Substance use disorder (SUD) in pregnancy poses undesirable effects on both mother and child. ACOG recommends universal screening at the initial prenatal visit using validated screening tools to identify prenatal substance and alcohol use. There are various barriers to early detection. However, providers have a unique chance to screen and identify high-risk patients during the prenatal period. Timely intervention can prevent continued substance use and improve maternal-fetal outcomes. This study aims to improve St. Barnabas Hospital's (SBH) approach to identification and management of patients with SUD by implementing the 4P screening tool into the EMR.
Methods
A retrospective chart review of SBH prenatal patients was conducted after the 4P screening tool was added to the EMR. Patient charts with a positive screen were reviewed for documentation of a brief intervention and plan of safe care. 50 unscreened patient charts were reviewed for documentation of other positive screening tools related to drugs and alcohol.
Results
314 prenatal patients were seen between 1/1/2024 and 2/29/2024. Of the 162 prenatal patients seen in January, 41% were screened and 2% resulted in a positive screen with a documented brief intervention. Of the 152 prenatal patients seen in February, 52% were screened with no positive results. Among the 50 charts reviewed without a 4P screen, three patients self-reported active nicotine use during pregnancy.
Conclusion
Implementing the 4P screening tool into the EMR may improve documentation of SUD in pregnancy. Tracking screening rates and interventions can be vital in enhancing SUD detection.
{"title":"Improving Early Detection and Management of Prenatal Substance Use Disorder","authors":"Tiffany A. Lacroix BS, Jillian Cherry MBA, BSN, RNC-OB, C-EFM, Meryl Grimaldi MD, FACOG","doi":"10.1016/j.jnma.2024.07.075","DOIUrl":"10.1016/j.jnma.2024.07.075","url":null,"abstract":"<div><h3>Introduction</h3><p>Substance use disorder (SUD) in pregnancy poses undesirable effects on both mother and child. ACOG recommends universal screening at the initial prenatal visit using validated screening tools to identify prenatal substance and alcohol use. There are various barriers to early detection. However, providers have a unique chance to screen and identify high-risk patients during the prenatal period. Timely intervention can prevent continued substance use and improve maternal-fetal outcomes. This study aims to improve St. Barnabas Hospital's (SBH) approach to identification and management of patients with SUD by implementing the 4P screening tool into the EMR.</p></div><div><h3>Methods</h3><p>A retrospective chart review of SBH prenatal patients was conducted after the 4P screening tool was added to the EMR. Patient charts with a positive screen were reviewed for documentation of a brief intervention and plan of safe care. 50 unscreened patient charts were reviewed for documentation of other positive screening tools related to drugs and alcohol.</p></div><div><h3>Results</h3><p>314 prenatal patients were seen between 1/1/2024 and 2/29/2024. Of the 162 prenatal patients seen in January, 41% were screened and 2% resulted in a positive screen with a documented brief intervention. Of the 152 prenatal patients seen in February, 52% were screened with no positive results. Among the 50 charts reviewed without a 4P screen, three patients self-reported active nicotine use during pregnancy.</p></div><div><h3>Conclusion</h3><p>Implementing the 4P screening tool into the EMR may improve documentation of SUD in pregnancy. Tracking screening rates and interventions can be vital in enhancing SUD detection.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 444"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.077
Sherin Lajevardi BS, MS
Purpose
Posterior segment involvement in patients with HLA-B27 associated uveitis is a relatively uncommon condition, with a prevalence of 17.4 to 23.1%. This retrospective cohort study investigated the prevalence and characterized the posterior segment involvement in eyes with HLA-B27 associated uveitis. We also aimed to assess the patient characteristics which are associated with posterior segment involvement.
Methods
Medical records of 65 patients (130 eyes) with HLA-B27 associated uveitis, from two university uveitis clinics (United States and Turkey) were reviewed. Posterior segment findings were identified based on medical records and optical imaging including color fundus photography, fluorescein angiography and optical coherence tomography. Findings identified were vitreous haze, vasculitis, optic disc leakage and macular edema. Clinical course of anterior uveitis was described as acute, recurrent, or chronic according to the standardization of uveitis nomenclature (SUN) classification. Recurrent uveitis was defined as repeated episodes separated by periods of inactivity without treatment ≥ 3 months in duration, and chronic uveitis was persistence or relapse of symptoms within 3 months after discontinuation of treatment. Patients who had significant systemic and ocular comorbidities were excluded from the study. Data was collected using REDCap and analyzed using Stata ver. 16.1.
