IMPORTANCE With the substantial increase in the proportion of women graduating from medical school, factors surrounding family leave require careful attention. Although many circumstances and experiences are unique to the training setting and specialty, a nationwide representation of physician mothers across all disciplines and all levels of training may reveal common themes and experiences among them, enable comparison across training setting and subspecialties, and identify best practices for supporting physician mothers throughout their careers. OBJECTIVE To characterize family leave and return-to-work experiences of physician mothers across subspecialties. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional US nationwide survey study evaluating the experiences of 844 physician mothers was administered electronically via REDCap from September 2 to December 20, 2018. MAIN OUTCOMES AND MEASURES A survey was developed using a modified Delphi process with a panel of experts to characterize physician mothers' family leave and return-to-work experiences. The survey covered both negative and positive experiences of physician mothers for each child they conceived or adopted after medical school to identify areas for change and strategies for successfully supporting physician parents. RESULTS Of 1465 potentially eligible survey respondents, 844 (57.6%) were verified as unique respondents with complete surveys. Their mean (SD) age was 35.8 (5.2) years (range, 27-67 years), with most women (826 [97.9%]) currently practicing and 138 women (16.4%) currently in a residency program. Participants were included from 19 subspecialty groups. Of the women surveyed, 619 (73.3%) felt that leave time was insufficient. The majority (751 [89.0%]) would have preferred 11 weeks to 6 months of leave vs the 5 to 12 weeks (often not paid) most commonly available. The most frequently reported negative experiences when returning to work were associated with lack of facilities for breast pumping (range, 12 of 78 [15.4%] for the third child to 272 of 844 [32.2%] for the first child) and time for breast pumping (range, 27 of 78 [34.6%] for the third child to 407 of 844 [48.2%] for the first child), difficulty obtaining childcare (eg, for the first child, 298 of 844 [35.3%]), and discrimination (eg, for the first child, 152 of 844 [18.0%]). The most common positive experience was emotional support (eg, for the first child, 504 of 844 [59.7%]), primarily from colleagues. CONCLUSIONS AND RELEVANCE The present study, capturing one of the largest and most heterogeneous samples of physician mothers, showed that a substantial number of women physicians working in a variety of specialties at all levels of training across the United States needed and wanted more support for maternity leave and return to work. Support at the institutional level, such as paid leave, adequate breast pumping time without penalty, on-site childcare, and schedule (continued) Key Points Question What do physician mothers experience when taking maternity leave and returning ...

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

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Objective:(1) To determine the reliability of the King–Devick (KD) test among wheelchair basketball athletes across a season and (2) to compare the KD test time changes among those with and without a clinically suspected concussion.Design:Prospective, observational study.Setting:Division 3 college athletics department.Participants:Twenty-nine intercollegiate wheelchair basketball athletes.Interventions:Athletes were prospectively monitored for concussions throughout the 2018 to 2019 season. King–Devick testing was completed preseason, midseason, postseason, and after clinically suspected concussions.Main Outcome Measures:Two-way random effects intraclass correlation coefficient (ICC) was calculated. Friedman's test and pairwise comparison with Bonferroni correction were used to compare for change over time. Mean KD times and changes were compared between athletes with and without suspected concussion.Results:The KD test demonstrated good test–retest reliability (ICC = 0.826). Among participants without a concussion, there was a significant decrease in the mean KD test time from preseason to midseason (−3.3 seconds; P = 0.0167) and preseason to postseason (−3.3 seconds; P = 0.0167). No change was seen from mid-to-post season. Six athletes had 7 suspected concussions. Each demonstrated an increase in the KD test time, with a mean increase from 44.3 ± 9.5 seconds to 53.7 ± 12.8 seconds. King–Devick test times returned to or below baseline by postseason.Conclusions:The KD test shows good reliability among wheelchair basketball athletes without a concussion. A learning effect is demonstrated initially but plateaus on subsequent testing. Unlike athletes without a concussion, players with a clinically suspected concussion showed an increase in the KD test time.

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