12 results on '"Megan G. Janeway"'
Search Results
2. Advocacy Toolbox: Training for Preclinical Medical Students Interested in Surgery
- Author
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Max Zhu, Miriam Y. Neufeld, Sarah G. Keller, Alexandra Leigh Boden, Megan G. Janeway, Lisa Allee, and Tracey Dechert
- Abstract
Health advocacy is a critical way to influence health policy and the wellbeing of our patients. Surgeons are increasingly recognizing the impact of the social determinants of health on surgical outcomes. Socially responsible surgery requires surgeons to advocate for their patients and communities to address inequity resulting from disparities related to the social determinants of health. However, further work is needed to teach aspiring surgeons how to advocate effectively. Introduction of surgical advocacy to medical students can help future surgical trainees understand that socially responsible advocacy is the work of surgeons and learn to incorporate advocacy into their future careers. To this end, we have developed a curriculum termed the Advocacy Toolbox: a program centered on surgical mentorship, advocacy didactics, and a longitudinal project. The Advocacy Toolbox aims to equip first year medical students with the tools needed to advocate for their patients and communities in a variety of contexts. The program is currently being implemented with a group of 15 first year medical students, with plans to expand the program in future years.
- Published
- 2021
3. Disparities in Utilization of Ambulatory Cholecystectomy: Results From Three States
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Amy K. Rosen, Gregory Patts, Karen E. Lasser, Tracey Dechert, Megan G. Janeway, Lisa Allee, and Sabrina E. Sanchez
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ethnic group ,Insurance Coverage ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Humans ,Cholecystectomy ,Healthcare Disparities ,Intraoperative Complications ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Middle Aged ,Health equity ,Underinsured ,United States ,Ambulatory Surgical Procedures ,Social Class ,030220 oncology & carcinogenesis ,Ambulatory ,Emergency medicine ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Cohort study - Abstract
Inpatient cholecystectomy is associated with higher cost and morbidity relative to ambulatory cholecystectomy, yet the latter may be underutilized by minority and underinsured patients. The purpose of this study was to examine the effects of race, income, and insurance status on receipt of and outcomes following ambulatory cholecystectomy.Retrospective observational cohort study of patients 18-89 undergoing cholecystectomy for benign indications in Florida, Iowa, and New York, 2011-2014 using administrative databases. The primary outcome of interest was odds of having ambulatory cholecystectomy; secondary outcomes included intraoperative and postoperative complications, and 30-day unplanned admissions following ambulatory cholecystectomy.Among 321,335 cholecystectomies, 190,734 (59.4%) were ambulatory and 130,601 (40.6%) were inpatient. Adjusting for age, sex, insurance, income, residential location, and comorbidities, the odds of undergoing ambulatory versus inpatient cholecystectomy were significantly lower in black (aOR = 0.71, 95% CI [0.69, 0.73], P0.001) and Hispanic (aOR = 0.71, 95% CI [0.69, 0.72], P0.001) patients compared to white patients, and significantly lower in Medicare (aOR = 0.77, 95% CI [0.75, 0.80] P0.001), Medicaid (aOR = 0.56, 95% CI [0.54, 0.57], P0.001) and uninsured/self-pay (aOR = 0.28, 95% CI [0.27, 0.28], P0.001) patients relative to privately insured patients. Patients with Medicaid and those classified as self-pay/uninsured had higher odds of postoperative complications and unplanned admission as did patients with Medicare compared to privately insured individuals.Racial and ethnic minorities and the underinsured have a higher likelihood of receiving inpatient as compared to ambulatory cholecystectomy. The higher incidence of postoperative complications in these patients may be associated with unequal access to ambulatory surgery.
