Journal of the National Medical Association最新文献_第5页

Racial and socioeconomic disparities in the treatment of unruptured intracranial aneurysms: A county hospital experience 治疗未破裂颅内动脉瘤的种族和社会经济差异：一家县级医院的经验。

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.008

Taylor Smith , Kelley Wormmeester , John Attia , Mesha Martinez , Nicolas Useche , Juan Tejada

Background

With increasing prevalence of unruptured intracranial aneurysms (UIAs), there is a need to provide appropriate management. Several studies have suggested that minorities in the United States have limited access to non-invasive imaging leading to increased presentation of aneurysmal subarachnoid hemorrhages (aSAHs). Given our medical institution's commitment to ensuring racial equality within our health care system, we chose to analyze our practice to assess the utilization of care provided by our neuroendovascular team. We hypothesized that given our diverse neuroendovascular care team along with our dedication to equity in healthcare, that we would find no difference in care provided to minority patients versus white patients who presented with UIAs.

Methods

We conducted a retrospective electronic medical record-based review of all patients with UIAs (n = 140) between September 2010 and June 2022 treated at a county hospital. Data regarding age at the time of treatment, gender, race, insurance type and aneurysm location were obtained.

Results

Of the 140 patients that underwent treatment, 54 % of patients were from the Black/Hispanic group and 46 % were from the white/non-Hispanic group. Commercial/private insurance was more common among White/NonHispanic patients (57.7 % vs 51.4 %) whereas Medicaid or uninsured status was more common among Black/Hispanic patients (25.7 % vs 15.4 %), although these differences were not statistically significant.

Conclusion

Building a diverse neuroendovascular physician team with intentionality to equity in healthcare, and providing appropriate funding and resources to facilities used by marginalized populations, such as safety-net institutions, can mitigate minority patients’ limited access to intracranial aneurysmal care.

背景：随着未破裂颅内动脉瘤（UIAs）发病率的增加，有必要提供适当的治疗。有几项研究表明，美国少数族裔获得非侵入性成像的机会有限，导致动脉瘤性蛛网膜下腔出血（aSAHs）的发病率增加。鉴于我们的医疗机构致力于确保医疗系统中的种族平等，我们选择对我们的实践进行分析，以评估我们的神经内血管团队所提供的医疗服务的利用率。我们假设，鉴于我们的神经内血管治疗团队是多元化的，而且我们致力于实现医疗保健的公平性，我们会发现在为患有 UIAs 的少数族裔患者和白人患者提供的治疗服务方面没有差异：我们对 2010 年 9 月至 2022 年 6 月期间在一家县级医院接受治疗的所有 UIA 患者（n = 140）进行了基于电子病历的回顾性分析。我们获得了有关治疗时的年龄、性别、种族、保险类型和动脉瘤位置的数据：在接受治疗的 140 名患者中，黑人/西班牙裔患者占 54%，白人/非西班牙裔患者占 46%。商业/私人保险在白人/非西班牙裔患者中更为常见（57.7% 对 51.4%），而医疗补助或无保险状态在黑人/西班牙裔患者中更为常见（25.7% 对 15.4%），尽管这些差异在统计学上并不显著：结论：建立一支多元化的神经血管内科医生团队，致力于实现医疗保健的公平性，并为边缘化人群使用的机构（如安全网机构）提供适当的资金和资源，可以减少少数族裔患者获得颅内动脉瘤治疗的机会。

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引用次数: 0

Disparities in Advanced Care Planning: Exploring Factors, Outcomes, and Equity 晚期护理规划中的差异：探索因素、结果和公平性

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.050

Toni-Ann J'nelle Lewis Degrees MD, MPH, Fatiah Joseph MD, Michael E. Kaiser MD, MPH, Gabriella J. Phillip MD, Joshua Green DPM, Francin Alexis MD, Louis Mudannayake MD, Anna Goehring MD, Kwesi Blackman MD, MBA, David Conner MD, MPH, William M. Briggs PhD

Purpose

ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.

Methods

A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p < 0.05) to uncover potential correlations with advanced care planning.

Results

End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value >0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.

Conclusion

Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.

