Journal of the National Medical Association最新文献

{"title":"Barriers and Strategies to Improve Colorectal Cancer Screening: Insights from a National Survey of African American Clinicians","authors":"Anushka Deogaonkar ,&nbsp;Chanda Nicole Holsey ,&nbsp;Camille Clare ,&nbsp;Angela Mosley-Nunnery ,&nbsp;Marie L. Borum","doi":"10.1016/j.jnma.2025.11.001","DOIUrl":"10.1016/j.jnma.2025.11.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States, with African Americans experiencing disproportionately higher incidence and worse outcomes. Despite modest gains following the Affordable Care Act, racial disparities in screening and follow-up persist. Few studies have centered the perspectives of African American clinicians, who are uniquely positioned to provide culturally concordant care and address structural barriers.</div></div><div><h3>Methods</h3><div>A cross-sectional electronic survey was administered to healthcare professionals attending the 2025 National Medical Association Annual Convention and Scientific Assembly in Chicago, IL. Eligible participants included physicians (MD/DO) and advanced practice practitioners (APPs) involved in adult patient care. The 23-item survey assessed clinician demographics, practice characteristics, CRC screening practices, patient education strategies, and perceived barriers. Responses were summarized using descriptive statistics, and open-text data were thematically categorized.</div></div><div><h3>Results</h3><div>A total of 141 clinicians (97.8% African American; 95.7% physicians) participated. Most respondents (82.1%) reported initiating CRC screening at age 45 in accordance with U.S. Preventive Services Task Force guidelines. Colonoscopy was the most commonly used modality (94.2%), with stool-based tests (86.2%) also widely implemented. Despite guideline adherence, only 30.4% estimated that &gt;75% of their patients were up to date with screening. Completion of follow-up colonoscopy after abnormal stool-based testing was reported as a major gap, with fewer than half of clinicians indicating that most patients completed diagnostic evaluation. Patient-level barriers included test preparation (68.1%), fear of diagnosis (63.8%), and fear of pain (62.3%). Systemic barriers included insurance status (51.9%), cost (44.4%), and limited specialty access (45.2%). While nearly all clinicians (97.7%) reported counseling patients directly, fewer used supplemental educational tools or communitybased outreach.</div></div><div><h3>Conclusions</h3><div>African American clinicians demonstrate high adherence to CRC screening guidelines but continue to face systemic and patient-level barriers that limit completion and follow-up. Racial concordance and cultural humility facilitate patient trust but are insufficient to overcome structural inequities. Findings highlight the need for multilevel strategies, including patient navigation, community outreach, EMR-based reminders, and insurance reform, to bridge the gap between guideline recommendations and real-world outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 96-102"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688890","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}

{"title":"Incidence and demographic patterns of neutropenia in clozapine-treated patients with schizophrenia: A 20-year retrospective cohort study","authors":"Sumaiya Ahmed ,&nbsp;Elizabeth Beyene ,&nbsp;Mekdem Bisrat ,&nbsp;Toyosi Falegan ,&nbsp;Aaron Hemphill ,&nbsp;Aaron Mack ,&nbsp;Rawan Elkomi ,&nbsp;Samrawit Zinabu ,&nbsp;Miriam Michael","doi":"10.1016/j.jnma.2025.11.010","DOIUrl":"10.1016/j.jnma.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS), yet its use is often limited by the risk of hematologic adverse effects, particularly neutropenia and agranulocytosis. These risks have led to strict monitoring requirements, contributing to underutilization despite strong evidence of clinical benefit. Real-world data on neutropenia incidence across demographic groups can inform risk-stratified monitoring and reduce unnecessary treatment interruptions.</div></div><div><h3>Objective</h3><div>To determine the incidence, prevalence, and demographic distribution of neutropenia in clozapine-treated patients with schizophrenia over a 20-year period using a large multicenter dataset.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using electronic health records from the TriNetX Research Network (2005–2025). Adult patients with schizophrenia receiving clozapine were identified. Neutropenia was defined by ICD-10-CM codes D70, D70.8, and D70.2. Incidence proportion, prevalence, and incidence rate (cases per million person-days) were calculated and stratified by age, sex, race, and ethnicity.</div></div><div><h3>Results</h3><div>Among clozapine-treated patients, the overall incidence proportion of neutropenia was 3.17 %, with an incidence rate of 8.6 cases per million person-days. The highest incidence occurred in patients aged ≥70 years, peaking at 76.9 % in the 75–79 age group. Rates were modest (2–4 %) among adults aged 20–64. Higher incidence was observed among Black or African American (4.6 %) and American Indian/Alaska Native patients (10.1 %), likely reflecting benign ethnic neutropenia.</div></div><div><h3>Conclusions</h3><div>Neutropenia is uncommon in most adult clozapine-treated patients, supporting the relative hematologic safety of broader use in TRS. Findings suggest that monitoring protocols could be revised to reflect actual risk, potentially improving clozapine access and reducing treatment disparities.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 149-155"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679846","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}

