Felipe De Jesus Perez

All Publications

• Decoding the Reference Letter: Strategies to Reduce Unintentional Gender Bias in Letters of Recommendation. MedEdPORTAL : the journal of teaching and learning resources Mieso, B. R., Barnett, J. F., Otero, T. M., Berquist, S. W., Perez, F. D., Han, P., Bhargava, S., Atasuntseva, A., Yemane, L. 2024; 20: 11419

  Abstract

  There is a growing body of literature on gender bias in letters of recommendation (LORs) in academic medicine and the negative effect of bias on promotion and career advancement. Thus, increasing knowledge about gender bias and developing skills to mitigate it is important for advancing gender equity in medicine. This workshop aims to provide participants with knowledge about linguistic bias (focused on gender), how to recognize it, and strategies to apply to mitigate it when writing LORs.We developed an interactive 60-minute workshop for faculty and graduate medical education program directors consisting of didactics, reflection exercises, and group activities. We used a postworkshop survey to evaluate the effectiveness of the workshop. Descriptive statistics were used to analyze Likert-scale questions and a thematic content analysis for open-ended prompts.We presented the workshop four times (two local and two national conferences) with one in-person and one virtual format for each. There were 50 participants who completed a postworkshop survey out of 74 total participants (68% response rate). Ninety-nine percent of participants felt the workshop met its educational objectives, and 100% felt it was a valuable use of their time. Major themes described for intended behavior change included utilization of the gender bias calculator, mindful use and balance of agentic versus communal traits, closer attention to letter length, and dissemination of this knowledge to colleagues.This workshop was an effective method for helping participants recognize gender bias when writing LORs and learn strategies to mitigate it.

  View details for DOI 10.15766/mep_2374-8265.11419

  View details for PubMedID 38974126

  View details for PubMedCentralID PMC11224141

• Perioperative Regional Anesthesia Pain Outcomes in Children: A Retrospective Study of 3,160 Regional Anesthetics in Routine Practice. The Clinical journal of pain Xie, J., De Souza, E., Perez, F., Suárez-Nieto, M. V., Wang, E., Anderson, T. A. 2023

  Abstract

  Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice.Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients ≤18 years undergoing orthopedic, urologic, or general surgeries with and without RA from 5/2014 to 9/2021 were categorized as single-shot, catheter-based, or no-block. Outcomes included: intraoperative opioid exposure and dose, pre-incision anesthesia time, post anesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables.11,292 procedures with 3,160 RAs were included. Compared to no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (i.e. while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours post-op, no difference of opioid use from 24 to 36 hours, and higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption.Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.

  View details for DOI 10.1097/AJP.0000000000001172

  View details for PubMedID 37942728

• Association of Race and Ethnicity with Pediatric Postoperative Pain Outcomes. Journal of racial and ethnic health disparities Rosenbloom, J. M., De Souza, E., Perez, F. D., Xie, J., Suarez-Nieto, M. V., Wang, E., Anderson, T. A. 2022

  Abstract

  INTRODUCTION: Inequitable variability in healthcare practice negatively affects patient outcomes. Children of color may receive different analgesic medications in the perioperative period, resulting in different outcomes.METHODS: Medical records of children 0 to≤18years old from May 2014 to August 2019 were reviewed. The exposure was racial or ethnic groups: Asian, Black, Hispanic, Pacific Islander, and White non-Hispanic (reference).PRIMARY OUTCOME: post-anesthesia care unit mean pain score.SECONDARY OUTCOMES: inpatient mean pain score; opioid, antiemetic, and antipruritic administration in the post-anesthesia care unit and inpatient ward. The association of race or ethnicity with outcomes was modeled using multilevel logistic regression, adjusting for confounders and covariates.RESULTS: Twenty-nine thousand six hundred fourteen cases are included. In the post-anesthesia care unit, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate-severe pain as compared to White non-Hispanic patients; Asian children had lower odds of receiving opioids and lower odds of having a moderate-severe mean pain score. In the inpatient setting, Black, Hispanic, and Pacific Islander children had no significant difference in the odds of receiving opioids or having moderate severe-pain as compared to White non-Hispanic children, but Asian children had lower odds of receiving opioids and of having a moderate-severe mean pain score.CONCLUSIONS: Asian children had lower odds of receiving opioids and having moderate-severe pain postoperatively compared to the White non-Hispanic children. These differences may be a function of variation in patient/caregivers culture or healthcare provider care and warrant further investigation.