Results
Forty-four patients were included from US while 21 patients were included from Turkey. The mean age at presentation was 41 ± 15.1 years with a majority being male [42 (65%)] and non-Hispanic Caucasian [34 (53%)]. Overall, 26 patients (36 eyes) demonstrated posterior segment findings; 15 (34%) belonged to US while 11 (52.4%) patients belonged to Turkey. Among eyes with posterior segment involvement, most common findings were peripheral vasculitis and vitreous haze [13 (36.11%) each] followed by macular edema and disc leakage [6 (16.67%) each]. Patients with chronic uveitis (5/7) presented with more posterior segment involvement in US while patients with recurrent uveitis (5/6) presented with more posterior segment findings in Turkish cohort.
Conclusions
Posterior ocular findings can be seen in up to 40% of patients with HLA-B27-associated uveitis. Patients with chronic or recurrent uveitis are more likely to have posterior segment involvement and therefore should warrant more comprehensive evaluation for posterior disease.
{"title":"Posterior segment manifestations in patients with HLA-B27 associated uveitis","authors":"Sherin Lajevardi BS, MS","doi":"10.1016/j.jnma.2024.07.077","DOIUrl":"10.1016/j.jnma.2024.07.077","url":null,"abstract":"<div><h3>Purpose</h3><p>Posterior segment involvement in patients with HLA-B27 associated uveitis is a relatively uncommon condition, with a prevalence of 17.4 to 23.1%. This retrospective cohort study investigated the prevalence and characterized the posterior segment involvement in eyes with HLA-B27 associated uveitis. We also aimed to assess the patient characteristics which are associated with posterior segment involvement.</p></div><div><h3>Methods</h3><p>Medical records of 65 patients (130 eyes) with HLA-B27 associated uveitis, from two university uveitis clinics (United States and Turkey) were reviewed. Posterior segment findings were identified based on medical records and optical imaging including color fundus photography, fluorescein angiography and optical coherence tomography. Findings identified were vitreous haze, vasculitis, optic disc leakage and macular edema. Clinical course of anterior uveitis was described as acute, recurrent, or chronic according to the standardization of uveitis nomenclature (SUN) classification. Recurrent uveitis was defined as repeated episodes separated by periods of inactivity without treatment ≥ 3 months in duration, and chronic uveitis was persistence or relapse of symptoms within 3 months after discontinuation of treatment. Patients who had significant systemic and ocular comorbidities were excluded from the study. Data was collected using REDCap and analyzed using Stata ver. 16.1.</p></div><div><h3>Results</h3><p>Forty-four patients were included from US while 21 patients were included from Turkey. The mean age at presentation was 41 ± 15.1 years with a majority being male [42 (65%)] and non-Hispanic Caucasian [34 (53%)]. Overall, 26 patients (36 eyes) demonstrated posterior segment findings; 15 (34%) belonged to US while 11 (52.4%) patients belonged to Turkey. Among eyes with posterior segment involvement, most common findings were peripheral vasculitis and vitreous haze [13 (36.11%) each] followed by macular edema and disc leakage [6 (16.67%) each]. Patients with chronic uveitis (5/7) presented with more posterior segment involvement in US while patients with recurrent uveitis (5/6) presented with more posterior segment findings in Turkish cohort.</p></div><div><h3>Conclusions</h3><p>Posterior ocular findings can be seen in up to 40% of patients with HLA-B27-associated uveitis. Patients with chronic or recurrent uveitis are more likely to have posterior segment involvement and therefore should warrant more comprehensive evaluation for posterior disease.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 445"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiation dermatitis presents challenges in radiotherapy, with conventional treatments often falling short in severe cases. Silverlon, a recent innovation, shows promise in managing this condition. This study aims to explore patient perspectives on Silverlon's effectiveness in radiation dermatitis management.
Methods
Eleven patients undergoing breast or head and neck radiation participated, with two excluded for protocol non-compliance. Patients used Silverlon at various treatment stages and completed surveys on ease of use, compliance, concurrent use with emollients, skin effects, and pain relief.
Results
Seven patients with complete data were included in the final analysis: five underwent head and neck radiation, while two underwent breast radiotherapy. Treatment fractionation schemes ranged from 15 – 33 with all patients beginning use of Silverlon after CTCAE grade 1 dermatitis. Patients were surveyed after a week of use. All patients were protocol compliant but ease of use, varied, with four head and neck patients experiencing difficulties, due to product displacement. Adverse effects, including rash exacerbation and allergic reactions, were reported by two patients. However, some patients noted benefits such as a cooling effect and aid in wound healing, with two patients reporting pain relief.
Conclusion
Overall, breast cancer patients viewed Silverlon more favorably, likely due to its compatibility with bra attachment. This preliminary data suggests Silverlon's efficacy, especially in breast cancer cases, warranting further investigation through a proof of concept trial. Silverlon shows promise in managing radiation dermatitis, particularly in breast cancer patients, with potential for further refinement and= clinical application.
