Jacobs Institute of Women's Health
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Attachment as a Primary Mechanism in Physician Cognition and Bias During Complex Medical Cases: A Narrative Review
No full textINTRODUCTION: In recent decades, improvements in diagnostic accuracy in medical cases have been minimal despite rapid advancements in technology. Moreover, in complex cases, diagnostic accuracy remains a significant challenge, often reflecting practices from the 18th and 19th centuries. This comprehensive narrative review explores how cognitive bias may act as a critical, yet neglected, factor contributing to the persistent diagnostic error rate. METHODS: A narrative review of the literature was conducted through a search of the George Washington University library databases and Google Scholar to identify studies related to physician cognition, complex medical diagnosis, and cognitive error. RESULTS: This review synthesizes existing literature to propose a theoretical framework explaining how cognitive error, clinician cognition, tolerance of uncertainty, and attachment theory interact to influence the formation of cognitive bias at the cost of diagnostic accuracy and efficiency. DISCUSSION: It is not only necessary for clinicians to focus on a patient\u27s words, symptoms, or data to improve diagnostic accuracy, but also for clinicians to relate to others\u27 distress through their own attachment styles: technology\u27s critical blind spot. Clinicians with insecure attachment styles may struggle with metacognition, exhibit lower cognitive flexibility, have reduced tolerance for uncertainty, experience lower thresholds for cognitive load, and rely more heavily on heuristics, leading to an increased likelihood of cognitive error during complex medical cases. This theory provides a foundation for further research into how attachment influences clinician decision-making and diagnostic performance while also highlighting how medical education may reinforce these patterns
What is the effect of postpartum hemorrhage on physical activity after cesarean?
No full textOBJECTIVES: This study introduces a novel approach, utilizing activity tracking devices (ATDs), such as Fitbit, to monitor mobility during cesarean recovery and investigate the relationship between physical activity (PA) and postpartum hemorrhage (PPH). METHODS: We conducted a prospective cohort study involving postpartum patients aged 18-50 years who delivered at George Washington University and underwent a scheduled or emergent cesarean from December 2022 to September 2023. The primary outcome was assessing the relationship between PPH and PA for 2 weeks postpartum using the Fitbit. Data from all patients were extracted from the electronic medical records. The Fitbit Model of Inspire was used to monitor patients\u27 PA. RESULTS: Statistical analyses of the relationship between quantitative blood loss (QBL) during cesarean delivery and average steps per day postpartum found statistically non-significant results (Δ1.16 [1.16%], P = 0.817) for the collective cohort. Excluding one outlier from the patient cohort, analysis of the relationship between the same two variables found statistically significant results (Δ1.83 [1.83%], P = 0.023). A coefficient of 1.83 (1.83%) on the QBL variable was found, signifying that an increase of 1 mL in QBL corresponds to an average decrease of 1.83 (1.83%) in average steps per day postpartum. CONCLUSION: This study\u27s findings underscore the potential clinical relevance of monitoring PA to identify and address postpartum complications. Further research could explore interventions to mitigate the observed decline in mobility associated with PPH, ultimately enhancing maternal healthcare outcomes
Refining Data Presentation in Data and Safety Monitoring Boards Reports: An Example from a Clinical Trial Evaluating Antifungal Therapy in Pediatric Uncomplicated Candidemia (COUNT)
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Discrepancies in Temporal Artery Biopsy Positivity Rate Among White and Black Patients Suspected of Having Giant Cell Arteritis
No full textOBJECTIVE: Our hypothesis is that biopsy-positive giant cell arteritis (GCA) is infrequent among Black patients. To evaluate this, we compared the temporal artery biopsy (TAB) positivity rates among White and Black patients. METHODS: This is a case-control study review from all patients who underwent TAB at our institution from 2012 until 2021. The main study outcome was the TAB positivity rate. The main independent variable was race/ethnicity. Clinical and demographic features of patients undergoing TAB were compared between those with positive and negative biopsies with t tests, Wilcoxon rank sum test, χ2 test, or Fisher exact test where appropriate. A multiple logistic regression with Firth correction was performed with factors found to be significant in bivariate analysis to evaluate for independent associations with a positive biopsy. RESULTS: Three hundred eighty-five patients who underwent TAB for suspected GCA were included (290 White, 95 Black). Mean sedimentation rate was higher in Black patients, but otherwise, both groups had similar demographic and clinical characteristics. Positivity rate of TAB in White patients was 20.3% and 8.4% in Black patients. White race was associated with higher likelihood of TAB positivity compared with Black race (odds ratio, 3.47). Patients with positive TAB were more likely to have jaw claudication, constitutional symptoms, and higher inflammatory markers. Other factors significant in the logistic regression model included age, and inversely with decreased visual acuity. CONCLUSIONS: Our study results support the hypothesis that there is a discrepancy in the frequency of biopsy-confirmed GCA in patients referred for TAB, with Black patients having lower rates than their White counterparts
New Directions For Women\u27s Health: Expanding Understanding, Improving Research, Addressing Workforce Limitations
No full textIn the United States, the field of women\u27s health faces critical challenges. This article, part of the National Academy of Medicine\u27s Vital Directions for Health and Health Care: Priorities for 2025 initiative, emphasizes the need for a holistic, lifespan approach to women\u27s health that considers biological sex, gender, and intersecting social factors. We identify three key challenges: broadening the understanding of women\u27s health beyond reproductive issues, improving the research ecosystem, and addressing workforce limitations. With innovative policies and investments across all areas of health, attention to structural determinants, and emphasis on the upstream factors affecting women\u27s lives, significant improvements in women\u27s health outcomes and substantial societal benefits can be achieved in 2025 and beyond
Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest
No full textAIMS: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained. METHODS: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497). RESULTS: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥ 1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥ 1-month, greater pre-arrest disability, and receiving CPR for ≥ 16 min. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU. CONCLUSIONS: Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors