All Publications

  • A Man With Leg Pain. Annals of emergency medicine Ghaith, S., Perez-Cruet, J., Moody, G., Hill, C., Lin, M., Batchelor, T. J. 2026; 88 (3): 417-418

    View details for DOI 10.1016/j.annemergmed.2026.03.005

    View details for PubMedID 42618177

  • A Man With Neck Pain and Swelling. Journal of the American College of Emergency Physicians open Perez-Cruet, J. M., Ghaith, S., Cortez, B., Kendall, J. L., Batchelor, T. J. 2026; 7 (3): 100408

    View details for DOI 10.1016/j.acepjo.2026.100408

    View details for PubMedID 42094253

    View details for PubMedCentralID PMC13140020

  • Public Health Limits of Medical Freedom. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics Hodge, J., Ghaith, S., Pasha, A. S. 2026: 1-5

    Abstract

    Through emerging interpretations of individual "medical freedoms," a panoply of state legislative bills seeks to undermine long-standing public health and health care requirements including recommendations to test, screen, treat, and vaccinate persons. To the extent these bills could upend decades of laws and policies protecting individual and communal health, especially among vulnerable individuals, they threaten the health - and freedoms - of all persons.

    View details for DOI 10.1017/jme.2026.10265

    View details for PubMedID 42130399

  • Exploring Constitutional Limits of Insurrection Powers Arizona State University Sandra Day O'Connor College of Law Hodge, J. G., Ghaith, S. 2026
  • Trends in Emergency Care Provided by Non-Physician Providers and Physicians: 2009-2021 ACADEMIC EMERGENCY MEDICINE Ghaith, S., Gettel, C., Mcelhinny, M., Mullan, A. F., Jeffery, M. M., Lindor, R. A. 2025; 32 (10): 1101-1110

    Abstract

    We describe the types of emergency department (ED) visits managed by non-physician providers (NPPs), including physician assistants and nurse practitioners, and emergency medicine (EM) physicians, assessing shifts in care patterns over time.We used data from the National Hospital Ambulatory Medical Care Survey collected from 2009 to 2021. We classified visits by provider type: physician only, physician with resident, physician with NPP, and NPP only. We described characteristics of visits by provider type, including patient demographics, triage urgency, imaging, length of stay, and disposition, and analyzed using Poisson regression. We described the change in type of provider seen over this study period and further analyzed by triage urgency and hospital location.Of 1.684 billion estimated ED visits from 2009 to 2021, 1.171 billion were managed by physicians without residents or NPPs (physicians only), 136.3 million by physicians with residents, 209.1 million by physicians with NPPs, and 167.4 million by NPPs only. Patients seen by physicians only were older, were triaged as having more urgent needs, had a longer ED length of stay, and were more likely to be admitted compared to those seen by NPPs only. Physician-only visits decreased from 77% to 62%, while NPP-only visits increased from 6% to 11%. The physician with the NPP group similarly grew from 9% to 17%. For visits assigned a triage urgency level of 2 ("emergent"), physician-only visits decreased by 20%, physician with NPP visits increased by 13%, and NPP-only visits increased by 3%. In metropolitan areas, physician-only visits dropped 14%, with a 5% increase in NPP-only visits. In non-metropolitan areas, physician-only visits decreased 17%, with a 9% increase in NPP-only visits.The EM workforce has shifted, with NPPs seeing a higher percentage of patients, including both lower- and higher-acuity patients. This shift is particularly prominent in rural areas but is evident across all regions.

    View details for DOI 10.1111/acem.70098

    View details for Web of Science ID 001546182300001

    View details for PubMedID 40781634

  • Characteristics, Interventions, and Outcomes for Patients Presenting to the Emergency Department With Abdominal Pain ACADEMIC EMERGENCY MEDICINE Ghaith, S., Campbell, R. L., Ginsberg, Z., McElhinny, M., Jones, D. D., Mullan, A. F., Lindor, R. A. 2026; 33 (1): e70110

    Abstract

    We sought to characterize patients presenting to emergency departments (EDs) with abdominal pain and to validate risk categories defined by the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) for low-risk recurrent abdominal pain.We conducted a retrospective cohort study of patients presenting with abdominal pain between November 2019 and November 2023 across 21 EDs in Arizona, the Midwest, and Florida. Patients were categorized per GRACE-2 into recurrent and non-recurrent pain as well as low- and high-risk groups. Primary outcomes included 72-h returns and mortality at 30 and 90 days.The study included 162,494 visits (112,896 unique patients; median age 46 years; 61.2% female). Among these, 4.3% had low-risk recurrent abdominal pain. Patients with recurrent and non-recurrent low-risk pain had similar ED length of stay and discharge rates to each other, compared to patients with high-risk pain who had longer length of stay and lower discharge rates. At 30 days after the ED encounter, patients with low-risk recurrent abdominal pain had similar mortality to patients with low-risk non-recurrent pain (0.4% vs. 0.3%; adjusted RR = 1.31, 95% CI: 0.85-2.03), while they had significantly lower mortality than patients with high-risk recurrent abdominal pain (0.4% vs. 2.3; adjusted RR = 3.14, 95% CI: 2.02-4.89).This study highlights the heterogeneity in patients presenting to the ED with abdominal pain. Among these patients, those with low-risk recurrent pain demonstrated similar lengths of stay, discharges, and mortality rates to those with low-risk non-recurrent pain and less favorable lengths of stay, discharges, and mortality rates compared to those with any high-risk features. These findings suggest that low- and high-risk features may be more useful than recurrent or non-recurrent pain in identifying patients who could benefit from more robust ED evaluations.