{"title":"Initial Patient Perspectives on Novel Radiation Dermatitis Intervention: Single-Center Experience","authors":"Phylicia Gawu DO, Oluwatomiwa Awobayiku BS, Alekhya Mitta MD, Christina Henson MD","doi":"10.1016/j.jnma.2024.07.101","DOIUrl":"10.1016/j.jnma.2024.07.101","url":null,"abstract":"<div><h3>Introduction</h3><p>Radiation dermatitis presents challenges in radiotherapy, with conventional treatments often falling short in severe cases. Silverlon, a recent innovation, shows promise in managing this condition. This study aims to explore patient perspectives on Silverlon's effectiveness in radiation dermatitis management.</p></div><div><h3>Methods</h3><p>Eleven patients undergoing breast or head and neck radiation participated, with two excluded for protocol non-compliance. Patients used Silverlon at various treatment stages and completed surveys on ease of use, compliance, concurrent use with emollients, skin effects, and pain relief.</p></div><div><h3>Results</h3><p>Seven patients with complete data were included in the final analysis: five underwent head and neck radiation, while two underwent breast radiotherapy. Treatment fractionation schemes ranged from 15 – 33 with all patients beginning use of Silverlon after CTCAE grade 1 dermatitis. Patients were surveyed after a week of use. All patients were protocol compliant but ease of use, varied, with four head and neck patients experiencing difficulties, due to product displacement. Adverse effects, including rash exacerbation and allergic reactions, were reported by two patients. However, some patients noted benefits such as a cooling effect and aid in wound healing, with two patients reporting pain relief.</p></div><div><h3>Conclusion</h3><p>Overall, breast cancer patients viewed Silverlon more favorably, likely due to its compatibility with bra attachment. This preliminary data suggests Silverlon's efficacy, especially in breast cancer cases, warranting further investigation through a proof of concept trial. Silverlon shows promise in managing radiation dermatitis, particularly in breast cancer patients, with potential for further refinement and= clinical application.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 456"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.084
Samantha N Little B.S., M.S., MPH
Introduction
A diagnosis of cholesteatoma necessitates a collaborative effort between otolaryngologists and patients for effective treatment. While physicians play a central role in providing medical education, patients often seek additional information from external sources to enhance the comprehension of their diagnosis. This study compared patient-focused cholesteatoma literature from established sources to ChatGPT-generated material. Emphasizing health literacy's crucial influence on patient health outcomes, it evaluates both sources' accuracy, readability, understandability, and actionability to highlight potential differences in these frequently accessed resources.
Methods
A quantitative assessment was conducted by calculating the Patient Education Materials Assessment Tool (PEMAT) score, DISCERN score, Flesch-Kincaid Grade Level (FKGL), and Flesch Reading Ease Score (FRES) for each website and ChatGPT response. Raters determined accuracy by quantifying the number of errors in each resource.
Results
The patient-focused content was associated with better understandability compared to ChatGPT responses with a mean PEMAT-U score of 80.2 ± 10.6 and 60.0 ± 3.72 (P < .001), respectively. There was a significant difference in readability and quality demonstrated by average FKGL (P < .001), FRES (P < .001), and DISCERN scores in the individual ChatGPT responses (P < .001). There was no significant difference with regard to DISCERN combined responses (p = 0.224) or PEMAT-A scores (p = 0.567). An average of 2.6 ± 1.1 errors were found in the combined ChatGPT responses.
Conclusion
Patient-focused content from established sources on cholesteatoma was easier to read, more understandable, and more accurate when compared to responses from ChatGPT. k T Nickles, B.S.
