Ezra Tilahun Yoseph
MD Student with Scholarly Concentration in Health Services & Policy Research / Surgery, expected graduation Spring 2027
All Publications
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Provider's exposure to diversity contributes to socioeconomic disparities in lumbar and cervical fusion outcomes.
World neurosurgery: X
2024; 23: 100382
Abstract
Studies report patient race, income, and education influence spinal fusion outcomes; fewer studies, however, examine the influence of provider factors such as exposure to diversity or cultural sensitivity.To examine how providers' experience with diverse patient populations affects spinal fusion outcomes.Retrospective review of 39,680 patients undergoing lumbar and cervical fusions, 2003-2021, in Clinformatics® Data Mart national database. We used the provider patient racial diversity index (pRDI)-a published metric of physician exposure to diverse patients-to divide patients into groups based their provider's category (I, II, III) where patients treated by category III providers had surgeons with the most diverse patient populations. Multivariate regression models on propensity score-matched cohorts examined the association between patient SES and provider category on post-operative outcomes.Black patients had decreased discharge home (OR 0.67; 95% CI 0.54-0.83) compared to white patients. Patients treated by category III providers had increased length of stay (Coeff. 0.62; 95% CI 0.43-0.81), charge (Coeff. 36800; 95% CI 29,200-44,400), and decreased discharge home (OR 0.90; 95% CI 0.83-0.97) compared to patients treated by category I providers. Asian patients treated by category II providers had decreased readmission (OR 0.38; 95% CI 0.14-0.96), and Black patients treated by category III providers had increased discharge home (OR 1.41; 95% CI 1.1-1.9) compared to those treated by category I providers.While our study found two specific instances of improved spine surgery outcomes for minority patients treated by providers serving diverse patient populations, we present mixed findings overall. This study serves as the foundation for future research to better understand how provider pRDI affects outcomes in patients undergoing lumbar and cervical spine surgery.
View details for DOI 10.1016/j.wnsx.2024.100382
View details for PubMedID 38756754
View details for PubMedCentralID PMC11097082
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Gender Differences in Electronic Health Record Usage Among Surgeons.
JAMA network open
2024; 7 (7): e2421717
Abstract
Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being.To investigate gender differences in EHR usage patterns.This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024.Surgeon's gender.The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables.This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours.This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.
View details for DOI 10.1001/jamanetworkopen.2024.21717
View details for PubMedID 39042410
View details for PubMedCentralID PMC11267410
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Analyzing Large Language Models' Responses to Common Lumbar Spine Fusion Surgery Questions: A Comparison Between ChatGPT and Bard.
Neurospine
2024; 21 (2): 633-641
Abstract
In the digital age, patients turn to online sources for lumbar spine fusion information, necessitating a careful study of large language models (LLMs) like chat generative pre-trained transformer (ChatGPT) for patient education.Our study aims to assess the response quality of Open AI (artificial intelligence)'s ChatGPT 3.5 and Google's Bard to patient questions on lumbar spine fusion surgery. We identified 10 critical questions from 158 frequently asked ones via Google search, which were then presented to both chatbots. Five blinded spine surgeons rated the responses on a 4-point scale from 'unsatisfactory' to 'excellent.' The clarity and professionalism of the answers were also evaluated using a 5-point Likert scale.In our evaluation of 10 questions across ChatGPT 3.5 and Bard, 97% of responses were rated as excellent or satisfactory. Specifically, ChatGPT had 62% excellent and 32% minimally clarifying responses, with only 6% needing moderate or substantial clarification. Bard's responses were 66% excellent and 24% minimally clarifying, with 10% requiring more clarification. No significant difference was found in the overall rating distribution between the 2 models. Both struggled with 3 specific questions regarding surgical risks, success rates, and selection of surgical approaches (Q3, Q4, and Q5). Interrater reliability was low for both models (ChatGPT: k = 0.041, p = 0.622; Bard: k = -0.040, p = 0.601). While both scored well on understanding and empathy, Bard received marginally lower ratings in empathy and professionalism.ChatGPT3.5 and Bard effectively answered lumbar spine fusion FAQs, but further training and research are needed to solidify LLMs' role in medical education and healthcare communication.