    View details for DOI 10.1111/acem.70110

    View details for Web of Science ID 001544226400001

    View details for PubMedID 40764816

  • Medical and Legal Risks in Tibial Plateau Fractures. Clinical practice and cases in emergency medicine Lindor, R., Ghaith, S., Newberry, J., Thomas, A. 2025; 9 (3): 255-258

    Abstract

    INTRODUCTION: Tibial plateau fractures, which comprise about 1% of all fractures, can be challenging to diagnose in the emergency department setting. Missed and delayed diagnoses can result in poor outcomes for patients and legal risks for clinicians, necessitating a high level of vigilance.CASE SERIES: In this article we review three malpractice cases related to tibial plateau fractures. Key issues included missed or delayed diagnosis, mismanagement of associated complications, inadequate discharge instructions, and lack of documentation.CONCLUSION: Tibial plateau fractures can be challenging to identify, heightening the risk of downstream complications. As a result, emergency physicians must remain vigilant in assessing patients who are at increased risk for these injuries and document their efforts to both evaluate for and communicate these risks to patients.

    View details for DOI 10.5811/cpcem.38452

    View details for PubMedID 42456294

  • Second Scope, New Findings: Pediatric Stridor Is Not Always Due to Croup or Laryngomalacia: A Case Report. Clinical practice and cases in emergency medicine Ghaith, S., Hsu, D., Dixon, W. 2025; 9 (3): 297-301

    Abstract

    Infantile subglottic hemangioma is a rare and serious condition characterized by stridor, respiratory distress, and a barking cough. This condition poses a significant risk as it can lead to life-threatening airway obstruction.We present a five-week-old patient who was diagnosed in the emergency department (ED) with moderate laryngomalacia via laryngoscopy by otolaryngology and discharged; he returned to the ED the next day with worsening symptoms of recurrent stridor, difficulty feeding, and worsening respiratory distress. A second laryngoscopic exam performed on the return ED visit revealed a subglottic mass that was later identified as a left-sided subglottic hemangioma via bronchoscopy and magnetic resonance imaging. The patient was treated with propranolol and discharged from the inpatient unit with dermatology and otolaryngology follow-up.Infantile subglottic hemangioma is a rare but serious cause of respiratory distress in infants, posing a risk of airway obstruction. This diagnosis should be considered in the ED, particularly for patients under two years of age, who present with recurrent stridor and respiratory distress and do not respond to standard treatments for croup.

    View details for DOI 10.5811/cpcem.38443

    View details for PubMedID 42456305

    View details for PubMedCentralID PMC12342669

  • Bell Palsy Mimics: Lessons from Four Malpractice Cases. Clinical practice and cases in emergency medicine Lindor, R., Ghaith, S. 2025; 9 (2): 125-128

    Abstract

    Bell palsy, an idiopathic dysfunction of the seventh cranial nerve, is the leading cause of unilateral facial paralysis, although other more serious entities such as stroke, infection, and tumor may present similarly, leading to both medical and legal risks in cases of misdiagnosis.We present four malpractice cases revolving around misdiagnosis of Bell palsy. These cases alleged failure to diagnose, failure to obtain informed consent, and failure to provide appropriate discharge instructions. Outcomes ranged from a jury verdict in favor of the physician, to an out-of-court settlment for $400,000, to a jury verdict in favor of the patieint for over $3.1 million.Bell palsy is the most common cause of unilateral facial paralysis. While the diagnosis can be made at the bedside without advanced testing, doing so requires a clear understanding of the pathophysiology of the disease, an appreciation for the role of advanced diagnostics, and thorough documentation of a supportive history and physical exam. Misdiagnosis or mismanagement confers both clinical and legal risks.

    View details for DOI 10.5811/cpcem.38451

    View details for PubMedID 40402054

    View details for PubMedCentralID PMC12097270

  • Trends in diagnostic workup and surgical management for recurrent urinary tract infections at a large tertiary teaching hospital JOURNAL OF CLINICAL UROLOGY Edmonds, V. S., Ghaith, S., Mi, L., Ahmadieh, K., Khan, A. 2025; 18 (6): 468-473

    View details for DOI 10.1177/20514158251331400

    View details for Web of Science ID 001478229000001

  • Second Scope, New Findings: Pediatric Stridor Is Not Always Due to Croup or Laryngomalacia: A Case Report Clin Pract Cases Emerg Med Ghaith, S., Hsu, D., Dixon, W. 2025; 9 (3): 297-301

    View details for DOI 10.5811/cpcem.38443

  • Men's Health & Sexual Medicine and the Litigious Patient: A Review of Malpractice Cases UROLOGY RESEARCH AND PRACTICE Voleti, S., Ghaith, S., Warren, C., Punjani, N. 2024; 50 (6): 328-331

    Abstract

    Recent literature suggests growing rates of malpractice claims against urologists. These cases provide insight into errors that may lead to litigation. We aim to analyze malpractice suits related to men's health and highlight clinical presentations and legal outcomes.Per STROBE guidelines, we searched the publicly available Thomson Reuters Westlaw legal database for "jury verdicts and settlements" from January 1970 to August 2023 to identify medical malpractice cases in Urology. Patient demographics, clinical presentation, alleged error, and legal outcomes were abstracted during a full case review by an independent screener. Cases related to men's sexual health or fertility that named a urologist as the defendant were fully analyzed.A total of 553 urology cases were extracted, with 23 men's health related cases subsequently analyzed. The most common conditions associated with litigation were penile prosthesis (39%), epidydimal pathology (13%), and varicocele (13%). The most common allegations were misdiagnosis (26%), surgical complication (22%), lack of informed consent (22%), and violation of standard of care (22%). Of the 23 cases, 57% ruled "no liability" in favor of the urologist and 39% ruled in favor of the plaintiff with a median award of $335,000 (IQR = 100 ,000-450, with 000). Among cases ruled as negligent, performing the incorrect procedure, surgical complications, and violating the standard of care were prominent allegations.This study characterizes malpractice cases related to men's sexual health naming urologists as defendants. Obtaining comprehensive informed consent, following national guidelines, and responding appropriately to surgical complications may minimize likelihood of litigation and maximize patient outcomes.