{"title":"Cholesteatoma: Conventional patient-focused versus AI-generated resources","authors":"Samantha N Little B.S., M.S., MPH","doi":"10.1016/j.jnma.2024.07.084","DOIUrl":"10.1016/j.jnma.2024.07.084","url":null,"abstract":"<div><h3>Introduction</h3><p>A diagnosis of cholesteatoma necessitates a collaborative effort between otolaryngologists and patients for effective treatment. While physicians play a central role in providing medical education, patients often seek additional information from external sources to enhance the comprehension of their diagnosis. This study compared patient-focused cholesteatoma literature from established sources to ChatGPT-generated material. Emphasizing health literacy's crucial influence on patient health outcomes, it evaluates both sources' accuracy, readability, understandability, and actionability to highlight potential differences in these frequently accessed resources.</p></div><div><h3>Methods</h3><p>A quantitative assessment was conducted by calculating the Patient Education Materials Assessment Tool (PEMAT) score, DISCERN score, Flesch-Kincaid Grade Level (FKGL), and Flesch Reading Ease Score (FRES) for each website and ChatGPT response. Raters determined accuracy by quantifying the number of errors in each resource.</p></div><div><h3>Results</h3><p>The patient-focused content was associated with better understandability compared to ChatGPT responses with a mean PEMAT-U score of 80.2 ± 10.6 and 60.0 ± 3.72 (P < .001), respectively. There was a significant difference in readability and quality demonstrated by average FKGL (P < .001), FRES (P < .001), and DISCERN scores in the individual ChatGPT responses (P < .001). There was no significant difference with regard to DISCERN combined responses (p = 0.224) or PEMAT-A scores (p = 0.567). An average of 2.6 ± 1.1 errors were found in the combined ChatGPT responses.</p></div><div><h3>Conclusion</h3><p>Patient-focused content from established sources on cholesteatoma was easier to read, more understandable, and more accurate when compared to responses from ChatGPT. k T Nickles, B.S.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 448"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.085
Ange Maxime TCHOUTANG BS, MacDonald BIN Eric, Severin Donald Kamdem, Marie Chrisitne NKUNO, NGUM Lesly NGUM, Arnauld Tepa, Palmer MASUMBE NETONGO
Introduction
Malaria and Typhoid fever are significant diseases in many parts of the world, especially in the tropics and fever is a common sign. Prominent markers for early diagnosis and better comprehension of this pathological association and immunity are vital to reduce mortality, drug resistance and for clinical purposes. We sought to explore the profile of severity, oxidative stress, and inflammatory markers during malaria and typhoid fever co-infection.
Methods
From a cross-sectional study, 81 malaria and/or typhoid fever-positive patients from 288 fever patients were selected. Malaria was diagnosed using a Rapid diagnostic test and microscopy while typhoid fever was diagnosed using a Rapid typhoid test and Widal. Severity, stress level and inflammatory responses were evaluated by hematological analysis using full blood count, erythropoietin, cortisol, IL-10, IL-4 and IFN-γ through ELISA, superoxide dismutase and Catalase activities by spectrophotometer. Data were analyzed using SPPS 26 and PRISM 9 software.
Results
Co-infected patients present significant alterations of red blood cell lines such as thrombocytopenia and anemia. We founded also a significant increase of stress marker cortisol, IFN-γ and IFN-γ/IL-10 ratio compared to other groups, a decrease in anti-oxidant activities and an alteration of erythropoietin production. The levels of IL-10 and IL-4 were higher during mono-infections.
Conclusion
Co-infected subjects show changes in hematological parameters. The presence of malaria and typhoid fever results in a significant increase in stress, alterations in erythropoietin production, anti-oxidants and TH1- cytokine dominance. These findings allow for better management by the clinicians of these infections in the tropics.
{"title":"Pathology Activity Booths Used to Promote Colon Health","authors":"Ange Maxime TCHOUTANG BS, MacDonald BIN Eric, Severin Donald Kamdem, Marie Chrisitne NKUNO, NGUM Lesly NGUM, Arnauld Tepa, Palmer MASUMBE NETONGO","doi":"10.1016/j.jnma.2024.07.085","DOIUrl":"10.1016/j.jnma.2024.07.085","url":null,"abstract":"<div><h3>Introduction</h3><p>Malaria and Typhoid fever are significant diseases in many parts of the world, especially in the tropics and fever is a common sign. Prominent markers for early diagnosis and better comprehension of this pathological association and immunity are vital to reduce mortality, drug resistance and for clinical purposes. We sought to explore the profile of severity, oxidative stress, and inflammatory markers during malaria and typhoid fever co-infection.</p></div><div><h3>Methods</h3><p>From a cross-sectional study, 81 malaria and/or typhoid fever-positive patients from 288 fever patients were selected. Malaria was diagnosed using a Rapid diagnostic test and microscopy while typhoid fever was diagnosed using a Rapid typhoid test and Widal. Severity, stress level and inflammatory responses were evaluated by hematological analysis using full blood count, erythropoietin, cortisol, IL-10, IL-4 and IFN-γ through ELISA, superoxide dismutase and Catalase activities by spectrophotometer. Data were analyzed using SPPS 26 and PRISM 9 software.</p></div><div><h3>Results</h3><p>Co-infected patients present significant alterations of red blood cell lines such as thrombocytopenia and anemia. We founded also a significant increase of stress marker cortisol, IFN-γ and IFN-γ/IL-10 ratio compared to other groups, a decrease in anti-oxidant activities and an alteration of erythropoietin production. The levels of IL-10 and IL-4 were higher during mono-infections.</p></div><div><h3>Conclusion</h3><p>Co-infected subjects show changes in hematological parameters. The presence of malaria and typhoid fever results in a significant increase in stress, alterations in erythropoietin production, anti-oxidants and TH1- cytokine dominance. These findings allow for better management by the clinicians of these infections in the tropics.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 448"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyperuricemia is a widespread health issue globally, with serum uric acid (SUA) implicated in inflammation and various chronic diseases. Our study seeks to assess the correlation between established inflammatory markers and SUA, aiming to define their relationship and predictive efficacy.
