Journal of the National Medical Association最新文献

Objective

To enhance recruitment and participation rates of Non-Hispanic Black (NHB) and Hispanic adult patients in a NIH-funded clinical trial studying an emerging health technology.

Data Sources and Study Setting: This study includes primary data collected in Los Angeles, California from November 2020 through November 2023

Study Design

In response to the underrepresentation of NHB and Hispanic patients in a NIH-funded trial on virtual reality for chronic lower back pain, we conducted a study utilizing a mixed-method approach. We conducted focus groups and based upon the feedback, study materials were culturally adapted concordantly. Additionally, a natural language processing program was used to micro target recruitment. Quantitative analysis was performed to assess the efficacy of the modified recruitment strategies by comparing the number of recruited and randomized NHB and Hispanic patients pre and post intervention.

Data Collection/Extraction Methods

Semi-structured focus groups were conducted with NHB and Hispanic patients and community members (age 18 and older). Thematic analysis of focus groups identified four key themes: mistrust, interest, culture, and communication. Adaptations, including revised language, multimedia instructions, targeted outreach, and micro-target recruitment were implemented in the second half of the study.

Principal Findings

Themes guided modifications, resulting in statistically significant increases in the overall proportion of Hispanic individuals approached for the study from 16.6% to 40.6% (p<0.001) and randomized from 16.7% to 34.4% (p<0.001). The randomization rate increased from 32.2% to 44.8% (p=0.045) for Hispanic participants and from 28.2% to 45.9% (p=0.011) for NH Black participants.

Conclusion

This study introduces culturally sensitive recruitment strategies addressing mistrust among NHB and Hispanic populations and microtargeting techniques harnessing technological advancements, yielding a notable increase in the randomization rate of underrepresented groups and enhancing clinical trial diversity.

Purpose

Current literature revealed that lower gastrointestinal hemorrhage (LGIH) complications increased with age or comorbid illnesses. However, the impact of racial disparities on this subpopulation group is limited. This study aimed to assess the relationship between LGIH complications and racial disparities nationally.

Methods

In a 2020 Nationwide cross-sectional study, patients with LGIH and associated complications, including acute kidney injury (AKI), respiratory failure (RS failure), mechanical ventilation use, and mortality rates were analyzed. Logistic regression analysis was used to assess the association between race and LGIH complications.

Results

We surveyed 104,359 hospitalizations with LGIH. Caucasians accounted for 65.3%, whereas African Americans accounted for 20%. The mean age was 74.25 years, with 51% being female. African Americans had a significantly higher AKI with (aOR 1.22; 95%CI (1.10-1.35), p<0.005) and mechanical ventilation use (aOR 1.7; 95%CI (1.19-2.42), p<0.005) but a lower incidence of respiratory failure (aOR 0.66; 95%CI (0.5-0.87), p<0.005) and a mortality rate (aOR 0.57; 95%CI (0.37-0.86), p<0.005) compared to Caucasians. The analysis also demonstrated a trend toward higher complication rates after LGIH, which varies among other races compared to Caucasians.

Conclusion

African Americans are at a higher risk of experiencing worsening clinical outcomes, but experience a lower mortality rate. Additional longitudinal studies are required to understand these relationships in the future.

Introduction

Compared with adults, differences in clinical treatment or patient/family experiences related to characteristics such as race, ethnicity, gender, gender identity, sexual orientation, ability status, language, weight status, and income gradient are rarely studied and addressed in the care of children. The objective of this study was to develop a quality collaborative among the three largest children's hospitals in Michigan to rigorously assess potential care inequities and test strategies for improvement.

Methods

All hospital Chief Executives agreed to participate in the collaborative. The coordinating center provides partner hospitals with expertise on research design and methods for assessing inequities. At each hospital, staff work with the coordinating center to retrieve and analyze data. Performance data are shared among the hospitals and strategies for improvement are developed. Each hospital will implement quality improvement strategies targeted to their specific context, including collecting and evaluating data. The partner hospitals will share results to facilitate joint learning, adjust strategies and improve equity in care delivery across the collaborative.

Results

With the assistance of the coordinating center, each hospital conducted >10 focus groups with nurses, physicians, child life specialists, social workers, and others to suggest potential inequities to assess. Jointly, the hospitals assessed the overlap of hypothesized inequities among the institutions and prioritized areas for action which included exploring differences in emergency department wait times and use of restraints.

Conclusions/Implications

Work from this innovative collaborative will help improve patient and family experiences, lead to more equitable pediatric care, foster greater patient trust, and improve employee morale.

Introduction

Concussion remains a common sports-related injury in the US. American football is known to be a leading cause of concussion compared to basketball among high school athletes, who in turn generally have a higher rate of concussions than collegiate athletes. However, the epidemiology for football and basketball concussions is not sufficiently characterized across both athlete populations.

