Browsing by Author "Rohr-Kirchgraber, Theresa"
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Item "But I could be allergic!" Food Allergies and Eating Disorders a Dangerous Duo.(2021-03) Harding, Michael; Alcaide, Doriann; Hardman, Sara; Rohr-Kirchgraber, TheresaFor many patients with eating disorders (ED) a diagnosis of food allergies can complicate treatment and allow the patients to avoid appropriate nutrition. Food allergy testing is cost intensive, often does not contribute to changing the plan of care for a patient, and can even lead to misdiagnosis. A thorough history is indispensable in assessing a patient for food allergies and ultimately an oral food challenge is the gold standard for the diagnosis. There may be psychological benefit to knowing the outcome of a food allergy test if this is having a significant impact on the patient’s quality of life. This comprehensive clinical assessment by a physician may bypass some of the added stress and financial burden brought on by formalized food allergy testing. A 35 yo woman with anorexia nervosa (AN) presents with concerns about bloating, inflammation and the influence of food allergies on her overall health. She has had AN for 3 years and her lowest Body Mass Index (BMI) was 13. With treatment it has improved to 17. However, she has been reading about how food allergies can affect her body and is asking for food allergy testing. A key role of healthcare is to provide accurate diagnoses with the combination of clinical reasoning and diagnostic testing. The US healthcare system is often an expensive model for patients and the financial burden of food allergy testing must be considered with the impact on the treatment plan. It is imperative that the healthcare model continue to assess the necessity of food allergy testing in order to provide the best care to patients while still being mindful of the financial cost and how results can complicate care, especially in patients with ED. Patients with ED frequently have multiple rules about how and what to eat, and the ED can use the results of allergy testing to further limit their intake. This can lead to disastrous effects. Patients with eating disorders do not need another reason not to eat.Item (Dis)Incentivizing Patient Satisfaction Metrics: The Unintended Consequences of Institutional Bias(Mary Ann Liebert, 2019-02-04) Sotto-Santiago, Sylk; Slaven, James E.; Rohr-Kirchgraber, Theresa; Medicine, School of MedicineBackground: Patient satisfaction surveys as a metric for quality-based financial incentives carry a risk of bias toward women and underrepresented physicians. Previous assessments in our department of medicine found that most women faculty were rated in the bottom quartile of patient satisfaction scores, whereas analysis of scores for underrepresented physicians had not been performed. To investigate, we compared patient satisfaction scores and relevant demographics of faculty physicians during 1 year when quality-related financial incentives were offered based on this metric. Methods: Patient satisfaction and communication scores collected during academic year 2015-2016 were obtained for 369 physicians (119 women and 250 men) at Indiana University Health system. Independent variables included physician gender, race, ethnicity, and subspecialty or division; 190 physicians constituted the study cohort for whom data were available for comparison. Statistical analyses were performed to determine if there were differences between gender and race in patient satisfaction scores (mean, median, t-tests, and Chi-square tests). A factorial analysis of variance model was performed to incorporate both main effects and to determine if there was a significant interaction between them. Results: Median and mean of scores were lower for women physicians and underrepresented physicians. Analysis demonstrated nonsignificant effect between gender-segregated cohorts. Racially underrepresented physicians had significantly lower mean scores than their white colleagues [F(4, 185)=2.46, p=0.046]. Conclusion and Relevance: Our results indicate a significant difference in patient satisfaction scores between underrepresented and white physicians. These data may suggest a potential bias, among patients and institutional practices, ultimately leading to pay inequities through differences in financial incentives toward underrepresented physicians.Item Eating Disorders in Adulthood(Office of the Vice Chancellor for Research, 2013-04-05) Mensah, Nicole Lurline; Rohr-Kirchgraber, Theresa; Stupiansky, Nathan; Teat, RachelThe lifetime prevalence of acquiring an Eating Disorder (ED) in the US is 0.6–4.5%. The focus of ED research has traditionally been in adolescents with minimal focus on adults. We aimed to compare and contrast the etiology and disease progression between two groups of adult patients with EDs: those diagnosed in adulthood versus those diagnosed in childhood (introduction). Thirty adult patient’s (29 females and 1 male) charts were reviewed from one eating disorders center. Data was extracted using a pre-constructed template and SPSS was used to determine existing trends (method). 50% were diagnosed with an ED in childhood and 50% in adulthood. The majority of the patients with an adult-onset ED were diagnosed with Eating Disorder not-otherwise-specified (ED-NOS). Common events that triggered the disease onset included death/ illness of a parent or child, and work-related stressors. In contrast, patients diagnosed as children had more varied diagnoses including ED-NOS, Bulimia Nervosa (BN), and Anorexia Nervosa (AN). Sexual abuse, personal illness, and the termination of a romantic relationship were common triggers in this patient group. Among all patients fatigue, emesis, constipation, diarrhea, heart palpitations, amenorrhea or irregular menses, and acid erosion of tooth enamel were common comorbidities. Psychiatric comorbidities, Major Depressive Disorder and Anxiety Disorder, were primarily seen and 29/30 patients were taking psychotropic medication to treat an underlying psychiatric