    View details for DOI 10.5152/tud.2025.24163

    View details for Web of Science ID 001473857800002

    View details for PubMedID 40243378

    View details for PubMedCentralID PMC12015753

  • Trends in Emergency Department Exam Medicare Reimbursements Between 2010 and 2018. Cureus Ghaith, S., Ginsberg, Z., Pollock, J., Rappaport, D. 2024; 16 (7): e64755

    Abstract

    As the Medicare population continues to grow, financial pressure is placed upon hospitals, physicians, and other providers as the payer mix has an increasing proportion of Medicare patients.The purpose of this study was to further the understanding of reimbursement trends surrounding the five levels of emergency department (ED) examinations (CPT codes 99281-99285) from 2010 to 2018 and determine how they have changed with respect to each procedure.CPT codes were filtered into the 2010 and 2018 Physician/Supplier Procedure Summaries from the Centers for Medicare and Medicaid Services' website to gather data on emergency physician submissions and Medicare denials and payments.In 2010, 15,669,196 ED examinations were submitted to Medicare for $7,628,693,382 while in 2018, 16,432,184 ED examinations were submitted for $14,522,456,383. Despite an increase of $397/submission made by emergency physicians, Medicare paid 20.5% of the submitted charges in 2010 for ED examinations and 11.9% in 2018. The denial rate in 2018 was highest for level I ED examinations (11.3%), and the lowest for level V examinations (5.1%). The utilization of level V ED examinations increased 22.3% from 2010 to 2018, while the utilization of the others decreased. Of the five levels of ED examinations, only the level I examination did not exhibit a decrease.From 2010 to 2018, emergency physicians charged a higher amount for ED examinations, yet Medicare reimbursement accounted for a smaller proportion of these charges, resulting in less payment per submission for the four most common levels. Downward trends in Medicare reimbursement may place financial burdens that could potentially hamper healthcare outcomes.

    View details for DOI 10.7759/cureus.64755

    View details for PubMedID 39156455

    View details for PubMedCentralID PMC11329332

  • The association of endosalpingiosis with chronic pelvic pain. Minerva obstetrics and gynecology Ghaith, S., Lewis, G. K., Craver, E. C., Li, Z., Wasson, M. N., Burnett, T. L., Carrubba, A. R. 2024; 76 (2): 151-158

    Abstract

    Endosalpingiosis is a pathologic diagnosis of ectopic epithelium resembling the fallopian tubes. It has been described with clinical characteristics that are similar to endometriosis. The primary objective is to determine if endosalpingiosis (ES) has a similar association with chronic pelvic pain when compared to endometriosis (EM).This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable EM cohort. Demographic and clinical data were obtained, and statistical analysis was performed.A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs. 48 years, P<0.001), but other demographic variables were similar. Fewer ES patients had baseline chronic pelvic pain than EM patients (25.3% vs. 47%, P<0.001), and patients with ES were less likely to undergo surgery for the primary indication of pelvic pain (16.1% vs. 35.4%, P<0.001). Pelvic pain as the surgical indication remained lower in the ES group in multivariable analysis (OR=0.49, P<0.001). There were similar rates of persistent postoperative pain between ES and EM groups (10.1% vs. 13.5%, P=0.109).Although endosalpingiosis can be associated with chronic pelvic pain, the incidence of pain is significantly lower than in patients who have endometriosis. These findings suggest that ES is a unique condition that differs from EM. Further research including long-term follow-up and patient-reported outcomes is imperative.

    View details for DOI 10.23736/S2724-606X.23.05241-7

    View details for PubMedID 36847525

  • Chapter 37 - Cohort study Translational Orthopedics Ghaith, S., Kirollos, M. Academic Press. 2024: 181-184

    View details for DOI 10.1016/B978-0-323-85663-8.00091-X

  • Design Principles Translational Orthopedics Kirollos, M., Ghaith, S., Newman, H. Academic Press. 2024: 169-171
  • Public health: Law policy and ethics Translational Orthopedics Ghaith, S. Academic Press. 2024: 487-490
  • Case Series Translational Orthopedics Kirollos, M., Ghaith, S. Academic Press. 2024: 173-175
  • Outcome Measurements Translational Orthopedics Ghaith, S. Academic Press. 2024: 101-105
  • Case Control Study Translational Orthopedics Ghaith, S., Kirollos, M. Academic Press. 2024: 177-180
  • Population and setting-specific implementation Translational Orthopedics Ghaith, S., Kirollos, M. Academic Press. 2024: 461-463

    View details for DOI 10.1016/B978-0-323-85663-8.00025-8

  • Primary and Specialist Palliative Care in Neurosurgery: A Narrative Review and Bibliometric Analysis of Glioblastoma and Stroke WORLD NEUROSURGERY Harrison, D., Wu, E., Singh, R., Ghaith, S., Suarez-Meade, P., Brown, N. J., Sherman, W. J., Robinson, M. T., Lin, M. P., Lawton, M. T., Quinones-Hinojosa, A. 2023; 180: E250-E257