{"title":"The minority student open: Utilizing the informal mentoring approach to enhance racial representation in HIV care and research","authors":"Kenric Ware ,&nbsp;Aaron Austin ,&nbsp;Alftan Dyson ,&nbsp;Cleophas d’Auvergne ,&nbsp;Michelle Ogle ,&nbsp;Ada Stewart ,&nbsp;William King ,&nbsp;M. Keith Rawlings ,&nbsp;Leonard Sowah","doi":"10.1016/j.jnma.2025.11.012","DOIUrl":"10.1016/j.jnma.2025.11.012","url":null,"abstract":"<div><h3>Introduction</h3><div>The imbalance between those impacted by HIV and the HIV healthcare workforce may be one of the drivers of racial health disparities in the epidemic. To address this, the Academy Council for Racial Equity (ACRE), a committee of the American Academy of HIV Medicine, developed a program of engagement and informal mentorship for underrepresented racial, ethnic and gender minority (UREGM) students and trainees of the health professions. This pilot program was designed to increase interest in HIV related careers among these trainees.</div></div><div><h3>Methods</h3><div>The program was developed as a career pathways and development workshop with a specific focus on UREGM trainees and students and named the Minority Student Open (MSO). Breakout sessions were included within the workshop to provide skills and potential solutions to workplace challenges these trainees may face.</div></div><div><h3>Results</h3><div>One hundred and thirty-one trainees registered for the MSO. Only (47) 35.8 % of registered students attended the MSO. Among registered students 42 (89 %) provided adequate evaluable information at registration. Post event, one student and faculty mentor provided detailed feedback with recommendations. All received feedback was reviewed based on potential impact and feasibility. Key recommendation was to continue similar events with engagement of a broader diversity of faculty. To improve attendance the team could embed events within student targeted meetings</div></div><div><h3>Conclusion</h3><div>Based on the response from student attendees, committee members, and other stakeholders, student engagement events would be continued. The team will continually evaluate and adapt students centered events in response to engagement and feedback.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 156-163"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746232","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}

{"title":"Risk factors associated with professional consequences in a cohort of black physicians","authors":"Dotun Ogunyemi ,&nbsp;Hascal Humes ,&nbsp;Otis Zeon ,&nbsp;Emmanuel Richards ,&nbsp;Oluchi Nwankwo ,&nbsp;Eric Poole","doi":"10.1016/j.jnma.2025.11.009","DOIUrl":"10.1016/j.jnma.2025.11.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Physicians underrepresented in medicine are more harshly punished, receive less appropriate guidance/coaching, and experience more attrition than other physicians.</div></div><div><h3>Objective</h3><div>To determine factors in the clinical work and learning environment that are associated with black physicians who experience disciplinary actions, professional misconducts complaints and lower rank assumption.</div></div><div><h3>Methods</h3><div>Prospective survey study was sent to members of the National Medical Association in March to May 2023. The survey included: demographic factors; Professional consequences defined as those who had disciplinary actions, complaints of professional misconducts or lower rank assumption, workplace resources; perceived stress scale; sources of stress in professional and personal life; self-defined burnout; stereotype threat; perceived discrimination survey and psychological Safety. Statistical Analysis done and <em>p</em> &lt; 0.5 taken as significant.</div></div><div><h3>Results</h3><div>Of 176 respondents; professional consequences occurred in 79 (45 %) who were more likely to come from Western US region and were females. Those with professional consequences scored significantly higher on Stereotype threat (71% versus 31%, <em>P</em> &lt; 0.001), Stigmatization/devaluation (9% vs. 0%, <em>p</em> = 0.004), Exclusion rejection (41% vs. 4%, <em>p</em> &lt; 0.001) and Discrimination at work/school (28% vs. 1%, <em>p</em> &lt; 0.001) and significantly lower on psychological safety (32% vs. 56%, <em>P</em> = 0.001). They also scored significantly higher on burnout (66% vs 30%, <em>p</em> &lt; 0.001), high stress (89% vs 54%, <em>p</em> &lt; 0.001) and high work factors contributing to stress (24% vs 4%, <em>p</em> &lt; 0.001), but significantly lower on accessing institutional wellness resources (18% vs 40%, <em>p</em> &lt; 0.002), initiating back-up systems without negative consequences from supervisors(42% vs 69%, <em>p</em> &lt; 0.001), and without negative consequences from peers (41% vs 75 %, <em>p</em> &lt; 0.001)</div></div><div><h3>Conclusions</h3><div>Black physicians with professional consequences are more likely to be female, practice in Western US and perceive the clinical workplace as hostile and unsafe. These physicians are more burned out, stressed and unable to access institutional support resources. Early identification, coaching and scaffolding of these at-risk physicians and learners is urgently required.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 141-148"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759011","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}