Method
In our analysis, we studied 9,450 adults aged 18 years and older from NHANES 2017-2018, defining hyperuricemia as SUA levels of 7 mg/dL for males and 6 mg/dL for females. We evaluated key inflammatory indices, including the Systemic Inflammation Response Index (SIRI), serum ferritin, and hs-CRP, using linear regression and ROC analysis. Additionally, we adjusted the linear regression model to predict inflammatory indices, considering factors such as age, race, lifestyle habits, and medical history (hypertension, diabetes and arthritis), as well as intake of anti-inflammatory nutrients including zinc, vitamin C, D, and selenium.
Result
In the adjusted model, SUA increased by 0.044 (95% CI: 0.028-0.060) and 0.003 (95% CI: 0.003-0.004) per unit increase in hs- CRP and ferritin, respectively, and by 0.160 (95% CI: 0.065-0.255) per unit increase in SIRI. In male population hs-CRP, showing an increased degree of correlation to 0.051 (95% CI: 0.009-0.251). The predictive ability of hsCRP and ferritin for hyperuricemia is evident especially for female, with the ideal cut-off points for prediction being 2.785 (AUC=0.653, Sensitivity=61.7%, Specificity=39.0%) and 75.35 (AUC=0.647, Sensitivity=61.0%, Specificity=39.4%), respectively.
Conclusion
A strong positive relationship between inflammatory markers and SUA was evident, with gender serving as a modifying influence. SIRI, determined solely through CBC analysis, might be utilized in predicting SUA.
{"title":"Predictive Efficacy of Inflammatory Indices for Hyperuricemia: NHANES Analysis 2017-2020","authors":"Chutawat Kookanok MD, Methavee Poochanasri MD, Tulaton Sodsri MD, Nicha Wareesawetsuwan MD, Vitchapong Prasitsumrit MD, Tatchaya Kanthajan MD, Vichayut Chayapinun MD, Sethapong Lertsakulbunlue MD, Nisha Wanichwecharungruang MD, Voramol Rochanaroon MD, Narathorn Kulthamrongsri MD, Wanprapit Noree MD, Adivitch Sripusanapan MD, Kamonluk Rodsom MD, Napat Suriyathumrongkul MD, Natee Deepan MD, Ekamol Tantisattamo MD, MPH","doi":"10.1016/j.jnma.2024.07.059","DOIUrl":"10.1016/j.jnma.2024.07.059","url":null,"abstract":"<div><h3>Purpose</h3><p>Hyperuricemia is a widespread health issue globally, with serum uric acid (SUA) implicated in inflammation and various chronic diseases. Our study seeks to assess the correlation between established inflammatory markers and SUA, aiming to define their relationship and predictive efficacy.</p></div><div><h3>Method</h3><p>In our analysis, we studied 9,450 adults aged 18 years and older from NHANES 2017-2018, defining hyperuricemia as SUA levels of 7 mg/dL for males and 6 mg/dL for females. We evaluated key inflammatory indices, including the Systemic Inflammation Response Index (SIRI), serum ferritin, and hs-CRP, using linear regression and ROC analysis. Additionally, we adjusted the linear regression model to predict inflammatory indices, considering factors such as age, race, lifestyle habits, and medical history (hypertension, diabetes and arthritis), as well as intake of anti-inflammatory nutrients including zinc, vitamin C, D, and selenium.</p></div><div><h3>Result</h3><p>In the adjusted model, SUA increased by 0.044 (95% CI: 0.028-0.060) and 0.003 (95% CI: 0.003-0.004) per unit increase in hs- CRP and ferritin, respectively, and by 0.160 (95% CI: 0.065-0.255) per unit increase in SIRI. In male population hs-CRP, showing an increased degree of correlation to 0.051 (95% CI: 0.009-0.251). The predictive ability of hsCRP and ferritin for hyperuricemia is evident especially for female, with the ideal cut-off points for prediction being 2.785 (AUC=0.653, Sensitivity=61.7%, Specificity=39.0%) and 75.35 (AUC=0.647, Sensitivity=61.0%, Specificity=39.4%), respectively.</p></div><div><h3>Conclusion</h3><p>A strong positive relationship between inflammatory markers and SUA was evident, with gender serving as a modifying influence. SIRI, determined solely through CBC analysis, might be utilized in predicting SUA.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 436-437"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.060
Eliana M. Schach BA, Yan Leyfman MD, Andriy Derkach PhD, Francesca Castro MS, RD, CDN, Jorge Arturo Hurtado Martínez MD, Ana M. Sahagun Sanchez Aldana MD, Patricia Alejandra Flores Pérez MD, Maria Malik BA, Jennifer M. Ahlstrom, Jay R Hydren PhD, Saad Z. Usmani MD, MBA, FRCP, FASCO, Jun J. Mao MD, MSCE, Susan Chimonas PhD
Purpose
Individuals diagnosed with plasma cell disorders (PCDs) have a significant interest to incorporate supplements to enhance their health. This survey investigates perceptions, habits, and awareness related to vitamin D, omega-3 fatty acids, turmeric/curcumin, and probiotics.