    Abstract

    Due to the increased demand for palliative care (PC) in recent years, a model has been proposed to divide PC into primary PC and specialist PC. This article aimed to delineate the indications for primary and specialist PC within 2 common neurosurgical conditions-glioblastoma (GBM) and stroke.A systematic review and bibliometric analysis was conducted to better appreciate the practice trends in PC utilization for GBM and stroke patients using several databases.There were 70 studies on PC for GBM, the majority of which related to patient preference (22 [31%]). During 1999-2022, there was significant growth in publications per year on this topic at a rate of approximately 0.3 publications per year (P < 0.01). There were 44 studies on PC for stroke, the majority of which related to communication strategies (14 [32%]). During 1999-2022, there was no significant growth in stroke publications per year (P = 0.22).Due to the progressively disabling neurological course of GBM, we suggest that a specialty PC team be used in conjunction with the neurosurgical team early in the disease trajectory while patients are still able to communicate their preferences, goals, and values. In contrast, short-term and long-term stages of management of stroke have differing implications for PC needs, with the short-term stage necessitating adept, time-sensitive communication between the patient, family, and care teams. Thus, we propose that primary PC should be included as a core competency in neurosurgery training, among other stroke specialists.

    View details for DOI 10.1016/j.wneu.2023.09.048

    View details for Web of Science ID 001137943600001

    View details for PubMedID 37739173

  • Supreme Court Impacts in Public Health Law: 2022-2023. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics Hodge, J. G., Barraza, L., Piatt, J. L., White, E. N., Ghaith, S., Hollinshead, S., Krumholz, L., Puchebner, M., Smith, E. 2023; 51 (3): 684-688

    Abstract

    In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment.

    View details for DOI 10.1017/jme.2023.105

    View details for PubMedID 38088608

  • The top social media influencers in obstetrics and gynecology on twitter ARCHIVES OF GYNECOLOGY AND OBSTETRICS Ghaith, S., Dyre, L. J., Vasilev, D. V., Wasson, M. N. 2023; 308 (6): 1891-1896

    View details for DOI 10.1007/s00404-023-07079-5

    View details for Web of Science ID 000998635100001

    View details for PubMedID 37266678

    View details for PubMedCentralID PMC10235838

  • Gender bias in medical education: A scoping review CLINICAL TEACHER Yaman, R., Hagen, K. M., Ghaith, S., Luong, H., Almader-Douglas, D., Langley, N. R. 2023; 20 (4): e13592

    Abstract

    This scoping review summarises five decades of research on gender bias in subjective performance evaluations of medical trainees.A medical librarian searched PubMed, Ovid Embase, Scopus, Web of Science and Cochrane DBSR in June 2020. Two researchers independently reviewed each abstract to determine if it met inclusion criteria (original research article investigating gender bias in subjective medical trainee evaluations by staff). References from selected articles were also reviewed for inclusion. Data were extracted from the articles, and summary statistics were performed.A total of 212 abstracts were reviewed, and 32 met criteria. Twenty (62.5%) evaluated residents, and 12 (37.5%) studied medical students. The majority of studies on residents were Internal Medicine (n = 8, 40.0%) and Surgery (n = 7, 35.0%). All studies were performed in North America and were either retrospective or observational. Nine (28.0%) were qualitative, and 24 (75.0%) were quantitative. The majority of studies were published in the last decade (n = 21, 65.6%). Twenty (62.5%) studies documented gender bias, of which 11 (55%) found that males received higher quantitative performance evaluations and 5 (25%) found that females received higher evaluation scores. The remaining 4 (20%) reported gender differences in qualitative evaluations.Most studies detected gender bias in subjective performance evaluations of medical trainees, with a majority favouring males. There is a paucity of studies on bias in medical education with a lack of standardised approach to investigating bias.

    View details for DOI 10.1111/tct.13592

    View details for Web of Science ID 000992908100001

    View details for PubMedID 37227068

  • Return Rates for Opioid versus Nonopioid Management of Patients with Abdominal Pain in the Emergency Department. The Journal of emergency medicine Ginsberg, Z., Lindor, R. A., Campbell, R. L., Ghaith, S., Buckner-Petty, S., McElhinny, M. L. 2023; 64 (4): 471-475

    Abstract

    Research suggests that opioid treatment for abdominal pain, which comprises a large proportion of patients presenting to the emergency department (ED), may contribute to long-term opioid use without significant benefits with regard to symptom management.This study seeks to assess the association between opioid use for management of abdominal pain in the ED and return ED visits for abdominal pain within 30 days for patients discharged from the ED at initial presentation.We conducted a retrospective, multicenter observational study of adult patients presenting to and discharged from 21 EDs with a chief concern of abdominal pain between November 2018 and April 2020. The proportion of 30-day return visits to the ED for patients who received opioid analgesics was compared with a reference group of patients who only received acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or both.Of the 4745 patients, 1304 (27.5%) received opioids and 1101 (23.2%) only received either acetaminophen, NSAIDs, or both. Among those given opioids, 287 (22.0%) returned to the ED for abdominal pain within 30 days, compared with 162 (14.7%) of those in the reference group (odds ratio 1.57, 95% confidence interval 1.27-1.95, p-value < 0.001).Patients given opioids for abdominal pain in the ED had 57% increased odds of a return ED visit within 30 days compared with those given only acetaminophen or NSAIDs. This warrants further research on the use of nonopioid analgesics in the ED, especially in patients with anticipated discharge.