  View details for DOI 10.1007/s40615-022-01327-1

  View details for PubMedID 35622316

• Content Evaluation of Residency Websites for All 159 Anesthesiology ACGME Programs in the USA. The journal of education in perioperative medicine : JEPM Cohen, S. A., Cohen, L. E., Perez, F. D., Macario, A., Xie, J. 2022; 24 (1): E683

  Abstract

  Background: The shift to virtual interviews during the COVID-19 pandemic has elevated the vital role of Accreditation Council for Graduate Medical Education residency program websites in conveying information to applicants. The purpose of our study was to assess the recruitment, education, and diversity and inclusion content on websites for anesthesiology residency programs. Second, we aimed to test the hypothesis that the content scores of websites are higher in programs with more National Institutes of Health funding, in programs that are university-based versus community-based, and in larger programs, as measured by number of residents.Methods: Two independent reviewers evaluated the websites of the 159 anesthesiology residency programs accredited by the Accreditation Council for Graduate Medical Education for the presence (yes/no) of 12 recruitment, 6 education, and 8 diversity and inclusion criteria. Multiple linear regression was used to determine which program factors were most associated with total website content score.Results: Anesthesiology residency program websites contained a mean of 12.9 (SD = 3.4; range, 3-21) of the 26 study-defined criteria. The most common recruitment, education, and diversity and inclusion criteria were, respectively, program description, rotation information, and community demographics. Controlling for program factors, a university-based affiliation (P = .016) was associated with higher website content scores.Conclusions: There is large variation in the recruitment, education, and diversity and inclusion content on anesthesiology residency program websites nationally. Since program websites averaged only half of criteria, this may provide an impetus for programs to modify their websites, which may inform applicant decisions about which programs align with their training and career goals.

  View details for DOI 10.46374/volxxiv_issue1_xie

  View details for PubMedID 35707018

• Association between regional anesthesia and analgesic outcomes: a single-center retrospective study of 2,761 pediatric regional anesthetics Xie, J. J., De Souza, B., Perez, F. D., Suarez-Nieto, M. V., Wang, E., Anderson, T. A. LIPPINCOTT WILLIAMS & WILKINS. 2021: 934-936

  View details for Web of Science ID 000752526600403

• Association Of Race and Ethnicity with Postoperative Analgesic Administration and Pain Scores in Pediatric Patients: A Single-Center Study of 29,614 Surgical Cases Perez, F. D., De Souza, B., Wang, E., Rosenbloom, J. M., Anderson, T. A. LIPPINCOTT WILLIAMS & WILKINS. 2020: 680–81

  View details for Web of Science ID 000619264500327

• Rhythmic expressed clock regulates the transcription of proliferating cellular nuclear antigen in teleost retina. Experimental eye research Song, H., Wang, D., De Jesus Perez, F., Xie, R., Liu, Z., Chen, C., Yu, M., Yuan, L., Fernald, R. D., Zhao, S. 2017; 160: 21-30