目的 ACP 在病人护理中举足轻重。它强调在决策过程中尊重个人的价值观、偏好和目标。虽然 ACP 对患者和家属有益，但差距依然存在，尤其是在边缘化群体中。我们开展了这项研究，以评估不同群体患者之间的 ACP 差异，并评估这些因素与共同决策之间的关系。方法回顾性队列分析收集了 2023 年 3 月至 9 月期间一家医疗机构的数据，重点关注姑息治疗。数据按人口统计学（种族、年龄、性别）和影响患者及家属决策的因素进行分类，包括宗教信仰、婚姻状况、诊断和最终选择（DNR/DNI、舒适措施、临终关怀）。我们通过逻辑回归模型、卡方检验和 F 检验（p < 0.05）对这些变量进行了研究，以发现它们与晚期护理规划之间的潜在关联。选择舒适护理、DNR/DNI 和临终关怀的患者与 ACP 显著相关。有趣的是，种族、性别、婚姻状况、宗教信仰或年龄与接受 ACP 的可能性之间没有统计学意义（p 值为 0.05）。其中一个可能的原因是我们的医疗机构整合了社会工作者，他们积极地与病人一起参与 ACP。这种方法有利于早期干预，并确保在门诊和住院环境中为患者提供全面的服务。克服 ACP 对话的障碍并接受不同的观点对于实现公平和富有同情心的临终关怀至关重要。

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引用次数: 0

Racial & Socioeconomic Disparities in Patients with B-Cell Prolymphocytic Leukemia B 细胞前淋巴细胞白血病患者的种族和社会经济差异

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.057

Kingsley Chinonyerem Nnawuba MD, Samantha Robinson PhD, Obed Asare Hanna Jensen MD, PhD

Background

Leukemia refers to blood cell cancers that originates from the bone marrow. The prolymphocytic leukemia (PLL) subtype consists of the T-Cell prolymphocytic leukemia(T-PLL) and rarer B-Cell prolymphocytic leukemia(B-PLL) variant. B-PLL is harder to treat owing to cytogenetic abnormalities like MYC rearrangement and TP53 mutations. There have been limited studies about this disease, especially outcomes among different patient demographics.

Methods

The National Cancer Institute's Surveillance, Epidemiology, and End-Result (SEER) registry research database 17(2000 -2020) was used to explore and compare the outcomes for B-PLL in adult & Adolescent and Young Adult (AYA) patients. Univariate & multivariate analyses were performed to assess prognostic outcomes. A p-value <0.05 was considered statistically significant.

Results

A total of 608 deidentified patients were sampled (375 males and 233 females). Race and ethnicity was categorized to Hispanic & non-Hispanic. The non-Hispanic patients were further subdivided into White, Black, Asian, and Pacific Islanders. Socioeconomic status was associated with urban vs rural dwelling. Significant racial/ethnic differences (p<0.01) were seen in patients for this cancer type with regard to age group and living status. Specifically, there were significantly more Hispanic (all races) patients that were younger i.e., AYA than other racial/ethnic groups (p=.002). Additionally, non-Hispanic Black and White patients were more likely to die from B-PLL compared to other racial/ethnic groups (p=.007).

Discussion

Interesting differences were observed in the age, socioeconomic status, geographical area, and survival status among different race groups with B-PLL. Further research is warranted to characterize the demographic variables that may impact cancer care and survival.

背景白血病是指起源于骨髓的血细胞癌症。原淋巴细胞白血病（PLL）亚型包括T细胞原淋巴细胞白血病（T-PLL）和更罕见的B细胞原淋巴细胞白血病（B-PLL）变异型。B-PLL由于细胞遗传学异常（如MYC重排和TP53突变）而更难治疗。方法利用美国国家癌症研究所（National Cancer Institute）的监测、流行病学和最终结果（SEER）登记研究数据库17（2000 -2020），探讨和比较成人和青少年（AYA）患者的B-PLL治疗效果。对预后结果进行了单变量和多变量分析。结果共抽取了 608 名身份不明的患者（男性 375 人，女性 233 人）。种族和民族分为西班牙裔和非西班牙裔。非西班牙裔患者又分为白人、黑人、亚裔和太平洋岛民。社会经济地位与城市居民和农村居民有关。该癌症类型的患者在年龄组和生活状况方面存在明显的种族/人种差异（p<0.01）。具体来说，西班牙裔（所有种族）患者中，年龄较小的患者（即 AYA）明显多于其他种族/族裔群体（p=.002）。此外，与其他种族/族裔群体相比，非西班牙裔黑人和白人患者更有可能死于 B-PLL（P=.007）。讨论：在 B-PLL 患者的年龄、社会经济地位、地理区域和生存状况方面，不同种族群体之间存在着有趣的差异。有必要进一步研究可能影响癌症护理和生存的人口统计学变量。