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- 2020
4. Utilization of Mental Health Services in Pediatric Patients Surviving Penetrating Trauma Resulting from Interpersonal Violence
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Su Yeon Lee, Sabrina E. Sanchez, Bindu Kalesan, Erin A. Smith, Miriam Y. Neufeld, Matthew I. Miller, Lisa Allee, Megan G. Janeway, and Tracey Dechert
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Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Wounds, Penetrating ,Interpersonal communication ,Violence ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Intervention (counseling) ,medicine ,Humans ,Child ,Retrospective Studies ,Receipt ,business.industry ,Mental Disorders ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Mental health ,Community violence ,Interpersonal violence ,Family medicine ,Surgery ,Female ,business ,Penetrating trauma ,Facilities and Services Utilization ,Pediatric trauma - Abstract
Background Violent trauma has lasting psychological impacts. Our institution’s Community Violence Response Team (CVRT) offers mental health services to trauma victims. We characterized implementation and determined factors associated with utilization by pediatric survivors of interpersonal violence-related penetrating trauma. Methods Analysis included survivors (0–21 years) of violent penetrating injury at our institution (2011–2017). Injury and demographic data were collected. Nonparametric regression models determined factors associated with utilization. Results There was initial rapid uptake of CVRT (2011–2013) after which it plateaued, serving >80% of eligible patients (2017). White race and higher injury severity were associated with receipt and duration of services. In post-hoc analysis, race was found to be associated with continued treatment but not with initial consultation. Conclusion Successful implementation required three years, aiding >80% of patients. CVRT is a blueprint to strengthen existing violence intervention programs. Efforts should be made to ensure that barriers to providing care, including those related to race, are overcome.
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- 2020
5. The Impact of Domestic Violence Firearm Restrictions on Firearm Injury Admissions in New Jersey
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Michael Siegel, Michael Poulson, Miriam Y. Neufeld, Sabrina E. Sanchez, and Megan G. Janeway
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Firearm injury ,business.industry ,Domestic violence ,Medicine ,Surgery ,Criminology ,business - Published
- 2020
6. Surgery service learning in preclinical years improves medical student attitudes toward surgery, clinical confidence, and social determinants of health screening
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Elisa Caron, Su Yeon Lee, Isabel K. Sausjord, Megan G. Janeway, Tracey Dechert, Lisa Allee, and Sabrina E. Sanchez
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Male ,medicine.medical_specialty ,Students, Medical ,Social Determinants of Health ,education ,Service-learning ,Health literacy ,Risk Assessment ,Young Adult ,Medicine ,Humans ,Social determinants of health ,Schools, Medical ,Career Choice ,business.industry ,Medical school ,General Medicine ,Surgery ,Health Literacy ,General Surgery ,Health Care Surveys ,Female ,sense organs ,Curriculum ,Educational Measurement ,business ,Merge (version control) ,Patient education ,Boston ,Education, Medical, Undergraduate - Abstract
Patient health literacy is paramount for optimal outcomes. The Service Learning Project (SLP) aims to merge the need for patient education with the desire of medical students for early clinical experience.This pretest-posttest study examined the effect of the SLP on medical students. First-year students spent 8 h each month educating inpatients and screening for social determinants of health (SDH). Students completed a 30-question survey pre- and post-SLP, and longitudinally throughout medical school. We used t-tests to assess changes in attitudes towards surgery, clinical confidence, and SDH screening.Student self-perceived value on surgical teams increased significantly (2.49 vs 3.63 post-SLP, p 0.001), as did their confidence interacting with patients (3.66-4.14, p = 0.002) and confidence assessing for SDH (3.13-4.75, p = 0.002). 100% of students continued to assess for SDH on clerkships.The SLP model improves medical students' skills and confidence working with patients and addressing SDH.
