Association of Racial and Socioeconomic Diversity With Implicit Bias in Acute Care Surgery

Abstract

8%-20.7%), although the upper extremity was the most frequently fractured region overall (52.1%; 95% CI, 48.1%-56.1%); 28.7% of patients (95% CI, 23.7%-33.8%) required hospital admission. Discussion | To our knowledge, this study is the first to identify and characterize leash-dependent dog walking as an activity that imparts a significant and rising injury risk in older adults. The gravity of this burden is exemplified by the hip being most frequently fractured, because this injury is associated with long-term decreases in quality of life and functional capabilities, as well as mortality rates approaching 30%. 5 Combined with the sex disparity in injury burden, older women considering dog ownership must be made aware of this risk. Clinicians may play a role in identifying at-risk patients and minimizing fracture risk by advocating for preventive actions, such as obedience training to ensure dogs do not lunge while leashed, or suggesting smaller dog breeds for individuals contemplating ownership. 6 The study has limitations. Despite the validated nature of the source database, our findings likely underestimate the morbidity associated with elderly Americans walking leashed dogs: only emergency department cases are contained within the National Electronic Injury Surveillance System, and our analysis excluded less severe, nonfracture injuries. Moreover, the database does not include comparative dog sizes, cases requiring operative intervention, or disposition after discharge; future research may clarify the consequences of these variables. This study draws attention to an activity that can result in significant injury. For older adults-especially those living alone and with decreased bone mineral density-the risks associated with walking leashed dogs merit consideration. Even one such injury could result in a potentially lethal hip fracture, lifelong complications, or loss of independence.

Disparities in Lung Protective Ventilation in the United States

“…If ARDS were differentially distributed amongst our demographic groups, this could confound our ndings. However, consistent demonstration of disparities in processes of care across different studies increases the likelihood of that the similar associations we report are robust [2][3][4]6,20,35 . Our ndings thus add to the evidence suggesting women, shorter people, and the underinsured are treated differently in U.S. ICUs.…”

“…It is possible that clinicians' implicit biases in uenced their adherence to lung protective ventilation 33,34 , negatively impacting underinsured patients. Prior studies have demonstrated that treatment decisions by clinicians in acute care are in uenced by socioeconomic status-based implicit bias 35,36 . Further work is warranted to identify whether insurance-based bias exists in critical care, de ne its effect on treatment decisions, and test strategies for its elimination.…”

Diversity, equity and inclusion in acute care surgery: a multifaceted approach

“… 13 Interestingly, increased racial diversity of acute care surgeons in addition to other healthcare staff has been shown to mitigate the existence of implicit bias with lower levels of racial bias on web-based testing. 14 Acute care surgeons treat a diverse and often disadvantaged patient population; therefore, addressing such bias through staff implicit bias training is necessary to be a true patient advocate.…”

Racism and urogynecology: what is the connection?

“…Moreover, implicit biases can be developed by societal influences that create the perception of our population. A recent study with physicians that work in the acute care surgery arena revealed a high prevalence of implicit bias against Black (49%) and Hispanic (63%) people, despite 88% of the respondents stating that they had no explicit preference for white people [6]. Black surgeons and their professional career are less likely to remain in academia and Black assistant professors have the lowest rates of promotion [7].…”