Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions

Context

Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.

Objective

Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.

Design

Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.

Setting

Four national SCI Model Systems sites.

Participants

Individuals with SCI (N = 162) and their SCI physicians (N = 14).

Outcome measures

SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.

Results

Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = −4.54, 95% CI= −8.79, −0.28).

Conclusion

This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes.     

Radiographic Anatomy of the Native Anterior Cruciate Ligament: a Systematic Review

BackgroundIn an attempt to improve the accuracy and reproducibility of tunnel positioning, radiographs are being analyzed in an attempt to recreate the native anatomy of the ACL. Understanding the native ACL radiographic anatomy is an essential prerequisite to understand the relevance of postoperative tunnel position.Questions/PurposesWe performed a systematic review of the literature to delineate the radiographic location of the native ACL femoral and tibial footprints.MethodsA search was performed in March 2014 in PubMed, the Cochrane Collaboration Library, and EMBASE to identify all studies that evaluated the native anterior cruciate ligament (ACL) anatomy on radiographs. Various measurement methods were used in each study, and averages were obtained of the data from studies with the same measurement methods.ResultsFifteen papers were identified (which included data on 177 femora and 207 tibiae in total). Evaluation of the femoral footprint using the quadrant method on lateral knee radiographs showed that the average percent distance location of the anteromedial (AM) bundle and posterolateral (PL) bundle was 22.8% (95% confidence interval (CI) 16.59–28.90) and 32.5% (95% CI 27.71–37.26) from the posterior condyle, respectively, and 23.2% (95% CI 19.52–26.94) and 50.0% (95% CI 46.16–53.76) from Blumensaat’s line, respectively. Using the Amis and Jacob method, the tibial footprint on the lateral knee radiograph average percent distances was 35.1% (95% CI 34.46–35.72) for the center of the AM bundle and 47.3% (95% CI 41.69–52.95) for the center of the PL bundle of the ACL. The femoral and tibial ACL footprints on the anteroposterior (AP) views of the knee were not well delineated by these studies.ConclusionThe information presented in this systematic review offers surgeons another important tool for accurate ACL footprint identification.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-014-9417-5) contains supplementary material, which is available to authorized users.     

Anatomy Relationship around Internal Carotid Artery in the Endoscopic Surgery of Nasopharynx: A Study Based on Computed Tomography Angiography

Objective Anatomic knowledge is needed to avoid injury to internal carotid artery (ICA) during the endoscopic surgery around nasopharynx and its surrounding space. Design We prospectively studied the computed tomography angiography (CTA) data of 28 patients with image processing software. Special attention was given to ICA and various landmarks around nasopharynx. Results The anatomic relationship between ICA and different landmarks around nasopharynx was clearly presented in three-dimension. The fossa of Rosenmuller is the nearest point of the nasopharyngeal cavity to ICA. The opening of the Vidian canal in the middle cranial fossa could be either above, below, or at the level of the horizontal segment of petrous ICA. The pharyngeal trunk of the ascending pharyngeal artery can also be clearly identified in most reconstructed CTA images. Multiple anatomic relationships were also quantified. Conclusions Reconstructed CTA can provide key anatomic information for a safe and accurate endoscopic dissection around nasopharynx.     

Evaluations of guided bone regeneration in canine radius segmental defects using autologous periosteum combined with fascia lata under stable external fixation

BackgroundAlthough bone defect is one of the most common orthopaedic diseases, treatment remains a challenge and an issue of debate. Guided bone regeneration (GBR) is primarily accompanied by barrier membranes; however, optional membranes show some inherent flaws in clinical application. The purpose of this study was to observe the healing velocity and quality of repairing canine radius segmental defect using transferred autologous periosteum combined with fascia lata, which can provide better biological safety than other materials.ResultsBone union was seen in most individuals from the autologous periosteum combined with fascia lata group, within an average of 14.2 weeks. Histopathologic and SEM examinations both showed the different osteogenesis state between groups. Necropsy confirmed US findings with regard to distance of bone defects and location.ConclusionThese findings suggest that autologous periosteum combined with fascia lata is as effective as a GBR membrane, even in long tubular bone defects. With reliable biological safety, the autologous periosteum combined with fascia lata is expected to achieve increasing application in orthopaedic trauma patients.

Level of evidence

Not applicable, animal study.     

The effects of interleukin‐33 on airways collagen deposition and matrix metalloproteinase expression in a murine surrogate of asthma

It has been suggested that interleukin‐33 (IL‐33) plays an important role in the pathogenesis of asthma through a variety of pathways, but its role in airways fibrosis in asthma has not been fully elucidated. In the present study we evaluated changes in the expression of extracellular matrix proteins (ECMs) as well as matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in an IL‐33‐induced, antigen‐independent murine surrogate of asthma as well as a conventional surrogate employing per‐nasal challenge of mice previously sensitized to produce an IgE response to ovalbumin (OVA). In addition, in in vitro experiments we explored the direct effects of IL‐33 on the proliferation and function of murine fibroblasts. Per‐nasal administration of IL‐33 alone was sufficient to induce airways deposition of ECMs, including collagens I, III, V and fibronectin, to a degree comparable with that observed in the OVA‐sensitized and challenged mice. These changes were associated with a local imbalance between the expression of extracellular MMPs and TIMPs. Per‐nasal challenge of mice with IL‐33 also induced elevated airways expression of connective tissue growth factor and fibroblast growth factor receptor 4, two key facilitators of local fibrosis, again to a degree compatible with that observed in OVA‐sensitized and challenged mice. Deletion of the ST2 gene, which encodes the IL‐33 receptor, abrogated these fibrotic changes in the airways in the OVA surrogate. In vitro, IL‐33 significantly increased the proliferation and expression of collagen III by murine lung fibroblasts. These data suggest that direct exposure of murine airways to IL‐33 is able to induce local fibrotic changes, at least partially through effects of signalling through the IL‐33/ST2 axis on fibroblast function and local expression of MMPs and their inhibitors, and other fibrosis‐related proteins.