  Abstract

  Teleost fish continues to grow their eyes throughout life with the body size. In Astatotilapia burtoni, the fish retina increases by adding new retinal cells at the ciliary marginal zone (CMZ) and in the outer nuclear layer (ONL). Cell proliferation at both sites exhibits a daily rhythm in number of dividing cells. To understand how this diurnal rhythm of new cell production is controlled in retinal progenitor cells, we studied the transcription pattern of clock genes in retina, including clock1a, clock1b, bmal1a (brain and muscle ARNT-Like), and per1b (period1b). We found that these genes have a strong diurnal rhythmic transcription during light-dark cycles but not in constant darkness. An oscillation in pcna transcription was also observed during light-dark cycles, but again not in constant darkness. Our results also indicate an association between Clock proteins and the upstream region of pcna (proliferating cellular nuclear antigen) gene. A luciferase reporter assay conducted in an inducible clock knockdown cell line further demonstrated that the mutation on predicted E-Boxes in pcna promoter region significantly attenuated the transcriptional activation induced by Clock protein. These results suggested that the diurnal rhythmic expression of clock genes in A. burtoni retina could be light dependent and might contribute to the daily regulation of the proliferation of the retina progenitors through key components of cell cycle machinery, for instance, pcna.

  View details for DOI 10.1016/j.exer.2017.04.004

  View details for PubMedID 28434813

• Characteristics and Direct Costs of Academic Pediatric Subspecialty Outpatient No-Show Events JOURNAL FOR HEALTHCARE QUALITY Perez, F. D., Xie, J., Sin, A., Tsai, R., Sanders, L., Cox, K., Haberland, C. A., Park, K. T. 2014; 36 (4): 32-42

  Abstract

  BACKGROUND: Clinic no shows (NS) create a lost opportunity for provider-patient interaction and impose a financial burden to the healthcare system and on society. We aimed to: (1) to determine the clinical and demographic factors associated with increased NS rates at a children's hospital's subsubspecialty clinics and (2) to estimate the direct institutional financial costs associated with NS events. METHODS: A comprehensive database was generated from all clinic encounters for 15 subspecialty outpatient clinics (five surgical and 10 medical) between September 12, 2005 and December 30, 2010. Multivariate logistic regressions were performed to identify the variables associated with NS events. Direct costs of NS events were estimated using annual revenue for each clinic. RESULTS: A total of 284,275 encounters and 17,024 NS events were available for analysis. Public insurance coverage (Medicaid and Title V), compared to private insurance or self-pay status, was associated with an increased likelihood NS (OR 2.19, 95% CI 2.10-2.28, p < 0.0005 for Medicaid; OR 1.56, 95% CI 1.50-1.62, p < 0.0005 for Title V). Compared to patients 21-30 years of age, patients <12 years (OR 2.08, 95% CI 1.77-2.45, p < 0.0005) had increased likelihood of NS. Scheduled visits with medical subspecialists were more likely than surgical subspecialty visits to result in a NS (OR 1.69, 95% CI 1.63-1.75, p < 0.0005). The predicted annualized lost revenue associated with NS visits was estimated at $730,000 from the 15 clinics analyzed, approximately $210 per NS event. CONCLUSION: Pediatric subspecialty NS events are common, costly, and potentially preventable.

  View details for Web of Science ID 000348450800003

  View details for PubMedID 23551280

• Cost-Effectiveness of Early Colectomy With Ileal Pouch-Anal Anastamosis Versus Standard Medical Therapy in Severe Ulcerative Colitis ANNALS OF SURGERY Park, K. T., Tsai, R., Perez, F., Cipriano, L. E., Bass, D., Garber, A. M. 2012; 256 (1): 117-124

