would correspond with more favorable views of collective representation.Cross-sectional observational survey (STROBE).A 26-item anonymous survey was distributed to all 1,041 members of the American Academy of Facial Plastic and Reconstructive Surgery; 104 responded (10%). Variables included practice type, ownership, union history, autonomy, compensation satisfaction, stressors, and openness to unionization. Analyses employed chi-square tests and qualitative content analysis.Surgeons in private practice reported the highest autonomy and compensation satisfaction and the lowest rates of feeling rushed. Hospital-employed and academic surgeons were more likely to report diminished autonomy, administrative stress, and lack of influence over workplace decisions. Only 11% of respondents expressed interest in unionizing, though prior union members generally described positive experiences. Surgeons' beliefs about whether unionization affects patient care did not vary significantly by practice setting.Structural factors, particularly the autonomy and ownership model, are strongly linked to satisfaction and stress among FPS. Organizational reforms that enhance autonomy and support collective voice may reduce burnout and improve workforce sustainability.

We report the case of a patient with a below-the-knee amputation who sustained a complex femur fracture ipsilateral to his residual limb after a fall from height. His fracture was managed with a lateral locking plate of the distal femur for fixation. He was followed for 16 months; at 7 months, he demonstrated return to pretrauma functional status. Fixation of the distal femur with a lateral locking plate did not interfere with the patient's ability to wear a prosthesis and should be considered for managing "periprosthetic" femur fractures in those with a below-the-knee amputation to maintain prosthetic usage.

BackgroundThe glenoid components in total shoulder arthroplasty (TSA) are numerous and have both advantages and disadvantages. This study aimed to compare 5-year functional outcomes, patient-reported outcomes, and conversion rates between patients who underwent TSA using metal-backed glenoid (MBG), hybrid, and all-polyethylene glenoid components.MethodsThe patients who were eligible for this study were retrospectively identified using electronic health records. The subjects underwent TSA performed by a fellowship-trained attending physician from November 2017 to December 2018 at a single institution. The inclusion criteria from 5-year follow-up data were adult-age patients (≥18 years old) who underwent TSA using MBG, hybrid, or all-polyethylene glenoid components.ResultsA total of 77 patients was included: 44 patients with all-polyethylene glenoid components, 17 with hybrid glenoid components, and 16 with MBG components. The mean patient age was 66.9 years, with the all-polyethylene patients being significantly younger (P<0.001). The all-polyethylene glenoid patients experienced a significantly longer operative time at 120 minutes (P=0.005) compared to those with other components. At the 5-year follow-up, no significant difference was shown in American Shoulder and Elbow Surgeons (ASES) and visual analog scale scores. However, a trend was evident in which the all-polyethylene patients had lower ASES scores (all polyethylene 87.0 vs. hybrid 100.0 vs. 97.0 MBG, P=0.086). The hybrid components tended to require revision more often at 12% vs. 6.8% of polyethylene glenoid vs. 0% of MBGs (P=0.310). No dislocation was reported, and only two complications occurred, both in the all-polyethylene group (P=0.387).ConclusionsAt 5-year follow-up, patient-reported outcomes were similar when utilizing MBG, all-polyethylene, and hybrid glenoid components. Given the similar outcomes, MBGs and hybrid glenoid components could be considered favorable or preferred for potential surgical ease in a revision setting with conversion to reverse TSA.Level of evidenceIII.

Abstract Introduction: There are approximately 225,000 new cases and 160,000 deaths annually from lung cancer alone in the United States. It is estimated that 90% of lung cancer cases are due to smoking, followed by exposure to other carcinogens such as asbestos. The vast majority of lung cancer is due to adenocarcinoma, squamous cell, or by small cell lung cancer. We present a rare case of mucoepidermoid lung cancer in a 49-year-old male treated with surgical resection. Description: The patient is a 49-year-old male, never smoker, with a history of well-controlled asthma who presented to the pulmonary office for recurrent right upper lobe (RUL) pneumonia. The patient had required two courses of antibiotics within the past few months. At that appointment, the patient was feeling better, so the plan was for a follow-up with a repeat CT chest in 2 months to monitor resolution. The repeat CT chest showed continued RUL pneumonia. The patient underwent a moderate sedation bronchoscopy that showed a RUL endobronchial lesion occluding the RB 2+3 bronchi. Multiple biopsies were taken and pathologic examination only showed fragments of benign bronchial mucosa. The patient returned a few weeks later and underwent a bronchoscopy under general anesthesia. Utilizing both a transbronchial aspiration needle and forceps, multiple biopsies of the lesion were taken. Pathologic examination this time suggested mucinous adenocarcinoma. He was referred to thoracic surgery and underwent a right upper lobectomy and node dissection. The pathology returned positive for mucoepidermoid carcinoma. Discussion: Mucoepidermoid carcinomas are rare salivary gland tumors comprising 0.1-0.2% of all lung cancers. They typically comprise mucin-secreting cells and squamous cells. Approximately half of the cases present before 30 years of age and affect men and women equally. They tend to be well-demarcated round tumors with a gray to pink color, usually around 3 cm in size. Mucoepidermoid carcinomas are classified as either low or high-grade with the low-grade tumors having excellent prognosis. Other prognostic features correlating with survival include younger age, no lymph node involvement, and a lower stage. Treatment of choice for these tumors is complete surgical resection if feasible. When complete resection is not feasible, chemotherapy and radiotherapy should be considered for high-grade disease. However, some experts believe that adjuvant therapy is ineffective.