Methods
Between September 2023 and January 2024, 480 survey responses were gathered through HealthTree Cure Hub. Summary statistics were employed to assess the deidentified survey responses.
Results
The study population was predominantly female (58%), aged 65+ (61%), at least college educated (67%), and from the US (90%). While white participants formed the majority (78%), minorities including African Americans, Hispanics, and American Indian or Alaska Natives comprised 9% of the respondents. Prior to diagnosis, 71% used supplements, with a notable 46% increase post-diagnosis, reaching 95% usage. Patients primarily obtained supplement information from online medical media (45%) or from healthcare providers (oncologists 46%, primary care physicians 34%). Motivations for supplement use were immune system support (70%), preventing nutritional deficiencies (54%), and slowing cancer progression (38%). Notably, 63% of patients discussed supplements with their physicians, with a strong preference for oncologist recommendations (74%). An overwhelming 91% of patients expressed interest in further research on supplement risks and benefits.
Conclusion
This survey highlights the growing demand for further investigation into supplements, as supplement usage increased post-diagnosis and there was a notable preference for oncologist recommendations. Addressing healthcare disparities necessitates diverse participant inclusion in future research endeavors, despite recruitment challenges. Enhanced outreach and enrollment strategies are crucial as research in this area progresses.
{"title":"Understanding Patterns of Supplement Use among Plasma Cell Disorder Patients","authors":"Eliana M. Schach BA, Yan Leyfman MD, Andriy Derkach PhD, Francesca Castro MS, RD, CDN, Jorge Arturo Hurtado Martínez MD, Ana M. Sahagun Sanchez Aldana MD, Patricia Alejandra Flores Pérez MD, Maria Malik BA, Jennifer M. Ahlstrom, Jay R Hydren PhD, Saad Z. Usmani MD, MBA, FRCP, FASCO, Jun J. Mao MD, MSCE, Susan Chimonas PhD","doi":"10.1016/j.jnma.2024.07.060","DOIUrl":"10.1016/j.jnma.2024.07.060","url":null,"abstract":"<div><h3>Purpose</h3><p>Individuals diagnosed with plasma cell disorders (PCDs) have a significant interest to incorporate supplements to enhance their health. This survey investigates perceptions, habits, and awareness related to vitamin D, omega-3 fatty acids, turmeric/curcumin, and probiotics.</p></div><div><h3>Methods</h3><p>Between September 2023 and January 2024, 480 survey responses were gathered through HealthTree Cure Hub. Summary statistics were employed to assess the deidentified survey responses.</p></div><div><h3>Results</h3><p>The study population was predominantly female (58%), aged 65+ (61%), at least college educated (67%), and from the US (90%). While white participants formed the majority (78%), minorities including African Americans, Hispanics, and American Indian or Alaska Natives comprised 9% of the respondents. Prior to diagnosis, 71% used supplements, with a notable 46% increase post-diagnosis, reaching 95% usage. Patients primarily obtained supplement information from online medical media (45%) or from healthcare providers (oncologists 46%, primary care physicians 34%). Motivations for supplement use were immune system support (70%), preventing nutritional deficiencies (54%), and slowing cancer progression (38%). Notably, 63% of patients discussed supplements with their physicians, with a strong preference for oncologist recommendations (74%). An overwhelming 91% of patients expressed interest in further research on supplement risks and benefits.</p></div><div><h3>Conclusion</h3><p>This survey highlights the growing demand for further investigation into supplements, as supplement usage increased post-diagnosis and there was a notable preference for oncologist recommendations. Addressing healthcare disparities necessitates diverse participant inclusion in future research endeavors, despite recruitment challenges. Enhanced outreach and enrollment strategies are crucial as research in this area progresses.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 437"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.014
Arushi Gupta MSN, Janice F. Hernandez DNP, RN, FNP-C, Jose Reyes DDS
Purpose
The purpose of this project is to identify major health risk factors among Latino patients and develop pre-surgical algorithms based on the most common risk factors to prevent complications before, during and after dental surgery.
Methods
A thorough literature review was conducted using CINAHL and PubMed to identify scholarly articles that address health risk factors in the Latino population, and to identify Evidence-based protocols used at outpatient surgery center. The top-ranked health risk factors associated with dental surgery were identified.