    View details for DOI 10.1016/j.jemermed.2023.01.008

    View details for PubMedID 36997433

  • Migraine and sleep quality: does the association change in midlife women? Menopause (New York, N.Y.) Faubion, S. S., Ghaith, S., Kling, J. M., Mara, K., Enders, F., Starling, A. J., Kapoor, E. 2023; 30 (4): 376-382

    Abstract

    The aim of this study was to compare the association between migraine and sleep quality in premenopausal versus perimenopausal women.A cross-sectional analysis from the Data Registry on the Experiences of Aging, Menopause and Sexuality was conducted using questionnaire data from premenopausal and perimenopausal women seen at women's health clinics at 3 geographic locations from 2015 to 2021. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index. Associations between poor sleep quality (Pittsburgh Sleep Quality Index >5) and self-reported migraine history (Y/N) were evaluated using a multivariable logistic regression model, adjusting for body mass index, anxiety, depression, and vasomotor symptoms.Of 2,067 women (mean age 43.2 years) included in the analysis, 594 (28.7%) reported a migraine history. Women were mostly white (92.2%), partnered (75.1%), and educated (86% with at least some college); 46.5% (n = 962) were premenopausal, 53.5% (n = 1,105) were perimenopausal, and 71.2% met the criteria for poor sleep. In univariate analysis, migraine history predicted poor sleep in both premenopausal and perimenopausal women ( P = 0.005 and P = 0.004, respectively). However, in multivariable analysis, migraine history remained associated with poor sleep in premenopausal women ( P = 0.044), but not in perimenopausal women ( P = 0.46).A migraine history was associated with poor sleep in premenopausal women. The relationship in perimenopausal women seemed to be influenced by confounding factors that are more prevalent during the menopause transition and are known to affect the frequency of migraine and sleep disturbances, such as anxiety, depression, and vasomotor symptoms. These conditions may need to be the focus of management in migraineurs with sleep disturbances during the menopause transition.

    View details for DOI 10.1097/GME.0000000000002149

    View details for PubMedID 36720087

    View details for PubMedCentralID PMC10038841

  • Gender differences in academic productivity, educational positions, and leadership appointments of physicians in the U.S. Work (Reading, Mass.) Talbott, J. M., Ghaith, S., Reed, D. A., Sadosty, A. T., Sandefur, B. J., Hayes, S. N., Halyard, M. Y., Mi, L., Lim, E. S., Lindor, R. A. 2023; 75 (3): 1031-1039

    Abstract

    Promotions in academic medicine are frequently based on number of publications and leadership positions held. While prior study has established women publish less than men, many evaluations are limited to individual specialties and do not evaluate involvement with educational activities.To compare gender differences in academic output, intramural leadership positions, and educational leadership positions of academic physicians.The curriculum vitae and de-identified demographic data of all permanent physicians employed at a multi-site academic medical center were reviewed from April to May 2020. Multivariable logistic and Poisson regressions evaluated leadership positions and number of publications.Of 3,359 physicians in the demographic database, 32.3% (n = 1,087) were women and 72.5% were white (n = 2,510). Of the 3,015 physicians in the curriculum vitae database, 32% (n = 962) were women. Women were more likely (p < 0.001) to be assistant professor (54% vs. 42.7%) and less likely to be associate (18.1% vs. 20.3%) or full professor (14.6% vs. 29.1%). Women assistant professors published 22% fewer articles (ratio estimate = 0.78, p < 0.001), associate professors 18% less (coefficient = 0.82, p < 0.001), and full professors 23% less (coefficient = 0.77, p < 0.001). Fewer women were program directors for residencies (1.6% vs. 2.9%, p = 0.02) or fellowships (5.4% vs. 7.4%, p = 0.04), and held fewer division or department leadership positions (OR 0.8, 95% CI as [0.6, 1.0], p = 0.03).Women physicians do not outperform men across any education, leadership, or publication category. A cultural shift is needed to redefine traditional metrics for leadership appointments if academic medicine hopes to achieve equity.

    View details for DOI 10.3233/WOR-220193

    View details for PubMedID 36683482

  • Resection of noncommunicating rudimentary horn American Journal of Obstetrics & Gynecology Beck, K., Vasilev, D., Ghaith, S., Magtibay, P., Wasson, M. 2023

    View details for DOI 10.1016/j.ajog.2022.12.265

  • Vaginal morcellation techniques: uncontained and contained American Journal of Obstetrics & Gynecology Beck, K., Ghaith, S., Vasilev, D., Magtibay, P., Wasson, M. 2023

    View details for DOI 10.1016/j.ajog.2022.12.206 External Link

  • Dizziness as a missed symptom of central nervous system pathology: A review of malpractice cases ACADEMIC EMERGENCY MEDICINE Ghaith, S., Voleti, S. S., Bellolio, F., Edlow, J. A., Lindor, R. A. 2023; 30 (5): 589-591

    View details for DOI 10.1111/acem.14627

    View details for Web of Science ID 000893922000001

    View details for PubMedID 36354754

  • The association of endosalpingiosis with gynecologic malignancy. Gynecologic oncology Lewis, G. K., Ghaith, S., Craver, E. C., Li, Z., Wasson, M. N., Burnett, T. L., Carrubba, A. R. 2022; 167 (1): 81-88