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- 2019
7. Evaluation of incidental adrenal masses at a tertiary referral and trauma center
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Stephanie D. Talutis, Avneesh Gupta, Timothy Feeney, Philip E. Knapp, James M. Moses, Frederick Thurston Drake, Megan G. Janeway, Praveen Sridhar, and David McAneny
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Male ,medicine.medical_specialty ,Referral ,MEDLINE ,Adrenal Gland Neoplasms ,030230 surgery ,Multimodal Imaging ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Trauma Centers ,Medicine ,Humans ,Medical diagnosis ,Referral and Consultation ,Aged ,Retrospective Studies ,Incidental Findings ,business.industry ,Medical record ,General surgery ,Trauma center ,Retrospective cohort study ,Emergency department ,Middle Aged ,030220 oncology & carcinogenesis ,Health Care Surveys ,Surgery ,Female ,business ,Follow-Up Studies - Abstract
Incidental adrenal masses are those that are found on imaging performed for any nonadrenal evaluation. Published guidelines define accepted follow-up criteria for incidental adrenal masses; however, adherence to these guidelines and barriers to appropriate follow-up are not well understood. We aimed to describe practice patterns for the discovery, evaluation, and follow-up of incidental adrenal masses.Medical records of patients with an incidental adrenal mass underwent retrospective review at a tertiary referral and level-1 trauma center, as well as regional ambulatory care locations. Individuals ≥18 years of age with an incidental adrenal mass identified during 2016 were included. Patterns of evaluation, follow-up, and associated adrenal diagnoses were determined.From a total of 19,171 cross-sectional imaging procedures (computed tomography and magnetic resonance imaging), 244 patients with new incidental adrenal masses were identified. A majority (52%) were discovered as part of an evaluation in the emergency department. Of 153 patients with an identifiable primary care provider, approximately 75% had an in-network primary care provider, and 12 (7.8%) had both follow-up imaging and biochemical evaluation. Twenty-three percent of patients with an in-network primary care provider underwent an appropriate cross-sectional imaging procedure in follow-up compared to 29% for a non-network primary care provider (P = .54). Patients with a mass described with benign terminology were less likely to undergo follow-up imaging compared to those with indeterminate terminology (5% vs 37%, P.001). Patients with imaging ordered as an outpatient were more likely to receive follow-up with imaging (22.8% outpatient vs 11.5% inpatient, P = .042). There was no difference between any groups regarding biochemical evaluation, which inappropriately was performed in only 15% of patients with an incidental adrenal mass.To optimize follow-up of incidental adrenal masses, efforts should be made to assure and prioritize inpatient/emergency department incidental findings and to communicate to the appropriate primary care provider the necessary next steps for evaluation. Further, efforts to increase biochemical testing should be pursued.
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- 2019
8. Association of Race, Health Insurance Status, and Household Income With Location and Outcomes of Ambulatory Surgery Among Adult Patients in 2 US States
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Tracey Dechert, Na Wang, Qi Chen, Amy K. Rosen, Sabrina E. Sanchez, Maia R. Nofal, and Megan G. Janeway
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Male ,Adult ,medicine.medical_specialty ,Outpatient Clinics, Hospital ,Adolescent ,Databases, Factual ,Surgicenters ,New York ,030230 surgery ,Medicare ,Insurance Coverage ,White People ,Health Services Accessibility ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Economic Status ,Humans ,Outpatient clinic ,Healthcare Disparities ,Young adult ,Healthcare Cost and Utilization Project ,Socioeconomic status ,Aged ,Original Investigation ,Aged, 80 and over ,Insurance, Health ,Medicaid ,business.industry ,Hispanic or Latino ,Odds ratio ,Middle Aged ,Ambulatory Surgical Procedure ,United States ,Race Factors ,Surgery ,Black or African American ,Treatment Outcome ,Ambulatory Surgical Procedures ,030220 oncology & carcinogenesis ,Ambulatory ,Florida ,Female ,business ,Cohort study - Abstract
IMPORTANCE: The receipt of surgery in freestanding ambulatory surgery centers (ASCs) is often less costly compared with surgery in hospital-based outpatient departments. Although increasing numbers of surgical procedures are now being performed in freestanding ASCs, questions remain regarding the existence of disparities among patients receiving care at ASCs. OBJECTIVE: To examine the association of patient race, health insurance status, and household income with the location (ASC vs hospital-based outpatient department) of ambulatory surgery. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the State Ambulatory Surgery and Services Databases of the Healthcare Cost and Utilization Project to perform a secondary analysis of patients who received ambulatory surgery in New York and Florida between 2011 and 2013. Patients aged 18 to 89 years who underwent 12 different types of ambulatory surgical procedures were included. Data were analyzed from December 2018 to June 2019. MAIN OUTCOMES AND MEASURES: Receipt of surgery at a freestanding ASC and 30-day unplanned hospital visits after ambulatory surgery. RESULTS: A total of 5.6 million patients in New York (57.4% female; 68.9% aged ≥50 years; and 62.5% White) and 7.5 million patients in Florida (57.3% female; 77.4% aged ≥50 years; 74.3% White) who received ambulatory surgery were included in the analysis. After adjusting for age, comorbidities, health insurance status, household income, location of surgery, and type of surgical procedure, the likelihood of receiving ambulatory surgery at a freestanding ASC was significantly lower among Black patients (adjusted odds ratio [aOR], 0.82; 95% CI, 0.81-0.83; P