Results and Findings
The literature review yielded five evidence-based articles identifying the top health-risk factors: patients on anticoagulation therapy, heart valve replacement, active atrial fibrillation, and medications associated with delayed gastrointestinal emptying such as Semaglutide. Four pre-surgical algorithms were developed after review. The pre-surgical algorithms will guide surgical protocols and procedures at Alamo City Dental.
Conclusion and Implications for Practice
As dentists continue to provide preventative and emergency dental services, the need for addressing health risk factors related to the decrease in access to primary care by their patients is increasing. This added workload and responsibility in becoming the first point of contact for patients with undiagnosed chronic conditions can become overwhelming. In addition, with the decrease in dental service and access to primary care in underserved areas, it is vital to reinforce and improve interprofessional collaboration and education regarding preventive dental hygiene in patients among medical professionals. With the collaboration and creation of these pre-surgical algorithms, dentist may now have the ability to enhance patient care, safety, and decrease emergency complications before, during and after dental surgery.
{"title":"Developing Pre-Surgical Dental Algorithms for Enhanced Patient Care","authors":"Arushi Gupta MSN, Janice F. Hernandez DNP, RN, FNP-C, Jose Reyes DDS","doi":"10.1016/j.jnma.2024.07.014","DOIUrl":"10.1016/j.jnma.2024.07.014","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this project is to identify major health risk factors among Latino patients and develop pre-surgical algorithms based on the most common risk factors to prevent complications before, during and after dental surgery.</p></div><div><h3>Methods</h3><p>A thorough literature review was conducted using CINAHL and PubMed to identify scholarly articles that address health risk factors in the Latino population, and to identify Evidence-based protocols used at outpatient surgery center. The top-ranked health risk factors associated with dental surgery were identified.</p></div><div><h3>Results and Findings</h3><p>The literature review yielded five evidence-based articles identifying the top health-risk factors: patients on anticoagulation therapy, heart valve replacement, active atrial fibrillation, and medications associated with delayed gastrointestinal emptying such as Semaglutide. Four pre-surgical algorithms were developed after review. The pre-surgical algorithms will guide surgical protocols and procedures at Alamo City Dental.</p></div><div><h3>Conclusion and Implications for Practice</h3><p>As dentists continue to provide preventative and emergency dental services, the need for addressing health risk factors related to the decrease in access to primary care by their patients is increasing. This added workload and responsibility in becoming the first point of contact for patients with undiagnosed chronic conditions can become overwhelming. In addition, with the decrease in dental service and access to primary care in underserved areas, it is vital to reinforce and improve interprofessional collaboration and education regarding preventive dental hygiene in patients among medical professionals. With the collaboration and creation of these pre-surgical algorithms, dentist may now have the ability to enhance patient care, safety, and decrease emergency complications before, during and after dental surgery.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 416"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.034
Krina V Patel BS, Lisa R Patel BS, Sunaina V Addanki BS
Introduction
Hidradenitis Suppurativa (HS) is an inflammatory disease affecting pilosebaceous skin units that has been linked with several autoimmune conditions. Hyperthyroidism is most commonly seen in Grave's Disease, an autoimmune condition that results in a hypermetabolic state. The aim of this study is to explore and establish the relationship between HS and hyperthyroidism in order to investigate the potential implications in patient care.
Methods
Data from the National Institute of Health (NIH) All of Us Researcher Program (AoU), was used to evaluate the relationship between hyperthyroidism and HS. A cross-sectional study was performed to evaluate the prevalence of HS in individuals with and without a history of hyperthyroidism matched by age ranges and health surveys. Significance and relative risk were obtained using standard statistical procedures.
Results
A total of 407,333 patients were matched by age range and health surveys in both the experimental and control groups. Amongst patients with a history of hyperthyroidism, the prevalence of HS was 1.40% compared to 0.38% in the control group. This difference was statistically significant by p<0.0001 with an OR=3.717, 95% CI 3.038-4.548.
Conclusion
The study shows a statistically significant correlation between hyperthyroidism and increased prevalence of HS. These results warrant further research regarding hyperthyroidism's role in HS and the potential screening tools and lifestyle management techniques that may be prevalent for both conditions. Implementation of patient education in those with hyperthyroidism about the signs and symptoms of HS may prompt earlier seeking of medical care and improved timelines for diagnosis and management.
