Monica Rakesh Saxena

All Publications

• Initiating medical abortion in an emergency department in the United States. BMJ sexual & reproductive health Preiksaitis, C., Saxena, M., Henkel, A. 2024

  Abstract

  The primary objective of this study was to assess the feasibility of initiating medical abortions in a large, academic emergency department (ED) in the United States.A retrospective case series analysis was conducted to evaluate a protocol for initiating medical abortion in the ED implemented from January 2020 to October 2023 at an academic, tertiary care hospital in California, USA. Participants included ED patients diagnosed with pregnancies in the first trimester that were undesired and who opted for medical abortion. The medical abortion protocol was collaboratively designed by a multidisciplinary team and follow-up was conducted by our institution's gynaecology department. Data were sourced from a data repository of electronic health records and subjected to descriptive statistical analysis.A total of 27 eligible patients initiated medical abortions in the ED during the study period. The cohort was diverse in terms of racial and ethnic backgrounds and almost evenly split between private and public insurance. No patients had significant complications identified in the medical record. Two patients required uterine aspiration by the gynaecology team; one patient in clinic and one during a return visit to the ED.Data from this case series suggest that initiating medical abortion in the ED is feasible. The ED may be considered as an additional access point for abortion care services, especially in areas where other care options are not readily available. Educational, legal and regulatory frameworks that allow emergency physicians to take a greater role in providing this care should be considered.

  View details for DOI 10.1136/bmjsrh-2023-202149

  View details for PubMedID 38365454

• Reworking Emergency Medicine Resident Education Post-Dobbs v Jackson Women's Health Organization. Journal of graduate medical education Saxena, M. R., Choo, E. K., Andrabi, S. 2023; 15 (3): 283-286

  View details for DOI 10.4300/JGME-D-23-00300.1

  View details for PubMedID 37363684

• Variation in ACS patient hospital resource utilization: Is it time for advanced NSTEMI risk stratification in the ED? The American journal of emergency medicine Saxena, M., Bloos, S. M., Graber-Naidich, A., Sundaram, V., Pasao, M., Yiadom, M. Y. 2023; 70: 171-174

  Abstract

  A majority of patients who experience acute coronary syndrome (ACS) initially receive care in the emergency department (ED). Guidelines for care of patients experiencing ACS, specifically ST-segment elevation myocardial infarction (STEMI) are well defined. We examine the utilization of hospital resources between patients with NSTEMI as compared to STEMI and unstable angina (UA). We then make the case that as NSTEMI patients are the majority of ACS cases, there is a great opportunity to risk stratify these patients in the emergency department.We examined hospital resource utilization measure between those with STEMI, NSTEMI, and UA. These included hospital length of stay (LOS), any intensive care unit (ICU) care time, and in-hospital mortality.The sample included 284,945 adult ED patients, of whom 1195 experienced ACS. Among the latter, 978 (70%) were diagnosed with NSTEMI, 225 (16%) with STEMI, and 194 with UA (14%). We observed 79.1% of STEMI patients receiving ICU care. 14.4% among NSTEMI patients, and 9.3% among UA patients. NSTEMI patients' mean hospital LOS was 3.7 days. This was shorter than that of non-ACS patients 4.75 days and UA patients 2.99. In-hospital mortality for NSTEMI was 1.6%, compared to, 4.4% for those with STEMI patients and 0% for UA. There are recommendations for risk stratification among NSTEMI patients to evaluate risk for major adverse cardiac events (MACE) that can be used in the ED to guide admission decisions and use of ICU care, thus optimizing care for a majority of ACS patients.

  View details for DOI 10.1016/j.ajem.2023.05.028

  View details for PubMedID 37327683

• Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021. Journal of graduate medical education Saxena, M. R., Ling, A. Y., Carrillo, E., Alvarez, A., Yiadom, M. Y., Bennett, C. L., Gallegos, M. 2023; 15 (2): 175-179

  Abstract

  Background: According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.Objective: To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.Methods: We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.Results: Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.Conclusions: Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.

  View details for DOI 10.4300/JGME-D-22-00384.1

  View details for PubMedID 37139207

• Trends in female first-author abstracts at the Society for Academic Emergency Medicine Annual Meeting, 1990-2020. The American journal of emergency medicine Cash, R. E., Bennett, C. L., Boggs, K. M., Samuels-Kalow, M. E., Saxena, M., Pasao, M., Raja, A. S., Camargo, C. A. 2022; 63: 22-28

  Abstract

  To describe first author gender differences and characteristics in 1) Society for Academic Emergency Medicine (SAEM) Annual Meeting abstracts and 2) resulting manuscript publications.We performed cross-sectional evaluation of SAEM abstracts from 1990, 1995, 2000, 2005, 2010, 2015, and 2020, compiling and reviewing a random sample of 100 abstracts for each year (total n = 700 abstracts). We documented abstract characteristics, including first author gender, and used the 2020 SAEM scoring rubric. We then searched PubMed to identify manuscript publications resulting from abstracts from 1990 to 2015 (n = 600). Finally, among abstracts that resulted in manuscript publication, we identified first and last author gender on both the abstracts and the resulting publication.Overall, 29% (202/695; n = 5 missing gender) of abstracts had female first authors. Female first authors increased over time (e.g., 17% in 1990 to 35% in 2020). Abstract quality scores were similar (both median [interquartile range] of 11 ([9-12]). Overall, 42% (n = 254/600) of abstracts resulted in a manuscript publication, 39% (n = 65/202) with female and 44% (n = 189/493) with male first authors (p = 0.26). The median time (IQR) from abstract to manuscript publication was longer for abstracts with female first authors vs. those with male first authors (2 [1-3] years and 1 [1, 2] years, p < 0.02); 77% and 78% of publications resulting from abstracts with female and male first authors, respectively, had the same first author. Female first author abstracts more often converted to a male first author manuscript publication (18%, n = 12/65) compared to male first author abstracts converting to female first author publications (7%, n = 14/189).A minority of SAEM abstracts, and manuscript publications resulting from them, had female first authors. Abstracts with female first authors took longer to achieve manuscript publication, and almost a fifth of female first author abstracts resulted in male first author manuscript publication.

  View details for DOI 10.1016/j.ajem.2022.10.028

  View details for PubMedID 36306648

• Journal update monthly top five. Emergency medicine journal : EMJ Saxena, M., Altamirano, J., Rose, C., Bennett, C., Govindarajan, P., Lumba-Brown, A., Hirst, R. 2022; 39 (7): 561-562

  View details for DOI 10.1136/emermed-2022-212603

  View details for PubMedID 35732304