illness at time of their first Eating disorder visit (results). The triggers and behaviors of patients diagnosed with EDs as children are different from patients diagnosed in adulthood. Regardless of the age of onset, comorbidities are equally severe and should be treated as such. The longer and ED remains untreated, the harder it is to get it into remission, therefore, adult health care providers must incorporate screening for ED’s when caring for this population (conclusion).Item Gender Harassment Persists in Medical Training(Mary Ann Liebert, Inc., 2020-10-08) Vogel, Carolina; Rohr-Kirchgraber, Theresa; Pediatrics, School of MedicineMedical students start their career with enthusiasm for a profession that emphasizes caring for others so as to promote health, treat injury, and prevent disease. The profession of medicine selects those who have demonstrated compassion, knowledge, and leadership. As students enter the profession, many possess a certain naiveté with the expectation for equity. After a few encounters of her own, one of our authors wondered whether the statistic that female medical students are ∼220% greater to experience harassment in medical education from faculty, staff, and patients was true and sought to determine whether her experience was unique. Unfortunately, with just a quick Instagram post, she received numerous messages from peers indicating that gender harassment is all too common.Item The Policy that Wasn’t: Surveying the Maternity Leave Policies of Indianapolis-Area Healthcare Systems(Office of the Vice Chancellor for Research, 2016-04-08) Combs, Larissa; Ellsperman, Susan; Menegotto, Jillian; Rohr-Kirchgraber, TheresaThe United States is one of only four countries that does not set national standards regarding paid maternity leave policies for working mothers. On a national level, 70% of working mothers took time off of work during their last pregnancy. In Indiana alone, over 83,000 women gave birth in 2013. In the greater Indianapolis area, the healthcare system serves as a microcosm of the national workforce. Of the 38,000 healthcare positions in this region, 48% are filled by females. Thus, it is important to address the lack of maternity leave legislation as it affects so many working mothers on both the national and state level. Eight Indianapolis area hospital systems were surveyed (including IU School of Medicine), and none provided paid maternity leave for its employees. Mothers are left with the option of deferring to the national Family and Medical Leave Act (FMLA), which allows for twelve weeks of unpaid leave following delivery. In addition, in certain hospital systems, employees can use accrued short-term disability if they are both eligible to apply for such benefits and have applied for coverage prior to the pregnancy. The greater Indianapolis healthcare systems were surveyed as a representation of the workforce as a whole and found to have varying policies regarding the time off given to new mothers. All were the same in that they provided no paid leave. As probable future working mothers, this issue is of great importance. It must be recognized that these findings add undue burden to mothers and infants. Only three states have created a paid family leave policy, and though national bills have been proposed, they have not been fully supported. With so many affected by this lack of policy, changes must be made to better serve working mothers in the state of Indiana and the nation as a whole.Item The PPE Pandemic: Sex-Related Discrepancies of N95 Mask Fit(EMJ, 2021-07-06) Christopher, Laura E.; Rohr-Kirchgraber, Theresa; Mark, Saralyn; Engineering Technology, School of Engineering and TechnologyDuring the COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2, healthcare professionals across the world have been at high risk of transmission because of their direct contact with infected patients. In October 2020, the International Council of Nurses (ICN) confirmed that 1,500 nurses had died from COVID-19 in 44 countries and estimated that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. To ensure protection of healthcare personnel, properly fitting personal protective equipment (PPE) must be worn. In a ‘one size fits all’ world, the differences between the fit of PPE for men and women can have devastating consequences. An N95 respirator mask is a component of PPE outlined by the Centers for Disease Control and Prevention (CDC) for protection against COVID-19; however, N95 masks do not offer protection if they do not fit properly. Fit testing is performed to ensure an adequate seal of the mask on the wearer. A single-institution retrospective review was performed on fit testing results for male versus female wearers in an attempt to elucidate a difference in failure rates. Females failed at a significantly higher rate than their male counterparts (6.67% female, 2.72% male; p=0.001), and the reason reported was often due to being ‘small-boned’ (p<0.0001). Sex-related differences in proper PPE fit are not new; however, the COVID-19 pandemic has made the situation more acute, and sex-specific N95 mask designs must be developed quickly, as the pandemic shows little signs of abating.Item Reframing Academic Productivity, Promotion and Tenure As a Result of the COVID-19 Pandemic(Magna, 2021-01-01) Sotto-Santiago, Sylk; Dilly, Christen K.; O'Leary, Heather A.; Craven, Hannah J.; Kara, Areeba; Brown, Cynthia; Kressel, Amy B.; Rohr-Kirchgraber, TheresaFaculty members have been impacted in a multitude of ways by the COVID-19 pandemic. In particular, faculty seeking promotion and tenure have been impacted by the disruption and inconsistent levels of productivity. In this article, we consider academic productivity in the context of clinical, research, education and service missions within higher education and the academic medicine professoriate. We offer a series of recommendations to faculty members, to institutions, and to professional societies in hopes we can challenge pre-existing deficits in promotion and tenure processes, and academic worth.