Publications by authors named "O Joe Hines"

221 Publications

Persistence of Gender Bias Over Four Decades of Surgical Training.

J Surg Educ 2021 Jul 19. Epub 2021 Jul 19.

Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California. Electronic address:

Objective: Female surgeons face gender-specific obstacles during residency training, yet longitudinal data on gender bias experienced by female surgery residents are lacking. We aimed to investigate the evolution of gender bias, identify obstacles experienced by female general surgery residents, and discuss approaches to supporting female surgeons during residency training.

Methods: Between August 2019 and January 2021, we conducted a retrospective cohort study using structured telephone interviews of female graduates of the UCLA General Surgery Residency training program. Responses of early graduates (1981-2009) were compared with those of recent graduates (2010-2020). Quantitative data were compared with Fisher's exact tests and Chi-squared tests. Interview responses were reviewed to catalog gender bias, obstacles experienced by female surgeons, and advice offered to training programs to address women's concerns.

Results: Of 61 female surgery residency graduates, 37 (61%) participated. Compared to early graduates (N = 20), recent graduates (N = 17) were significantly more likely to pursue fellowship training (100% vs. 65%, p < 0.01) and have children before or during residency (65% vs. 25%, p = 0.02). A substantial proportion in each cohort experienced some form of gender bias (71% vs. 85%, p = 0.43). Compared to early graduates, recent graduates were significantly less likely to report experiencing explicit gender bias (12% vs. 50%, p = 0.02) but equally likely to report implicit gender bias (71% vs. 55%, p = 0.50). Female graduates across the decades advocated for specific measures to champion work-life balance in residency (51%), strengthen female mentorship (49%), increase childcare support (41%), and promote women into leadership positions (32%).

Conclusions: While having children during residency has become more common and accepted over the decades, female surgery residents continue to experience implicit gender bias in the workplace. Female surgeons advocate for targeted interventions to establish systems for parental leave, address gender bias, and strengthen female mentorship.
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http://dx.doi.org/10.1016/j.jsurg.2021.06.008DOI Listing
July 2021

Sex Differences in Milestones Achievement-An Issue of Learning or Assessment Bias?

JAMA Surg 2021 Jul 7. Epub 2021 Jul 7.

Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles.

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http://dx.doi.org/10.1001/jamasurg.2021.3049DOI Listing
July 2021

The Effect of Perioperative Blood Transfusion on Long-Term Survival Outcomes After Surgery for Pancreatic Ductal Adenocarcinoma: A Systematic Review.

Pancreas 2021 May-Jun 01;50(5):648-656

From the Department of Surgery, David Geffen School of Medicine at UCLA.

Objective: To evaluate survival outcomes associated with perioperative allogeneic red blood cell transfusion (RBCT) in patients with pancreatic ductal adenocarcinoma undergoing surgery.

Methods: PubMed, Embase, Cochrane, and Web of Science Core Collection were queried for English-language articles until May 28, 2020. Studies evaluating long-term outcomes of RBCT compared with no transfusion in adults with pancreatic ductal adenocarcinoma undergoing pancreatectomy were included. E-value sensitivity analysis assessed the potential for unmeasured confounders to overcome these findings.

Results: Of 4379 citations, 5 retrospective cohort studies were included. Three studies reported shorter recurrence-free survival by 1 to 5 months with RBCT. Two studies found shorter disease-specific survival by 5 to 13 months with RBCT. Overall survival was reduced by 5 to 7 months with RBCT in 3 studies. All multivariable findings associated with RBCT could be readily overcome unmeasured confounding on sensitivity analysis. Confounding in baseline characteristics resulted in high risk of bias.

Conclusions: Imprecision, unmeasured confounding, small effect sizes, and overall low quality of the available literature result in uncertainty regarding the effect of transfusion on recurrence-free survival, disease-specific survival, and overall survival in patients undergoing surgery for pancreatic cancer. Randomized trials are needed to determine if there is a causal relationship between transfusion and survival after pancreatic resection.
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http://dx.doi.org/10.1097/MPA.0000000000001825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375579PMC
January 2022

Management of Intraductal Papillary Mucinous Neoplasms-Watch and Wait or Operate?

JAMA Surg 2021 Sep;156(9):825-826

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.

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http://dx.doi.org/10.1001/jamasurg.2021.0951DOI Listing
September 2021

Robust Inference for Mediated Effects in Partially Linear Models.

Psychometrika 2021 Jun 18;86(2):595-618. Epub 2021 May 18.

Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.

We consider mediated effects of an exposure, X on an outcome, Y, via a mediator, M, under no unmeasured confounding assumptions in the setting where models for the conditional expectation of the mediator and outcome are partially linear. We propose G-estimators for the direct and indirect effects and demonstrate consistent asymptotic normality for indirect effects when models for the conditional means of M, or X and Y are correctly specified, and for direct effects, when models for the conditional means of Y, or X and M are correct. This marks an improvement, in this particular setting, over previous 'triple' robust methods, which do not assume partially linear mean models. Testing of the no-mediation hypothesis is inherently problematic due to the composite nature of the test (either X has no effect on M or M no effect on Y), leading to low power when both effect sizes are small. We use generalized methods of moments (GMM) results to construct a new score testing framework, which includes as special cases the no-mediation and the no-direct-effect hypotheses. The proposed tests rely on an orthogonal estimation strategy for estimating nuisance parameters. Simulations show that the GMM-based tests perform better in terms of power and small sample performance compared with traditional tests in the partially linear setting, with drastic improvement under model misspecification. New methods are illustrated in a mediation analysis of data from the COPERS trial, a randomized trial investigating the effect of a non-pharmacological intervention of patients suffering from chronic pain. An accompanying R package implementing these methods can be found at github.com/ohines/plmed.
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http://dx.doi.org/10.1007/s11336-021-09768-zDOI Listing
June 2021
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