    Abstract

    Endosalpingiosis is a poorly understood condition of ectopic epithelium resembling the fallopian tubes. It has been described as an incidental pathology finding, a disease similar to endometriosis, and in association with malignancy. The objective of this study is to determine if endosalpingiosis (ES) has an increased association with gynecologic malignancy when compared to endometriosis (EM).This is a retrospective case-control analysis of patients with a histologic diagnosis of endosalpingiosis or endometriosis at three affiliated academic hospitals between 2000 and 2020. All ES patients were included, and 1:1 matching was attempted to obtain a comparable cohort of EM patients. Demographic and clinical data were obtained, and statistical analysis was performed.A total of 967 patients (515 ES and 452 EM) were included. ES patients were significantly older than EM patients (median age 52 vs 48 years, p < 0.001). The ES group had significantly more cancer diagnoses at surgery than the EM group (40.1% vs 18.1%, p < 0.001); this difference persisted in a sub-analysis excluding patients with known or suspected malignancy (20.9% vs 5.6%, p < 0.001). ES patients had lower overall survival (10-year freedom from death: 77.0% vs 90.5%, p < 0.001). After adjusting for confounders, multivariable analysis showed that ES patients had increased cancer diagnosed at surgery (OR = 2.48, p < 0.001) and greater risk of death (OR = 1.69, p = 0.017).Endosalpingiosis was found concurrently with malignancy in 40% of cases, and this effect was preserved in multi-variable and sub-group analyses. Further research consisting of longer follow-up and exploration of molecular relationships between ES and cancer are forthcoming.

    View details for DOI 10.1016/j.ygyno.2022.07.025

    View details for PubMedID 35909004

  • Evaluating the Link Between Self-Reported Endometriosis and Female Sexual Dysfunction JOURNAL OF SEXUAL MEDICINE Kling, J. M., Ghaith, S., Smith, T., Kapoor, E., Wasson, M., Mara, K., Enders, F. T., Faubion, S., Kuhle, C. 2022; 19 (10): 1553-1561

    View details for DOI 10.1016/j.jsxm.2022.07.009

    View details for Web of Science ID 000929740500009

  • Medical Malpractice Lawsuits Involving Trainees in Obstetrics and Gynecology in the USA HEALTHCARE Ghaith, S., Campbell, R. L., Pollock, J. R., Torbenson, V. E., Lindor, R. A. 2022; 10 (7)

    Abstract

    While the liability risks for obstetrics and gynecology (ob/gyn) physicians are widely recognized, little is known about how trainees have been involved in ob/gyn lawsuits.To characterize involvement of trainees in malpractice lawsuits related to ob/gyn.The legal database Westlaw was utilized to collect ob/gyn-related malpractice lawsuits involving trainees reported from 1986 to 2020 in the USA.Forty-six malpractice cases involving ob/gyn trainees were identified, including 34 cases related to obstetrics and 12 to gynecology. There were 11 cases alleging lack of informed consent, including 7 cases alleging lack of consent for trainee involvement. Of the 34 obstetrics cases, 27 related to procedural complications, 17 to treatment, 13 to diagnosis, and 4 to informed consent. Of these, 17 were decided in favor of the physician, 6 resulted in findings of negligence, 9 had unknown outcomes, and 3 ended in settlement. For the 6 cases ending in a finding of negligence, the mean award was $2,174,472 compared to $685,000 for those that were settled. Of the 12 gynecology cases, 8 related to procedural complications, 7 to informed consent, 3 to diagnosis, and 2 to treatment. Of these, 6 were decided in favor of the physician, 3 resulted in findings of negligence, and 3 had unknown outcomes. For the cases ending in a finding of negligence, the mean award was $465,000.This review of malpractice cases highlights types of situations in which trainees are sued and reveals the importance of designing curriculum around faculty training and supervision regarding trainee involvement in patient care.

    View details for DOI 10.3390/healthcare10071328

    View details for Web of Science ID 000832103800001

    View details for PubMedID 35885853

    View details for PubMedCentralID PMC9319230

  • Charting Practices to Protect Against Malpractice: Case Reviews and Learning Points WESTERN JOURNAL OF EMERGENCY MEDICINE Ghaith, S., Moore, G. P., Colbenson, K. M., Lindor, R. A. 2022; 23 (3): 412-417

    Abstract

    Medical documentation issues play a role in 10-20% of medical malpractice lawsuits. Inaccurate, incomplete, or generic records undermine a physician's defense and make a plaintiff's lawyer more likely to take on a case. Despite the frequency of documentation errors in malpractice suits, physicians receive very little education or feedback on their documentation. Our objective in this case series was to evaluate malpractice cases related to documentation to help improve physicians' documentation and minimize their liability risks.We used Thomson Reuters Westlaw legal database to identify malpractice cases related to documentation. Common issues related to documentation and themes in the cases were identified and highlighted.We classified cases into the following categories: incomplete documentation; inaccurate text; transcription errors; judgmental language; and alteration of documentation. By evaluating real cases, physicians can better understand common errors of other practitioners and avoid these in their own practice.Emergency physicians can reduce their liability risks by relying less on forms and templates and making a habit of documenting discussions with the patients, recording others' involvement in patient care (chaperones, consultants, trainees, etc.), addressing others' notes (triage staff, nurses, residents, etc.), paying attention to accuracy of transcribed or dictated information, avoiding judgmental language, and refraining from altering patient charts.