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- 2020
9. Disparities in Rehab Placement for Victims of Violence
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Victoria Liang, Stephanie D. Talutis, Tracey Dechert, Ella Cornell, Sabrina E. Sanchez, Nina Jreige, Lisa Allee, Megan G. Janeway, and Timothy Munzert
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medicine.medical_specialty ,business.industry ,Family medicine ,Medicine ,Surgery ,business - Published
- 2019
10. Socially Responsible Surgery: Building Recognition and Coalition
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Diane N. Haddad, Theresa R. Timmes, Tyler D. Robinson, Jacqueline M. Mills, Matthew M. Fleming, Feroze Sidhwa, Ryan Macht, Tracey Dechert, Douglas F. Kauffman, Nichole Starr, Thiago M. Oliveira, and Megan G. Janeway
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general surgery ,medicine.medical_specialty ,Poverty ,Curriculum, Instruction, and Pedagogy ,business.industry ,Public health ,trauma surgery ,030208 emergency & critical care medicine ,030230 surgery ,Surgery ,03 medical and health sciences ,Scholarship ,Underserved Population ,0302 clinical medicine ,Nursing ,social determinants of health ,Health care ,socially responsible surgery ,medicine ,Social determinants of health ,business ,Social responsibility ,Trauma surgery ,disparities - Abstract
Importance: Socially Responsible Surgery (SRS) integrates surgery and public health, providing a framework for research, advocacy, education and clinical practice to address the social barriers of health that decrease surgical access and worsen surgical outcomes in underserved patient populations. These patients face disparities in both health and in healthcare, which can be effectively addressed by surgeons in collaboration with allied health professionals. Objective: We reviewed the current state of surgical access and outcomes of underserved populations in American rural communities, American urban communities, and in low- and middle- income countries. Evidence review: We searched PubMed using standardized search terms, and reviewed the reference lists of highly relevant articles. We reviewed the reports of two recent global surgery commissions. Conclusions: There is an opportunity for scholarship in rural surgery, urban surgery and global surgery to be unified under the concept of SRS. The burden of surgical disease and the challenges to management demonstrate that achieving optimal health outcomes requires more than excellent perioperative care. Surgeons can and should regularly address the social determinants of health experienced by their patients. Formalized research and training opportunities are needed to meet the growing enthusiasm among surgeons and trainees to develop their practice as socially responsible surgeons.□
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- 2017
11. Implementation of a Novel Structured Social and Wellness Committee in a Surgical Residency Program: A Case Study
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Megan G. Janeway, Aaron P. Richman, Tracey Dechert, Joanna H. Ng-Glazier, Stephanie D. Talutis, Kathryn Van Orden, Elliot C. Pennington, and Douglas F. Kauffman
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Safety net ,media_common.quotation_subject ,surgical residency ,competence ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,basic needs ,Nursing ,social wellness ,Medicine ,autonomy ,Competence (human resources) ,media_common ,East coast ,Medical education ,belongingness ,Curriculum, Instruction, and Pedagogy ,business.industry ,Belongingness ,Residency program ,030220 oncology & carcinogenesis ,self determination ,Surgery ,Residence ,Basic needs ,business ,Autonomy - Abstract
This article provides a theoretical and and practical rational for the implementation of an innovative and comprehensive social wellness program in a surgical residency program at a large safety net hospital on the East Coast of the United States. Using basic needs theory, we describe why it is particularly important for surgical residency programs to consider the residents sense of competence, autonomy, and belonging during residence. We describe how we have developed a comprehensive program to address our residents' (and residents' families) psychological needs for competence, autonomy, and belongingness.
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- 2017
12. Socioeconomic Status Affects Access to Ambulatory Cholecystectomy
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Karen E. Lasser, Lisa Allee, Megan G. Janeway, Eric A. Jones, Amy K. Rosen, Tracey Dechert, and Gregory Patts
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Emergency medicine ,Ambulatory ,medicine ,Surgery ,Cholecystectomy ,business ,Socioeconomic status - Published
- 2018
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