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Purpose Guidelines regarding parental leave in oral and maxillofacial surgery do not exist. This inconsistency may contribute to gender disparities and an increase in resident burnout. The purpose of this study was to examine perceptions and attitudes of oral and maxillofacial surgery residents toward parental leave. Materials and Methods This was a cross-sectional study in which an anonymous 26-item questionnaire was electronically mailed to all current oral and maxillofacial surgery residents in the United States during August 2020. The survey consisted of 5 sections: 1) resident information, 2) residency program information, 3) parental policy information, 4) attitudes regarding parental leave, and 5) attitudes regarding early parenthood. Results Surveys were sent to 860 oral and maxillofacial surgery residents; 220 completed the questionnaire (25.6%). Majority of respondents were male between the ages of 26 and 30. Half of the respondents did not know whether their oral and maxillofacial surgery program had a formal parental leave policy. Almost a third of residents reported that their program did not have a policy regarding parental leave. Only some programs had a policy regarding parental leave. Most programs allotted 2 days to 2 weeks for parental leave. Parenthood did not prevent pursuit of fellowship training. The majority of co-residents indicated that parenthood had a neutral impact on the performance of their colleagues. Lactation facilities and/or childcare services were not present in all programs. Conclusions Most oral and maxillofacial surgery residents support parental leave despite the lack of a formal policy in their residency program. Residents who had a child during residency received up to 2 weeks as parental leave. Residents felt that their programs were supportive of parental leave. Parenthood did not prevent the pursuit of fellowship training.

Guidelines regarding parental leave in oral and maxillofacial surgery (OMS) do not exist. This inconsistency may contribute to gender disparities and an increase in resident burnout. The purpose of this study was to examine perceptions and attitudes of OMS residents toward parental leave. This was a cross-sectional study in which an anonymous 28-item questionnaire was electronically mailed to all current residents in OMS residency programs in the United States during August 2020. The survey consisted of 5 sections: 1) resident demographics (age, gender, parental status), 2) residency program information (geographic location, MD/non-MD status), 3) parental policy information (presence of formal parental leave policy, time allowed for parental leave, requirements associated with time off, on-call duties for parental leave), 4) attitudes regarding parental leave (regarding additional on-call time, performance, emotions toward parental time off, program support during pregnancy), 5) resident well-being (lactation facilities, availability of childcare). Statistical analysis was completed using R statistical software (Version 4.0.3). Descriptive statistics were completed. Univariate analyses were performed using the Wilcoxon Rank Sum test for ordinal outcome and categorical exposure. Fisher exact test for categorical outcome and categorical exposure and the Spearman test to analyze correlation between an ordinal outcome and an ordinal exposure were conducted. Statistical significance was 2-sided P-values Surveys were sent to 860 OMS residents; 220 completed the questionnaire (25.6%). The majority of respondents were male (n = 156, 70.9%) between the ages of 26-30 (n = 114, 51.8%). Respondents had no children (n = 135, 61.4%), had at least 1 child during residency (n = 60, 27.3%), were currently expecting (n = 14, 6.4%), or had a child prior to residency (n = 11, 5%). Half of the respondents did not know whether their OMS program had a formal parental leave policy (n = 110, 50%). Almost one-third of OMS residents reported that their program did not have a policy regarding parental leave (n = 60, 27.3%). Some programs had a policy regarding parental leave (n = 38, 17.3%) or only regarding maternity leave (12, 5.5%). Most programs allotted 2-6 days (n = 26, 11.8%) or 1-2 weeks (n = 16, 7.3%) off. Residents felt that their co-residents usually gave enough notice for parental leave (n = 74, 33.6%). Pregnancy was reported to the program director in the first trimester (n = 25, 11.4%) or second trimester (34, 15.5%). Some residents reported no negative emotions from the program (n = 43, 19.6%) and co-residents regarding parental leave (n = 51, 23.2%). Most respondents felt that parental leave is fair in their program (n = 170, 77.3%). During parental leave, residents found support in family (n = 45, 20.5%), co-residents (n = 20, 9.1%), and/or attendings (n = 3, 1.4%). Some residents believed that becoming a parent positively impacted their performance (n = 28, 12.7%). Some residents believed that residency had a negative impact on their performance as a parent (n = 41, 18.6%). Parenthood did not prevent pursuit of fellowship training (n = 44, 20%). The majority of co-residents indicated that parenthood had a neutral (n = 64, 29.1%), negative (n = 18, 8.2%), or positive (n = 16, 7.3%) impact on the performance of their colleagues. Respondents indicated that their program/hospital has lactation facilities (n = 57, 25.9%) and/or childcare services (n = 47, 21.4%). The researchers found that most residents are supportive of parental leave despite the lack of a formal policy in their programs. For those residents who conceived during residency, the time allowed for parental leave was on average 1-2 weeks in length, considerably less than what is allowed in the Family and Medical Leave Act of 1993 (FMLA). Additionally, parental status did not have an effect on a resident's decision to pursue fellowship training. In conclusion, parental leave guidelines within the OMS specialty are needed to support the integration of family with postgraduate OMS training and to encourage the pursue of the specialty.