  Abstract

  Inflammatory bowel diseases are costly chronic gastrointestinal diseases. We aimed to determine whether immediate colectomy with ileal pouch-anal anastamosis (IPAA) after diagnosis of severe ulcerative colitis (UC) was cost-effective compared to the standard medical therapy.We created a Markov model simulating 2 cohorts of 21-year-old patients with severe UC, following them until 100 years of age or death, comparing early colectomy with IPAA strategy to the standard medical therapy strategy. Deterministic and probabilistic analyses were performed.Standard medical care accrued a discounted lifetime cost of $236,370 per patient. In contrast, early colectomy with IPAA accrued a discounted lifetime cost of $147,763 per patient. Lifetime quality-adjusted life-years gained (QALY-gained) for standard medical therapy was 20.78, while QALY-gained for early colectomy with IPAA was 20.72. The resulting incremental cost-effectiveness ratio (Δcosts/ΔQALY) was approximately $1.5 million per QALY-gained. Results were robust to one-way sensitivity analyses for all variables in the model. Quality-of-life after colectomy with IPAA was the most sensitive variable impacting cost-effectiveness. A low utility value of less than 0.7 after colectomy with IPAA was necessary for the colectomy with IPAA strategy to be cost-ineffective.Under the appropriate clinical settings, early colectomy with IPAA after diagnosis of severe UC reduces health care expenditures and provides comparable quality of life compared to exhaustive standard medical therapy.

  View details for DOI 10.1097/SLA.0b013e3182445321

  View details for Web of Science ID 000306083300020

  View details for PubMedID 22270693

• Cost-effectiveness Analysis of Adjunct VSL#3 Therapy Versus Standard Medical Therapy in Pediatric Ulcerative Colitis JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Park, K. T., Perez, F., Tsai, R., Honkanen, A., Bass, D., Garber, A. 2011; 53 (5): 489-496

  Abstract

  Inflammatory bowel diseases (IBDs) are costly chronic gastrointestinal diseases, with pediatric IBD representing increased costs per patient compared to adult disease. Health care expenditures for ulcerative colitis (UC) are >$2 billion annually. It is not clear whether the addition of VSL#3 to standard medical therapy in UC induction and maintenance of remission is a cost-effective strategy.We performed a systematic review of the literature and created a Markov model simulating a cohort of 10-year-old patients with severe UC, studying them until 100 years of age or death. We compared 2 strategies: standard medical therapy versus medical therapy + VSL#3. For both strategies, we assumed that patients progressed through escalating therapies--mesalamine, azathioprine, and infliximab--before receiving a colectomy + ileal pouch anal anastamosis (IPAA) if the 3 medical therapy options were exhausted. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), defined as the difference of costs between strategies for each quality-adjusted life-year (QALY) gained. One-way sensitivity analyses were performed on variables to determine the key variables affecting cost-effectiveness.Standard medical care accrued a lifetime cost of $203,317 per patient, compared to $212,582 per patient for medical therapy + VSL#3. Lifetime QALYs gained was comparable for standard medical therapy and medical therapy + VSL#3 at 24.93 versus 25.05, respectively. Using the definition of ICER <50,000/QALY as a cost-effective intervention, medical therapy + VSL#3 produced an ICER of $79,910 per QALY gained, making this strategy cost-ineffective. Sensitivity analyses showed that 4 key parameters could affect the cost-effectiveness of the 2 strategies: cost of colectomy + IPAA, maintenance cost after surgery, probability of developing pouchitis after surgery, and the quality of life after a colectomy + IPAA. High surgical and postsurgical costs, a high probability of developing pouchitis, and a low quality of life after a colectomy + IPAA could make adjunct VSL#3 use a cost-effective strategy.Given present data, adjunct VSL#3 use for pediatric UC induction and maintenance of remission is not cost-effective, although several key parameters could make this strategy cost-effective. The quality of life after an IPAA is the single most important variable predicting whether this procedure benefits patients over escalating standard medical therapy.

  View details for DOI 10.1097/MPG.0b013e3182293a5e

  View details for Web of Science ID 000296383000007

  View details for PubMedID 21694634

• IMPACT OF A QUALITY IMPROVEMENT CURRICULUM FOR PRE-CLERKSHIP STUDENTS Basaviah, P., Hooper, K., Pederson, J., Smith, S., Perez, F., Bhat, S., Leva, N., Helgerson, P., Leo, T., Braddock, C. H. SPRINGER. 2011: S608

  View details for Web of Science ID 000208812703337