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引用次数: 0

A Comparative Analysis of Large Language Model Accuracy for Image-Based Hair Disease Identification in Diverse Skin Tones 基于图像的不同肤色毛发疾病识别大语言模型准确性对比分析

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.035

Willow D. Pastard MS , Willow Pastard MS , Zane Sejdiu BS , Alexis Arza BS , James Cross MBA , Razmig Garabet BS , Anna Chacon MD , Ellen N. Pritchett MD

Purpose

The rapid integration of artificial intelligence (AI) in dermatology shows promise for support of clinical practice and democratization of diagnosis access. Significant limitations and ethical concerns persist, however. Despite growing research into AI's effectiveness in identifying skin conditions, fewer studies have explored its ability to accurately diagnose hair disorders.

Methods

This study explores the capacity of the large language model (LLM) ChatGPT to correctly identify alopecia areata, androgenetic alopecia, traction alopecia, and central centrifugal cicatricial alopecia across a range of skin tones. Utilizing the Monk Skin Tone Scale, images of hair disorders were sorted into lighter (Monk Scale 1-5) and darker (Monk Scale 6-10) categories. Images were sourced from publicly accessible databases.

Results

Our analysis revealed significant differences in diagnosis rates. ChatGPT was more likely to correctly identify disease in lighter skin, notably for alopecia areata (p<.001) and androgenetic alopecia (p=.003). This trend was also seen in overall diagnosis rates (p<.001). Interestingly, the program repeatedly incorrectly identified 24.48% of all hair conditions in dark skin as traction alopecia. Additionally, while initially this study sought to explore ChatGPT's ability to diagnose common nail disorders across skin tones this could not be completed due to the insufficient availability of images depicting nail disorders in darker skin.

Conclusion

These findings highlight some of the limitations of LLMs in accurate diagnosis of diseases of the hair and nails. It emphasizes potential implications for the performance of artificial intelligence trained on dermatologic databases with limited representation.

目的人工智能（AI）在皮肤病学领域的快速应用为临床实践提供了支持，也为诊断的民主化带来了希望。然而，人工智能仍然存在很大的局限性和伦理问题。本研究探讨了大型语言模型（LLM）ChatGPT 在各种肤色中正确识别斑秃、雄激素性脱发、牵引性脱发和中枢性离心环状脱发的能力。利用蒙克肤色量表，将毛发疾病的图片分为浅色（蒙克量表 1-5）和深色（蒙克量表 6-10）两类。结果我们的分析表明诊断率存在显著差异。ChatGPT 更有可能正确识别浅色皮肤的疾病，尤其是斑秃（p<.001）和雄激素性脱发（p=.003）。这一趋势也体现在总体诊断率上（p< .001）。有趣的是，该程序多次将 24.48% 的深色皮肤毛发病症错误地识别为牵引性脱发。此外，虽然本研究最初试图探索 ChatGPT 诊断不同肤色常见指甲疾病的能力，但由于描述深色皮肤指甲疾病的图像不足而未能完成。它强调了在代表性有限的皮肤病数据库中训练人工智能的潜在意义。

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引用次数: 0

Effect of Tobacco and E-Cigarette-Related Social Media Content on Youth 烟草和电子烟相关社交媒体内容对青少年的影响

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.023

Daniel P Ashley MPA, BSc (Hons), Brienna N. Rutherford BS, Carmen C.W. Lim BS, Brandon Cheng BS, Tianze Sun BS, Gigi Vu BS, Benjamin Johnson BS, Jack Chung BS, Sandy Huang BS, Janni Leung PhD, Daniel Stjepanović PhD, Jason P. Connor PhD, Gary C.K. Chan PhD

Introduction

E-cigarette and tobacco-related content on social media has been linked to various mechanisms of increased e-cigarette and tobacco use. This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviors and attitudes.

Methods

A comprehensive search was conducted as part of a larger study on social media and recreational substance use. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behavior or attitude outcomes were included.

Results

32 studies (N = 274,283, 9-25 years) were included. Meta-analyses revealed significant associations between engagement with tobacco content and use, to content and never users’ risk and exposure to e-cigarette content and use. There was no observed relationship between exposure to tobacco content and ever users’ risk perceptions. Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and reduced risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviors, and dual engagement on dual susceptibility.