    View details for DOI 10.5811/westjem.2022.1.53894

    View details for Web of Science ID 001107711200015

    View details for PubMedID 35679491

    View details for PubMedCentralID PMC9183775

  • A Scoping Review of Published Intimate Partner Violence Curricula for Medical Trainees JOURNAL OF WOMENS HEALTH Ghaith, S., Voleti, S. S., Ginsberg, Z., Marks, L. A., Files, J. A., Kling, J. M. 2022; 31 (11): 1596-1613

    Abstract

    Intimate partner violence (IPV) affects many, and health care has the potential to provide a safe space for individuals experiencing IPV. However, physicians cite lack of time and education as barriers. The aim of this study is to complete a review of published IPV curricula in medical school, residency training, and postresidency training. We performed a scoping review to provide a quantitative assessment and summary review of existing IPV curricula. In May 2020, a librarian conducted a search of Ovid MEDLINE, Ovid EMBASE, and Scopus. We evaluated each article for the following curriculum content and structure items: (1) year introduced; (2) delivery method; (3) curriculum type; (4) curriculum content; (5) curriculum effectiveness; and (6) implementation barriers. Fifty-six articles met criteria, most were for medical school learners (n = 32, 57.1%) and short-term (lasting less than one academic year) (n = 41, 73.2%). For residency, IPV curricula were most frequently taught in family medicine, internal medicine, and emergency medicine. Formal lecture and use of standardized patients were the most popular delivery methods. Most curricula taught risk factors for and identification of individuals who have experienced IPV. The most cited implementation barrier was limited time in standard medical education, followed by inability to measure the effectiveness of the curriculum. There was great variation in the methods of assessing effectiveness of IPV curricula. Published IPV curricula are varied, without consistent validated tools for assessing efficacy. Future initiatives to establish a standard of competency for medical students regarding IPV, including a standard curriculum, may better ensure that physicians are capable of identifying and caring for individuals who have experienced IPV.

    View details for DOI 10.1089/jwh.2021.0345

    View details for Web of Science ID 000764281900001

    View details for PubMedID 35231186

  • Impact of timing of preoperative gabapentin administration on postoperative somnolence JOURNAL OF OSTEOPATHIC MEDICINE Ghaith, S., Quillen, J. K., Mead-Harvey, C., Buras, M. R., Wasson, M. N. 2022; 122 (6): 303-311

    Abstract

    Enhanced Recovery After Surgery (ERAS) is a multimodal protocol aimed to improve quality of postoperative recovery, minimize complications, and optimize overall self-regulation. Preoperative gabapentin decreases postoperative pain but can be associated with prolonged postoperative somnolence and respiratory depression risk. Although it is known that gabapentin affects the postoperative course, it is unclear if the timing of preoperative administration affects this finding.This study aims to assess the optimal preoperative timing for gabapentin administration in patients undergoing gynecologic surgery to minimize postoperative somnolence risk.A retrospective cohort study evaluated patients who underwent major gynecologic surgery and received preoperative gabapentin. Patients were grouped based on timing from gabapentin administration to surgical incision (<4 h group vs. ≥4 h group). Preoperative, intraoperative, and postoperative data were abstracted and compared. Univariate associations between the timing of gabapentin administration and the patient and surgical characteristics and outcomes were tested utilizing two-sample equal-variance t-tests, linear model ANOVA, or Fisher's exact tests. Associations between the timing of gabapentin administration and the time until the Richmond Agitation Sedation Scale (RASS) score of 0 were modeled utilizing linear regression, adjusted for age, initial postoperative anesthesia care unit (PACU), RASS score, and postoperative narcotics.Each group contained 127 patients. Demographics were similar except for age (<4 h group mean=44.2 years; ≥4 h group mean=40.5 years; p=0.021), chronic pain (<4 h group=17.6%; ≥4 h group=43.3%; p<0.001), and surgical indication (<4 h group=pelvic pain [29.1%]; ≥4 h group=pelvic pain [51.2%]; p=0.007). The <4 h group had a similar postoperative narcotic administration (<4 h group mean morphine milligram equivalents [MME]=3.667; ≥4 h group mean MME=4.833; p=0.185). The minutes from surgical closure until the patient received a RASS score of 0 and initial PACU pain score (Visual Analogue Scale [VAS]) were similar. The initial PACU oxygen administration volume, hours from surgical closure until the patient transitioned to room air, and initial PACU respiratory rate were similar. The PACU duration, admission secondary to somnolence, and initial PACU Glasgow Coma Scale (GCS) score showed no difference. Postoperative nausea/vomiting was decreased in the ≥4 h group (<4 h group=24.4%; ≥4 h group=13.4%; p-value=0.036), and urinary retention (<4 h group=14.2%; ≥4 h group=5.5%; p-value=0.033) was decreased in the ≥4 h group.The timing of gabapentin administration less than or more than 4 h preoperatively in patients ≥18 years does not significantly affect postoperative somnolence or respiratory depression. Further, it does not have a significant effect on GCS scores or VAS scores.

    View details for DOI 10.1515/jom-2021-0256

    View details for Web of Science ID 000758591100001

    View details for PubMedID 35191281

  • Federalism's Fallacy at the Forefront of Public Health Law. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics Hodge, J. G., Ghaith, S., Krumholz, L. 2022; 50 (4): 848-851

    Abstract

    Amid undulating conceptions of the role and prowess of federalism emerges its central constitutional role: protecting American liberties against unwarranted governmental intrusions. To the extent that federalism is used as a guise for withdrawing fundamental rights to abortion by the U.S. Supreme Court in Dobbs v. Jackson Women's Health Organization, individual rights are sacrificed in contravention of constitutional structural norms.