{"title":"Exploring the Association of Hidradenitis Suppurativa and Hyperthyroidism","authors":"Krina V Patel BS, Lisa R Patel BS, Sunaina V Addanki BS","doi":"10.1016/j.jnma.2024.07.034","DOIUrl":"10.1016/j.jnma.2024.07.034","url":null,"abstract":"<div><h3>Introduction</h3><p>Hidradenitis Suppurativa (HS) is an inflammatory disease affecting pilosebaceous skin units that has been linked with several autoimmune conditions. Hyperthyroidism is most commonly seen in Grave's Disease, an autoimmune condition that results in a hypermetabolic state. The aim of this study is to explore and establish the relationship between HS and hyperthyroidism in order to investigate the potential implications in patient care.</p></div><div><h3>Methods</h3><p>Data from the National Institute of Health (NIH) All of Us Researcher Program (AoU), was used to evaluate the relationship between hyperthyroidism and HS. A cross-sectional study was performed to evaluate the prevalence of HS in individuals with and without a history of hyperthyroidism matched by age ranges and health surveys. Significance and relative risk were obtained using standard statistical procedures.</p></div><div><h3>Results</h3><p>A total of 407,333 patients were matched by age range and health surveys in both the experimental and control groups. Amongst patients with a history of hyperthyroidism, the prevalence of HS was 1.40% compared to 0.38% in the control group. This difference was statistically significant by p<0.0001 with an OR=3.717, 95% CI 3.038-4.548.</p></div><div><h3>Conclusion</h3><p>The study shows a statistically significant correlation between hyperthyroidism and increased prevalence of HS. These results warrant further research regarding hyperthyroidism's role in HS and the potential screening tools and lifestyle management techniques that may be prevalent for both conditions. Implementation of patient education in those with hyperthyroidism about the signs and symptoms of HS may prompt earlier seeking of medical care and improved timelines for diagnosis and management.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 425"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.jnma.2024.07.097
Mayenha E Guerrier MD
Introduction
The underrepresentation of disenfranchised communities in clinical research on the top three mental health disorders—anxiety, major depressive disorder (MDD), and post-traumatic stress disorder (PTSD)—presents significant challenges to the development of effective and inclusive mental health interventions. This study aims to identify barriers to diverse participation and propose actionable strategies to improve representation in clinical research.
Methods
To address these issues, a comprehensive review of existing literature and analysis of current clinical research practices was conducted. The study examined the extent of underrepresentation across various demographic groups and explored the systemic, cultural, and logistical barriers that prevent equitable participation.
Results
The findings reveal persistent disparities in clinical research, with marginalized groups (including but not limited to racial and ethnic minorities and low-income individual populations) often underrepresented in studies. Barriers to inclusion include limited access to healthcare and research opportunities, language and cultural differences, and mistrust of the medical system. To combat these issues, the study proposes several strategies, such as community engagement initiatives, culturally sensitive recruitment practices, and partnerships with local organizations to build trust and awareness. Additionally, providing resources such as transportation, translation services, and financial compensation can help facilitate participation.
Conclusion
In conclusion, this research underscores the importance of implementing inclusive practices in clinical research on anxiety, MDD, and PTSD. By addressing barriers to participation and promoting equitable representation, the research community can ensure that findings are applicable to diverse populations and improve mental health outcomes for all individuals.
{"title":"Improving Research Representation in Anxiety, MDD, PTSD for Disenfranchised Groups","authors":"Mayenha E Guerrier MD","doi":"10.1016/j.jnma.2024.07.097","DOIUrl":"10.1016/j.jnma.2024.07.097","url":null,"abstract":"<div><h3>Introduction</h3><p>The underrepresentation of disenfranchised communities in clinical research on the top three mental health disorders—anxiety, major depressive disorder (MDD), and post-traumatic stress disorder (PTSD)—presents significant challenges to the development of effective and inclusive mental health interventions. This study aims to identify barriers to diverse participation and propose actionable strategies to improve representation in clinical research.</p></div><div><h3>Methods</h3><p>To address these issues, a comprehensive review of existing literature and analysis of current clinical research practices was conducted. The study examined the extent of underrepresentation across various demographic groups and explored the systemic, cultural, and logistical barriers that prevent equitable participation.</p></div><div><h3>Results</h3><p>The findings reveal persistent disparities in clinical research, with marginalized groups (including but not limited to racial and ethnic minorities and low-income individual populations) often underrepresented in studies. Barriers to inclusion include limited access to healthcare and research opportunities, language and cultural differences, and mistrust of the medical system. To combat these issues, the study proposes several strategies, such as community engagement initiatives, culturally sensitive recruitment practices, and partnerships with local organizations to build trust and awareness. Additionally, providing resources such as transportation, translation services, and financial compensation can help facilitate participation.</p></div><div><h3>Conclusion</h3><p>In conclusion, this research underscores the importance of implementing inclusive practices in clinical research on anxiety, MDD, and PTSD. By addressing barriers to participation and promoting equitable representation, the research community can ensure that findings are applicable to diverse populations and improve mental health outcomes for all individuals.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 454"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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