Conclusion

Exposure to and engagement with content depicting e-cigarette or tobacco products may significantly influence the behaviors and attitudes of youth. Policies should continue to monitor the potential implications of interactions with this content and implementing strategies to reduce the impact of this content.

引言社交媒体上的电子烟和烟草相关内容与电子烟和烟草使用增加的各种机制有关。本研究旨在综合分析接触电子烟和烟草相关内容与青少年行为和态度之间的关联。方法作为社交媒体和娱乐性物质使用大型研究的一部分，我们进行了全面搜索。结果纳入了 32 项研究（N = 274,283, 9-25 岁）。元分析表明，接触烟草内容和使用烟草、接触烟草内容和从未使用烟草的风险以及接触电子烟内容和使用电子烟之间存在显著关联。没有观察到接触烟草内容与从不吸烟者的风险认知之间的关系。定性综合研究发现，烟草接触与当前使用增加和亲烟态度之间、电子烟接触与易感性增加和风险认知降低之间、烟草参与与易感性增加之间、电子烟参与与使用增加之间、双重接触与易感性增加之间、双重参与与双重使用增加之间存在重要关联。对于电子烟暴露对态度的影响、烟草暴露对易感程度的影响、双重暴露对双重使用行为的影响以及双重参与对双重易感程度的影响，研究结果不一。政策应继续监测与这些内容互动的潜在影响，并实施策略减少这些内容的影响。

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引用次数: 0

Time to diagnosis and treatment of emergent postpartum hypertensive disorders 产后高血压急症的诊断和治疗时间

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.074

Gabrielle J. Ezell MS, Nicolina Smith DO/MBA/MCSR, D'Angela S. Pitts MD, Mary Codon MSN, Katherine Joyce MD/MPH, John Joseph MD

Objective

Approximately 12% of postpartum patients seek treatment in the emergency department (ED). Hypertensive disorders are commonly seen during this time. This study assessed time to diagnosis and treatment of hypertensive disorders in postpartum patients with the hope to improve care through quality improvement.

Study Design

This is a retrospective study in metro-Detroit analyzing patients with hypertension in the ED from postpartum day 2 through 28. Primary outcomes included average time elapsed between severe range blood pressure (BP) readings to administration of antihypertensives and magnesium sulfate. Secondary outcomes included the presence of diagnostic laboratory testing, for classifying hypertensive disorders.

Results

Our cohort included 430 postpartum patients. The average time elapsed between the first severe BP reading and antihypertensive administration was 189 minutes for Black patients and 370 minutes for White patients. 72% received a complete blood count, 66% received creatinine and liver profile labs, and 4% had urine protein ordered. 15 patients (4.03%) with severe range BP received correct magnesium sulfate dosing. No statistically significant differences in time elapsed between severe BP readings to administration of antihypertensives, lab workup or administration of magnesium sulfate between racial groups were found.

Conclusion

Areas for improvement include the timeliness of administration of antihypertensive medications after severe range BP readings and ordering essential laboratory tests to classify the disorder. Fortunately, our institution did not demonstrate disparities of care with Black patients, despite existing literature. Moving forward, a targeted quality improvement plan will be implemented to address identified areas of concern.

目标约有 12% 的产后患者到急诊科（ED）寻求治疗。在此期间，高血压疾病很常见。本研究评估了产后患者高血压疾病的诊断和治疗时间，希望通过提高质量来改善护理。研究设计这是在底特律市进行的一项回顾性研究，分析了产后第 2 天到第 28 天急诊科的高血压患者。主要结果包括从严重范围血压 (BP) 读数到服用降压药和硫酸镁之间的平均时间。次要结果包括是否进行了诊断性实验室检测，以便对高血压疾病进行分类。从第一次严重血压读数到使用降压药的平均时间，黑人患者为 189 分钟，白人患者为 370 分钟。72%的患者接受了全血细胞计数检查，66%的患者接受了肌酐和肝功能检查，4%的患者接受了尿蛋白检查。15 名（4.03%）血压在严重范围内的患者获得了正确的硫酸镁剂量。从严重血压读数到服用降压药、实验室检查或服用硫酸镁，不同种族群体之间的时间差异没有统计学意义。结论需要改进的方面包括在严重血压范围读数后服用降压药的及时性，以及订购必要的实验室检查来对疾病进行分类。值得庆幸的是，尽管已有文献报道，但我院在黑人患者的护理方面并未出现差异。今后，我们将实施一项有针对性的质量改进计划，以解决已发现的问题。