Purpose

This study aims to assess the differences in sports specific concussion risk for high school and collegiate athletes in a 10-year period.

Methods

We analyzed the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission, which has data from 100 United States Emergency Departments (ED). We reviewed visits due to concussion from January 2014 to December 2023 sustained by football and basketball athletes aged 18 and 23 years. R programming language was used for statistical analysis and chi square was used.

Results

A total of 6,340 reported cases of concussion resulting from both high school and college aged football and basketball players. Over 90% occurred in high school players. There is a significant difference in concussion rates between the two sports (p< 0.05) with football accounting for about 64%. Also, the concussion rates in both sports showed a significant difference among both genders (p<0.05).

Conclusion

This study shows the need for tailored interventions on safety measures and policies to address concussion based on the type of sport and population. This will ensure a safe sporting environment and reduce the economic burden of concussion.

Purpose

Breast cancer is the leading cause of cancer-related death in Black women. Its concurrence with major depressive disorder (MDD) presents complex challenges for patients and clinicians. Our study aims to compare the clinical and economic impact of these comorbid conditions between racial groups.

Methods

We reviewed HCUP NIS data from 2018 to 2020 for 14,105 discharge cases of breast cancer with concurrent MDD, identified using ICD-10-CM code C50.xx. SPSS and SAS facilitated the data analysis, considering cost, demographics, length of stay, expected primary payer, and urban-rural patient location between White and Black racial groups. T-tests and chi-square tests determined statistical significance at p<0.05.

Results

12,312 patients were racially identified as White, 1,793 were Black, and 1,777 were of other races. On average, Black patients presented at a younger median age and were less likely to have elective admissions compared to White patients. A significant racial difference was observed in hospital location based on the census division (p<.001). Black patients had shorter hospital length of stay (p<.001). Chi-square analysis highlighted differences in the expected primary payer (p<.001) and urban-rural patient location (p<.001), indicating disparities in healthcare access and socioeconomic status. No significant difference in in-hospital mortality between racial groups was observed (p=.228).

Conclusions

Breast cancer patients with concurrent MDD encounter notable clinical and economic difficulties. Black patients typically experience more disadvantages in terms of admission metrics, reflecting significant racial disparities. Community-based research initiatives are necessary to address the root causes of these disparities and inform effective interventions for Black populations.

Purpose

The burden of chronic pain continues to present a dichotomy of immeasurable and measurable impacts on functional status and quality of life. Racial disparities in the recognition and management of chronic pain have been widely demonstrated in literature. On average, black patients with chronic pain present with higher pain scores than white patients, though they are less likely to be prescribed opioids, fill opioid prescriptions, and take opioids when prescriptions are filled. A large retrospective cohort study found that white patients had a higher volume of opioid prescriptions written, while also having a greater risk of opioid use disorder, relative to racial/ethnic minority patients. Additionally, nonsteroidal anti-inflammatory drugs, often used to treat chronic pain, are often contraindicated in black patients.

Methods

We performed a single-center, cross-sectional study of patients who experience chronic pain and have been prescribed opioids for at least 90 days. Patients were asked a series of questions related to their chronic pain and asked to compare their lived experiences before management with opioids to after management with opioids.

Results

Data suggest there was an overall improvement in quality of life amongst all patients. However, greater improvement in quality of life, based on composite scores, was noted in black patients compared to white patients who were prescribed opioids.

Conclusion

With the recent increased focus and attention on mental health in minority communities, more research is needed to determine the impact of untreated or undertreated chronic pain on depression, anxiety and overall quality of life in minority patients.

Objectives/ Purpose

Over the decade social media usage has drastically increased and so is the pressure to have an ideal thin body. In the pursuit of an ideal body, many individuals especially teenagers and young adults develop an eating pathology. This study's main aim was to investigate the impact of social media on the development of Anorexia nervosa in medical students of Karachi and analyze the factors that increase the risk of development of Anorexia nervosa in them

Methods

A cross sectional study was conducted from December 2021 to February 2022 in Karachi. The study population comprised of 214 undergraduate MBBS students from Karachi, aged 18-24 years. Data was collected through an online questionnaire sent in the form of a Google form.

Results

The mean age of the participants was 20.48 ± 1.5 years. Female participation was more than male participation (179; 83.6% Vs. 35; 16.4%). Female participants were more prone to the development of Anorexia nervosa with a higher percentage of positive SCOFF scores (83%) as compared to the male participants, who had a lesser percentage of positive SCOFF scores (16%). Increased frequency of usage of social media increased the risk of development of Anorexia nervosa. The study findings also suggested a statistically significant relationship between increased usage of Instagram and development of Anorexia nervosa in the sample population.