View details for DOI 10.14245/ns.2448098.049
View details for PubMedID 38955533
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Patient perspectives on AI: a pilot study comparing large language model and physician-generated responses to routine cervical spine surgery questions
Artificial Intelligence Surgery
2024
View details for DOI 10.20517/ais.2024.38
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A Novel Mouse Model for Cerebral Inflammatory Demyelination in X-Linked Adrenoleukodystrophy: Insights into Pathogenesis and Potential Therapeutic Targets
Annals of Neurology
2024
View details for DOI 10.1002/ana.27117
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Visualizing Sphingosine-1-Phosphate Receptor 1(S1P1) Signaling During Central Nervous System De- and Remyelination.
Cellular and molecular neurobiology
2022
Abstract
Multiple sclerosis (MS) is an inflammatory-demyelinating disease of the central nervous system (CNS) mediated by aberrant auto-reactive immune responses. The current immune-modulatory therapies are unable to protect and repair immune-mediated neural tissue damage. One of the therapeutic targets in MS is the sphingosine-1-phosphate (S1P) pathway which signals via sphingosine-1-phosphate receptors 1-5 (S1P1-5). S1P receptors are expressed predominantly on immune and CNS cells. Considering the potential neuroprotective properties of S1P signaling, we utilized S1P1-GFP (Green fluorescent protein) reporter mice in the cuprizone-induced demyelination model to investigate in vivo S1P - S1P1 signaling in the CNS. We observed S1P1 signaling in a subset of neural stem cells in the subventricular zone (SVZ) during demyelination. During remyelination, S1P1 signaling is expressed in oligodendrocyte progenitor cells in the SVZ and mature oligodendrocytes in the medial corpus callosum (MCC). In the cuprizone model, we did not observe S1P1 signaling in neurons and astrocytes. We also observed beta-arrestin-dependent S1P1 signaling in lymphocytes during demyelination and CNS inflammation. Our findings reveal beta-arrestin-dependent S1P1 signaling in oligodendrocyte lineage cells implying a role of S1P1 signaling in remyelination.
View details for DOI 10.1007/s10571-022-01245-0
View details for PubMedID 35917044
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Examining Healthcare Workers' Perspectives Concerning Medical Equipment Availability in Three Ethiopian Hospitals: A Qualitative Pilot Study.
Cureus
2021; 13 (3): e14134
Abstract
Background Hospitals in the United States often have an abundance of unused medical supplies and equipment while many developing countries are in considerable need of these resources. Many nongovernmental organizations (NGOs) have donated medical equipment to health centers in low-resource settings to rectify this issue; however, studies show many of these donations are not usable by the facilities that receive them. To better serve the partner hospitals of our NGO, Oasis Medical Relief, we investigated the perspectives and insights of Ethiopian healthcare workers (HCWs) on the medical equipment distribution paradigm of the country. Methodology Qualitative analysis including semi-structured, open-ended interviews was conducted. Semi-structured interviews (n = six) were conducted with HCWs (four physicians and two hospital administrators) working in hospitals in Addis Ababa and Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. Interviews were recorded and transcribed. Categorical content analysis was utilized to develop themes. The topical areas addressed by our questions include populations served, prevalence of diseases, laws, and strategies guiding medical equipment distribution, funding and budget for medical equipment, etc. Results Three themes related to perspectives and insights of HCWs on the current medical equipment distribution paradigm in Ethiopia interviewed include: (1) state of healthcare concerns, (2) medical equipment scarcity, and (3) policy shaping medical distribution paradigm. Conclusions Pre-donation assessments utilized to understand equipment needs are recognized by the World Health Organization to more effectively address medical equipment/supply. However, to further strengthen such efforts, qualitative interviews with HCWs are a tool that can be utilized to better understand the intricacies of Ethiopia's complex medical distribution paradigm. This can potentially lead to more effective partnerships between NGOs and their partner hospitals. Furthermore, increasing decentralized methods of procuring medical equipment should be further explored to mitigate issues with national distribution of medical supplies.
View details for DOI 10.7759/cureus.14134
View details for PubMedID 33927937
View details for PubMedCentralID PMC8075826