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引用次数: 0

Process Improvement of Lipid Screening at Walter Reed PCMH 沃尔特里德 PCMH 的血脂筛查流程改进

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.067

Brandon J. Neal MD, Samantha Hanciles MD, Henry Goetzman MD, Wendy Hoffner MD, Wanda Foxx MD

Purpose

In 2008, The American Academy of Pediatrics (AAP) released guidelines supporting universal lipid screenings for children between the ages of 9 and 11 years old with the goal of accomplishing earlier detection of children who may be at risk of developing cardiovascular issues. A review of our current practice at Walter Reed National Military Medical Center found that only 17% of children ages 9-11 years old had lipid screenings, showing missed opportunities for early intervention.

Methods

This project aimed to improve the lipid screening process with the implementation of countermeasures amongst a target population of children ages 9-11 in our pediatric clinic. Utilizing the CarePoint database, baseline data was gathered for the target population of children who were enrolled in the Walter Reed PCMH in September 2023. Countermeasures focused on addressing inconsistent recommendations from providers, lack of a lipid screening prompt in standard intake paperwork, and lack of patient/parent awareness.

Results

Re-evaluation of CarePoint data after countermeasures implementation revealed an increase in the percentage of children aged 9-11 years old with lipid screening performed from 17% to 19%. Factors affecting the lack of change may include late introduction of countermeasures, incomplete acceptance of guidelines, and difficulty for families to get labs drawn at our crowded outpatient laboratory.

Conclusions

Implementation of a multifaceted approach to increase education and awareness of lipid screening in the Walter Reed PCMH may improve adherence to the current AAP lipid screening guidelines. However, with our limited data we are not yet seeing substantial change.

目的 2008 年，美国儿科学会 (AAP) 发布了支持对 9-11 岁儿童进行普遍血脂筛查的指南，目的是更早地发现可能有心血管问题风险的儿童。我们对沃尔特里德国家军事医疗中心目前的做法进行了回顾，发现只有 17% 的 9-11 岁儿童进行了血脂筛查，这表明我们错失了早期干预的机会。方法该项目旨在改进血脂筛查流程，在我们儿科诊所的 9-11 岁儿童目标人群中实施对策。利用 CarePoint 数据库，我们收集了 2023 年 9 月加入 Walter Reed PCMH 的目标儿童群体的基线数据。结果实施对策后对 CarePoint 数据的重新评估显示，9-11 岁儿童进行血脂筛查的比例从 17% 提高到了 19%。结论在沃尔特里德 PCMH 中实施多方面的方法来提高对血脂筛查的教育和认识，可能会提高对现行 AAP 血脂筛查指南的遵守率。然而，由于数据有限，我们尚未看到实质性的改变。

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引用次数: 0

Hidradenitis Suppurativa and Vulvar Lichen Sclerosus: a Case Series 化脓性外阴阴道炎和外阴硬皮病：一个病例系列

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.039

Sydney A. Martin BA, Julia M. Riley MD, Kelsey S. Flood MD

Purpose

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with many cutaneous comorbidities, including acne, dissecting cellulitis of the scalp, pilonidal cysts, and pyoderma gangrenosum (1-4). Although there is a plethora of literature on HS comorbidities, the association between HS and vulvar lichen sclerosus (VLS) needs further investigation. To date, two cases have been reported of HS and VLS in Caucasian women in their 4th to 6th decade of life (5). This study describes a series of 27 women with HS and VLS.

Methods

Retrospective review of 27 female patients diagnosed with HS, identified by ICD-10 code L73.2, and comorbid VLS, identified by ICD-10 code L90.0, who presented to Northwestern Dermatology between October 2015 - December 2023. Demographic variables of age, sex, and race were extracted for all included patients.

Results

Out of 27 female patients, 74.1% identified as white, 7.4% identified as black, and 18.5% declined to respond. The mean age was 57.1 years old (SD 17.2). All patients were either diagnosed with HS first (15/27) or HS and VLS simultaneously (12/27). For the 15 patients diagnosed with HS first, the average time between HS and VLS diagnosis was 25.1 months (2.09 years).