INTRODUCTION Compared with the older pediatric population, neonates have greater perioperative morbidity and mortality. Difficulty with glucose regulation may be a contributing modifiable risk factor during perioperative anesthetic management. To mitigate the risk of hyperglycemia in neonates, some providers empirically halve the preoperative rate of dextrose-containing infusions during surgery. AIM To assess the association between halving the preoperative maintenance dextrose rate and postoperative euglycemia in neonatal intensive care unit patients undergoing exploratory laparotomies. METHODS Neonatal intensive care unit patients who underwent exploratory laparotomy under general anesthesia from 1/1/2014 to 11/21/2019 were included in this analysis. Hyperglycemia and hypoglycemia were defined as >150 mg/dL and

At least twelve percent of primary care patients over the age of 60 experience major or minor depression.1 Despite evidence that both psychotherapy and pharmacologic treatments are effective in older adults, depression is often untreated or undertreated in this population.2–5 While medication for depression is often prescribed in primary care, adherence is low and may be related to the negative views toward antidepressants expressed by both patients and the general public.6 Beliefs about medication are cited by patients as important determinants of depression treatment acceptance and are also known to affect adherence.7, 8 Antidepressants are well established as the recommended treatment for major depression in the elderly9; however, their effectiveness in treating minor depression and dysthmia is less certain and psychological treatments may be equally effective.4, 10 In these situations where the optimal treatment is uncertain, patient beliefs and preferences regarding antidepressants are particularly salient. Underlying our study is the premise that beliefs affect behavior, an assumption supported by cognitive models of health behavior such as the Health Belief Model and the Theory of Reasoned Action. In these models, health-related behaviors are explained by knowledge, beliefs, and attitudes. The Health Belief Model stresses beliefs about perceived susceptibility to illness and severity of illness. The Theory of Reasoned Action includes perceived social approval or disapproval as a determinant of behavior.11 Evidence that patients view medications with caution and resist taking them is increasing.12 The most common negative attitudes toward psychotropic medication are fears about side effects and addiction.7, 13 Attitudes felt to prevent depressed older patients from using antidepressants include the associated stigma, concerns about side effects, and lack of education or support from providers.2, 14 In order to further explore potential barriers to antidepressant use in older depressed adults, this qualitative study investigates reasons for resisting the use of pharmacologic treatment for depression and builds a thematic framework for understanding these concerns in order to facilitate patient-provider communication in a clinical setting.

BACKGROUND: Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings. OBJECTIVE: To explore attitudes toward antidepressants in a sample of depressed, community-dwelling elders who were offered treatment. DESIGN. Cross-sectional, qualitative study utilizing semi-structured interviews. PARTICIPANTS: Primary care patients age 60 years and over with depression, from academic and community primary care practices of the University of Pennsylvania Health System and the Philadelphia Department of Veterans Affairs. Patients participated in either the Prevention of Suicide in Primary Care Elderly: Collaborative Trial or the Primary Care Research in Substance Abuse and Mental Health for the Elderly Trial. Sixty-eight patients were interviewed and responses from 42 participants with negative attitudes toward medication for depression were analyzed. MEASUREMENTS: Interviews were audiotaped, transcribed, and entered into a qualitative software program for coding and analysis. A multidisciplinary team of investigators coded the transcripts and identified key features of narratives expressing aversion to antidepressants. RESULTS: Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression. CONCLUSIONS: Many elders resisted the use of antidepressants. Patients expressed concerns that seems to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.