{"title":"Practice and factors of early childhood developmental milestone assessment among health professionals at public health institution in Bahir Dar, Ethiopia","authors":"Dagnew Tigabu ,&nbsp;Tobianesh Ademasu ,&nbsp;Eden Amsalu ,&nbsp;Silenat Muluken ,&nbsp;Abraham Dessie Gessesse","doi":"10.1016/j.jnma.2025.10.002","DOIUrl":"10.1016/j.jnma.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Early childhood developmental assessment is a continuous process that involves observing, collecting, recording, and analyzing information about young children. This helps educators and health professionals evaluate the children's growth and development their instruction accordingly. However, there are limited standardized assessment tools that are widely adopted. The goal of this study was to explore how health professionals at public health institutions assess developmental milestones in early childhood</div></div><div><h3>Methods</h3><div>The study used an institution-based cross-sectional design. 356 study participants from public health facilities were selected by using a simple random sampling technique. Questionnaires and observational checklists were employed to evaluate the practice and related elements. An SPSS version 27 program was used to clean, code, and enter the data after it had been verified as consistent and complete. The binary logistic regression model was used to analyze bivariate and multivariable and the model fitness was checked. The p-value was &lt;0.05, indicating a significant association. Lastly, texts, tables, and graphs are used to present the results.</div></div><div><h3>Results</h3><div>Only 33.8 % of health professionals had good practice with early childhood developmental milestone assessment. Professions (Physicians and Health officers), training, standardized assessment tools available and supervision were factors that significantly related to good practices.</div></div><div><h3>Conclusion</h3><div>Assessment of the practice of developmental milestones assessment in early childhood was still done poorly. Standardized assessment tools available, training, supportive supervision, and the type of types of profession (physician or health officer) were all statistically significant determinants. As a result, providing health workers with training, carrying out ongoing supporting supervision, and making standardized assessment tools are crucial.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Pages 34-44"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411201","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}

{"title":"“Primary Primary Prevention” of sickle cell disease","authors":"Chase Rector,&nbsp;Richard Gillum","doi":"10.1016/j.jnma.2025.11.013","DOIUrl":"10.1016/j.jnma.2025.11.013","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 1","pages":"Page 18"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644373","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}

{"title":"More than pain: Speech, language, neurocognitive, and hearing issues among children with sickle cell disease","authors":"Candice J. Adams-Mitchell ,&nbsp;Charles Ellis","doi":"10.1016/j.jnma.2025.08.102","DOIUrl":"10.1016/j.jnma.2025.08.102","url":null,"abstract":"<div><h3>Importance</h3><div>Significant advancements have been made in the management of sickle cell disease (SCD); an inherited blood disorder most prevalent among African Americans. While chronic pain is a hallmark of SCD and has been the primary focus of treatment, contemporary literature highlights the potential presence of developmental issues related to speech, language, neurocognitive, and auditory abilities that are often overlooked in SCD management.</div></div><div><h3>Observations</h3><div>This paper explores the spectrum of communication-related challenges that specifically affect children with SCD and fall within the scope of practice for speech-language pathologists (SLPs) and audiologists (AUDs). We advocate for the consistent inclusion of assessments related to communication and hearing in the standard care of children with SCD and recommend that comprehensive evaluation practices incorporate both SLP and AUD evaluations.</div></div><div><h3>Conclusions and Relevance</h3><div>Speech, language, neurocognitive, and hearing difficulties are common among children with SCD. Effective management should include early developmental assessments and regular re-evaluations to address the range of communication issues that may emerge throughout early childhood and adolescence.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 438-442"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031528","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}