    View details for DOI 10.1017/jme.2023.26

    View details for PubMedID 36883407

    View details for PubMedCentralID PMC10009372

  • Curbing reversals of Non-Textual constitutional rights U. Md. LJ Race, Religion, Gender & Class Hodge, J., Piatt, J., White, E., Ghaith, S., Puchebner, M. 2022
  • Emergency Medical Treatment and Labor Act (EMTALA) Laws of Medicine: Core Legal Aspects for the Healthcare Professional Lindor, R., Ghaith, S. Springer International Publishing. 2022: 93-106
  • Comparison of radical hysterectomy with pelvic lymphadenectomy and radical prostatectomy with lymphadenectomy: Medicare reimbursement 2010-2019 Voleti, S., Newman, H., Ghaith, S., Yi, J., Magtibay, P. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2021: S119

    View details for Web of Science ID 000687070800214

  • RELATIONSHIP BETWEEN PAIN MANAGEMENT MODALITY AND RETURN RATES FOR LOWER BACK PAIN IN THE EMERGENCY DEPARTMENT JOURNAL OF EMERGENCY MEDICINE Ginsberg, Z., Ghaith, S., Pollock, J. R., Hwang, A. S., Buckner-Petty, S. A., Campbell, R. L., Rappaport, D. E., Lindor, R. A. 2021; 61 (1): 49-54

    Abstract

    Emerging evidence suggests that opioid use for patients with acute low back pain does not improve functional outcomes and contributes to long-term opioid use. Little is known about the impact of opioid administration in the emergency department (ED) for patients with low back pain.This study compares 30-day return rates after administration of various pain management modalities for emergency department (ED) patients with low back pain.We conducted a retrospective multicenter observational study of patients in the ED who were diagnosed with low back pain and discharged home in 21 EDs between November 2018 and April 2020. Patients were categorized based on the pain management they received in the ED and compared with the reference group of patients receiving only nonsteroidal anti-inflammatory drugs, acetaminophen, or a combination of the two. The proportions of ED return visits within 30 d for each medication category was calculated and associations between analgesia categories and proportions of return visits were assessed using logistic regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs).Patients with low back pain who received any opioid, intravenous opioid, or intramuscular opioid had significantly increased proportions of a return visit within 30 d (32% [OR 1.78 {95% CI 1.21-2.64}]; 33% [OR 1.83 {95% CI 1.18-2.86}]; and 39% [OR 2.38 {95% CI 1.35-4.12}], respectively) when compared with patients who received nonsteroidal anti-inflammatory drugs (19%), acetaminophen (20%), or a combination of the two (8%).Patients receiving opioids were more likely to return to the ED within 30 d than those receiving received nonsteroidal anti-inflammatory drugs or acetaminophen. This suggests that the use of opioids for low back pain in the ED may not be an effective strategy, and there may be an opportunity to appropriately treat more of these patients with nonopioid medications.

    View details for DOI 10.1016/j.jemermed.2021.01.022

    View details for Web of Science ID 000675523300012

    View details for PubMedID 33637379

  • Legal Challenges Underlying COVID-19 Vaccinations JOURNAL OF LAW MEDICINE & ETHICS Hodge, J. G., Piatt, J. L., Barraza, L., Freed, R., Ghaith, S., Wells, N. 2021; 49 (3): 495-499

    Abstract

    Immunizing hundreds of millions against COVID- 19 through the most extensive national vaccine campaign ever undertaken in the United States has generated significant law and policy challenges.

    View details for DOI 10.1017/jme.2021.70

    View details for Web of Science ID 000721266600022

    View details for PubMedID 34665094

  • Legal challenges underlying COVID-19 vaccinations Journal of Law, Medicine & Ethics Hodge, J., Piatt, J., Barraza, L., Freed, R., Ghaith, S., Wells, N. 2021
  • Vaccinating Urban Populations in Response to COVID-19: Legal Challenges and Options Fordham Urb. LJ Hodge, J., Piatt, J., Barraza, L., Freed, R., Ghaith, S. 2021
  • IMAGES IN EMERGENCY MEDICINE <i>Behcet</i>'<i>s disease</i> ANNALS OF EMERGENCY MEDICINE Ghaith, S., Urumov, A. 2021; 77 (1): 46-+

    View details for DOI 10.1016/j.annemergmed.2020.06.051

    View details for Web of Science ID 000600775100014

    View details for PubMedID 33349372

  • Tumor-free margins and local recurrence in squamous cell carcinoma of the vulva GYNECOLOGIC ONCOLOGY Yang, J., Delara, R., Ghaith, S., Newman, H., Magrina, J., Butler, K., Kumar, A., Dinh, T., Chen, L., Magtibay, P. 2020; 158 (3): 555-561

    Abstract

    To investigate the relation of pathologic tumor-free margins and local recurrence in patients who underwent primary surgery for vulvar squamous cell carcinoma.In this retrospective analysis, patients with stage I-III vulvar squamous cell carcinoma who underwent primary surgery between 2000 and 2018 were identified from the Mayo Clinic Cancer Registry.A total of 335 patients were included and divided into three groups according to tumor-free margins: group 1 (<3 mm, n = 32); group 2 (≥3 to <8 mm, n = 151); group 3 (≥8 mm, n = 152). The median follow-up time was 73 months (range 2-240). A total of 78 (23.3%) patients developed local recurrence. With the inverse propensity score weighing method adjusting baseline characters, margins <8 mm had inferior local control (HR 1.98, 95% CI 1.13-3.41). The 5-year local disease-free survival (DFS) was 48.2%, 81.5% and 84.6% for group 1, 2 and 3 respectively (p < 0.001). There were no differences in groin lymph nodes relapse (p = 0.850), distant metastases (p = 0.253), or disease-specific survival (DSS) (p = 0.289) among the three groups. Margins <8 mm, midline involvement, multifocal disease, precancerous lesions on margins and depth of invasion >1 mm were found to be poor prognosticators for local DFS in univariate analysis. Multifocal disease was the strongest predictor for local recurrence in multivariate analysis (HR 4.32, 95% CI 2.67-6.99).Patients undergoing primary surgery for vulvar squamous cell carcinoma with tumor free-margins <8 mm have a higher local recurrence rate.

    View details for DOI 10.1016/j.ygyno.2020.06.503

    View details for Web of Science ID 000571454700007

    View details for PubMedID 32624236