Conclusion

We present a cohort of patients with HS and VLS, two chronic inflammatory conditions that often present unique challenges in diagnosis and management. Providers caring for patients with HS may consider screening for VLS. This is especially pertinent as both diseases are associated with an increased risk of cutaneous squamous cell carcinoma (6-7).

目的化脓性扁桃体炎（HS）是一种慢性炎症性皮肤病，与许多皮肤合并症有关，包括痤疮、头皮剥脱性蜂窝织炎、皮样囊肿和脓皮病（1-4）。尽管有关 HS 并发症的文献很多，但 HS 与外阴硬皮病（VLS）之间的关联还需要进一步研究。迄今为止，已有两例高加索女性在第 4 到第 6 个十年中同时患有 HS 和 VLS 的报道（5）。本研究描述了一系列 27 名患有 HS 和 VLS 的女性患者。方法回顾性研究了 2015 年 10 月至 2023 年 12 月期间在西北皮肤科就诊的 27 名女性患者，这些患者被诊断为 HS（由 ICD-10 编码 L73.2 确定）和合并 VLS（由 ICD-10 编码 L90.0 确定）。研究提取了所有纳入患者的年龄、性别和种族等人口统计学变量。结果在27名女性患者中，74.1%为白人，7.4%为黑人，18.5%拒绝回答。平均年龄为 57.1 岁（标准差 17.2）。所有患者要么先确诊为 HS（15/27），要么同时确诊为 HS 和 VLS（12/27）。在先确诊为 HS 的 15 名患者中，确诊 HS 和 VLS 之间的平均间隔时间为 25.1 个月（2.09 年）。为 HS 患者提供护理的医疗人员可考虑对 VLS 进行筛查。这一点尤为重要，因为这两种疾病都与皮肤鳞状细胞癌的风险增加有关 (6-7)。

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引用次数: 0

Examining the Impact of the Affordable Care Act on Access to Care For Black Men and White Men: Implications for Policy and Practice 研究《平价医疗法案》对黑人男性和白人男性获得医疗服务的影响：对政策和实践的启示

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.047

Okechuku K. Enyia MPH, DrPH

Introduction

Black men experience poor health outcomes across a spectrum of chronic medical conditions and co-morbidities that ultimately lead to lower quality of life and premature death. Lack of access to medical care is one of many factors that contributes to these poor outcomes. This study examines the impact of the Patient Protection and Affordable Care Act of 2010 (ACA) on Black men's access to care compared to White men ages 18-64; and proposes strategies to help address any inequities. The ACA undergirds this study because it includes several provisions that are specifically meant to help address racial and ethnic health disparities and improve health outcomes.

Methods

This study took a longitudinal approach by examining access to care among non-Hispanic Black men and non-Hispanic White men ages 18-64 from 2011-2019. Using a publicly available secondary data source, the Medical Expenditure Panel Survey (MEPS), a descriptive and multi-variate analysis was conducted to examine the relationship between race, sociodemographic characteristics, and two indicators of health care access (insurance status and usual source of care).

Results

The analysis found that the ACA decreased the proportions of non-Hispanic Black men and non-Hispanic White men who were uninsured after 2014 by nearly 50%; however, racial disparities persisted. Other key findings are as follows: 1) race was a significant predictor of being uninsured, with non-Hispanic Black men having 30% greater odds than non-Hispanic White men of being uninsured and 2) non-Hispanic Black men had 25% lower odds than non-Hispanic White men of having a usual source of care.

Conclusion

Specific policy recommendations proposed include: 1) develop pathways to coverage for states that have yet to adopt Medicaid expansion and 2) use a multilevel approach to expand the proportion of men with a usual source of care that includes: a) disseminating educational messages to improve men's awareness of the value of having a regular source of care and b) facilitating health care delivery and payment reforms that incentivize health care institutions to increase the number of Black men who are meaningfully engaged with a regular source of care.