{"title":"The true cost of the white coat: How academic medicine’s definition of success silences authenticity and compounds trauma in medical training","authors":"Kennedy E. Musgrave","doi":"10.1016/j.jnma.2025.08.105","DOIUrl":"10.1016/j.jnma.2025.08.105","url":null,"abstract":"<div><div>The author examines the impact of academic medicine's rigid definition of success on the authenticity and well-being of medical students. Through a reflective analysis grounded in personal experience, the author highlights the discrepancy between institutional success metrics—such as perfect grades, prestigious publications, and competitive research grants—and the value of community advocacy, health equity work, and authentic expression. The narrative illustrates how success in medical education often adheres to an unspoken curriculum, promoting assimilation over inclusion and forcing students to choose between authenticity and conformity to advance in their careers. The author describes how this pressure to fit a narrow mold not only diminishes the value of diverse voices but also perpetuates trauma and moral injury among students striving to honor their communities and passions. The paper argues that academic medicine’s focus on traditional success benchmarks fails to recognize the transformative potential of work that challenges systemic inequities and promotes holistic healing. The author calls for a redefinition of success in medical education that values purpose-driven contributions, fosters true inclusion, and supports the mental and emotional health of future physicians. By redefining success to embrace authenticity and equity, the author suggests that academic medicine could create a more inclusive and resilient healthcare workforce- one where uplifting the diverse narratives of trainees ultimately amplifies the voices of the communities they serve. In doing so, medicine moves beyond assimilation toward true advocacy, ensuring that the healing of those in white coats translates into the healing of the patients they are called to serve- all communities.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 433-436"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017065","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}

{"title":"Determinants of HIV infection among children born to mothers on prevention of mother to child tranmission program in Addis Ababa, Ethiopia: Unmatched case control study","authors":"Zerihun Niguse Duruma ,&nbsp;Elias Teferi Bala ,&nbsp;Tufa Kolola Huluka ,&nbsp;Lencho Kajela Solbna","doi":"10.1016/j.jnma.2025.08.109","DOIUrl":"10.1016/j.jnma.2025.08.109","url":null,"abstract":"<div><h3>Background</h3><div>Despite the fact that Ethiopia is currently implementing mother-to-child transmission through the PMTCT program, existing evidences indicate that the number of children in Ethiopia who are HIV positive has increased. However, little research has been done in Ethiopia on the factors that increase the risk of HIV in women on antiretroviral treatment. Consequently, the aim of this research was to identify determinants of HIV infection in children whose mothers are participating in the PMTCT program.</div></div><div><h3>Methods</h3><div>An unmatched case-control study was conducted in Addis Ketema from April 5 to May 4, 2024, involving 157 children born to women on PMTCT whose HIV status was diagnosed at or before 24 months of pregnancy. The case-to-control ratio was 1:4. Data was gathered using structured questionnaires, loaded into Epidata version 3.1, and then exported to SPSS version 22.0 for analysis. Binary logistic regression was used to identify the factors linked to HIV infection at the 0.05 level of significance.</div><div>Unplanned pregnancy (AOR: 3.2; 95 % CI: 1.2, 4.2), poor ART adherence (AOR: 2.5; 95 % CI: 1.1, 3.6), lack of prenatal care (AOR: 3.5; 95 % CI: 1.2, 7.2), and WHO clinical stage &gt;II (AOR: 1.3; 95 % CI: 1.1, 3.1) were all found to be determinants of HIV infection.</div></div><div><h3>Conclusion</h3><div>Poor ART adherence, unplanned pregnancies, insufficient prenatal care, and advanced HIV stages were significant risk factors for HIV infection. Therefore, it is recommended to enhance ART medication adherence, prenatal care, and family planning use.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 490-498"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088681","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}

{"title":"Health care access and patient empowerment in kidney transplantation","authors":"Terry Everett ,&nbsp;Bryant Murphy ,&nbsp;Bryant Tran","doi":"10.1016/j.jnma.2025.08.111","DOIUrl":"10.1016/j.jnma.2025.08.111","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 6","pages":"Pages 360-363"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093367","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}