Conclusions

In light of the above-listed results it was found that increased use of social media inculcates a drive for thinness among the consumers making them more vulnerable to eating pathologies like Anorexia nervosa. However further investigation is necessary in other sections of the society to reach a more concrete conclusion.

Purpose

The COVID-19 pandemic transformed medical education in the US, prompting medical residency programs to increasingly rely on online platforms for interviews and engagement. This study investigates social media usage by Ophthalmology residency programs, focusing on Twitter, Facebook, and Instagram, to understand the types of posts and preferred platforms. Our aim is to provide Ophthalmology applicants with insights into prospective programs beyond traditional interviews.

Method

We identified Ophthalmology residency program accounts on Twitter, Facebook, and Instagram using the Accreditation Council for Graduate Medical Education (ACGME) database as of January 2024. We categorized posts into 5 categories: education, research, residency, resident lifestyle, or other/general, and compared social media usage by the Top 10 Residency Rankings by Doximity.

Results

Among 124 accredited programs, Instagram was the most used (84), followed by Twitter (51) and Facebook (42). Twitter had the most educational (1672) and research (1170) posts, while Instagram had more residency-specific (566) and lifestyle (1010) posts. Lastly, Facebook had the most other/general posts (1577). Top 10 Residency programs were most active on Twitter, with the most posts (35099) and followers (50746).

Conclusion

This study highlights the evolving social media landscape in Ophthalmology residency programs, with Twitter favored for research and academic content, and Instagram for residency and lifestyle posts. It provides applicants with valuable information beyond traditional interviews, facilitating connections with programs. Effective social media utilization can enhance transparency and engagement within Ophthalmology residency education.

Purpose

AMD degrades reading vision in aged persons worldwide. Hyper-transmission defects (HTDs) on optical coherence tomography (OCT), a structural clinical imaging biomarker for AMD progression, represents loss of shadowing by degenerating retinal pigment epithelium (RPE). We sought HTDs in individuals with normal eyes, early AMD (eAMD), and intermediate AMD (iAMD).

Methods

One eye of each participant in the baseline visit of the Alabama Study on Early Age-Related Macular Degeneration 2 (ALSTAR2) was analyzed. AMD presence and severity was determined using standardized color fundus photography. Participants underwent volume OCT angiography imaging. HTDs were defined in en face scans by hyper-intensity of signal in the choroid, confirmed on B-scans by the presence of RPE disruption, and measured by fitting circles.

Results

In 460 eyes of 460 participants (normal N=236, eAMD N=134, iAMD N=90), HTDs were detected in 134. Prevalence of any HTD (minimum diameter ≥62 μm) was higher in eyes with iAMD (86.7%, N=78) and eAMD (35.1%, N=47) compared to normal eyes (3.8%, N=9). Prevalence of HTD ≥250 μm was higher in eyes with iAMD (13.3%, N=12) and eAMD (5.2%, N=7) compared to normal eyes (0.4%, N=1).

Conclusions

More and larger HTDs are found in later stages of AMD. Degeneration of the RPE layer leads to HTDs and can be quickly identified on face OCTA scans. Persistent HTDs are markers for geography atrophy, an AMD end-stage (PMID 36958537). The prognostic significance of HTD identified at early stages of AMD will be clarified by imaging of the same participants at 3-year follow-up.

Introduction

DENGUE is one of the most frequent communicable diseases in rainy season. Along with enteric fever this year patients frequently affected by this disease which was worsen in some cases. Though DENGUE associated enteric fever is not so much common, it's management by Tab AZITHROMYCIN bring an effective outcome with reduced hospital admission.

Methods

68(age interval 24-59(+-2years) patients with history of fever who came in emergency & OPD (outdoor patient department)participated in this cross sectional study. 39 of them diagnosed DENGUE associated enteric fever based on relevant investigations like blood culture sensitivity, DENGUE NS1 and DENGUE IgM & IgG. 2

Results

6 patients comparatively feel better who refused hospital admission and seek for oral medications although having high WBC (White blood cells) counts in their CBC reports.3 of them (11.53%) were excluded for irrational drugs abuse .Rest of 23 patients (88.46%) had history of maintaining rational antibiotics . 15 patients came for follow up within 3 weeks specially for further CBC reviewing although they are mostly asymptomatic comparing with previous state. CBC reports of 12 patients indicate decrease WBC count(ranging 7000-9500 / mm^3) whose previous WBC range 11,000- 14000/mm^3 of blood. 3 patients have found constant leukocytosis though it is overlooked(p<0.05).

Conclusion

DENGUE associated enteric fever can be managed under home observation by rational AZITHROMYCIN uses which can bring a new era in clinical field of Bangladesh. But it should be monitored with rational antibiotic use.