导言黑人男性在各种慢性疾病和并发症方面健康状况欠佳，最终导致生活质量下降和过早死亡。无法获得医疗保健是导致这些不良后果的众多因素之一。与 18-64 岁的白人男性相比，本研究探讨了 2010 年《患者保护与平价医疗法案》（ACA）对黑人男性获得医疗服务的影响，并提出了帮助解决任何不平等问题的策略。ACA 是本研究的基础，因为它包括几项专门用于帮助解决种族和民族健康差异并改善健康结果的规定。方法本研究采用纵向方法，考察了 2011-2019 年间非西班牙裔黑人男性和 18-64 岁非西班牙裔白人男性获得医疗服务的情况。结果分析发现，2014 年后，ACA 将非西班牙裔黑人男性和非西班牙裔白人男性中没有保险的比例降低了近 50%；然而，种族差异依然存在。其他主要发现如下1）种族是预测无保险的一个重要因素，非西班牙裔黑人男性无保险的几率比非西班牙裔白人男性高 30%；2）非西班牙裔黑人男性拥有惯常护理来源的几率比非西班牙裔白人男性低 25%：1）为尚未扩大医疗补助范围的州制定参保途径；2）采用多层次的方法来扩大拥有固定医疗来源的男性比例，包括：a）传播教育信息，提高男性对拥有固定医疗来源的价值的认识；b）促进医疗服务和支付改革，激励医疗机构增加拥有固定医疗来源的黑人男性的数量。

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引用次数: 0

BiZact vs Bipolar Pediatric Tonsillectomy: A Randomized Controlled Trial BiZact 与双极小儿扁桃体切除术：随机对照试验

IF 2.5 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association

Pub Date : 2024-08-01 DOI: 10.1016/j.jnma.2024.07.080

Daniel P Ashley MPA, BSc, Jemma Porrett MBBS, Jeremy Lee, Jodie Ballantine, Ripudaman Jalota, Nicola Slee MBChB

Introduction

Tonsillectomy is a commonly performed and relatively safe procedure, however it does have side effects and complications. Post-operative pain is the most common side effect and bleeding is the most significant complication. There is currently no evidence-based surgery-specification guidelines in the United States, United Kingdom and Australia describing the optimal technique for tonsillectomies. ‘Cold-steel’ dissection remains the most common technique worldwide while bipolar tonsillectomy is the most commonly used technique at the Queensland Children's Hospital. The BiZact device, with advanced bipolar energy allowing for continuous measurement of tissue impedance, was approved for use in Australia in 2016. This study aimed to determine postoperative morbidity in pediatric patients undergoing BiZact tonsillectomy compared to bipolar tonsillectomy.

Methods

A prospective, double-blinded, randomized control trial was conducted at the Queensland Children's Hospital. A total of 100 children, aged 3-17 years, with sleep disordered breathing or recurrent tonsillitis requiring tonsillectomy were included. Participants were randomized (1:1) to undergo BiZact or bipolar tonsillectomy. The primary objective was to assess post-operative pain using the FACES® Pain Rating Scale Revised and the Numeric Pain Rating Scale. The use of oxycodone and the return to normal diet and activities was also measured. Surgical timing, time taken to reach haemostasias, and post-operative complications were compared.

Results

This project's results are currently pending.

Conclusion

Guidelines describing the optimal technique for tonsillectomies need to be developed on evidence-based outcomes. This study will determine if BiZact is more effective than Bipolar tonsillectomy at reducing post-operative pain and bleeding in the pediatric population.

导言扁桃体切除术是一种常见且相对安全的手术，但也存在副作用和并发症。术后疼痛是最常见的副作用，出血是最主要的并发症。目前，美国、英国和澳大利亚都没有循证手术规范指南来描述扁桃体切除术的最佳技术。冷钢 "剥离仍然是全球最常用的技术，而双极扁桃体切除术则是昆士兰儿童医院最常用的技术。BiZact设备具有先进的双极能量，可连续测量组织阻抗，于2016年获准在澳大利亚使用。本研究旨在确定与双极扁桃体切除术相比，接受BiZact扁桃体切除术的儿童患者的术后发病率。方法在昆士兰儿童医院进行了一项前瞻性、双盲、随机对照试验。共纳入了 100 名患有睡眠呼吸障碍或复发性扁桃体炎、需要进行扁桃体切除术的 3-17 岁儿童。参与者被随机（1:1）安排接受 BiZact 或双极扁桃体切除术。主要目标是使用 FACES® 疼痛评分量表修订版和数字疼痛评分量表评估术后疼痛。此外，还测量了羟考酮的使用情况以及恢复正常饮食和活动的情况。结论扁桃体切除术的最佳技术指南需要根据循证结果来制定。这项研究将确定 BiZact 是否比双极扁桃体切除术更能有效减少儿童患者的术后疼痛和出血。

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引用次数: 0