Objectives: Food insecurity has been rising in the United States, disproportionally affecting populations with no insurance, low socioeconomic status, and racial minorities. It is associated with overall poorer health, especially in terms of glycemic control, mental health, and cardiovascular disease. Addressing it is critical because although studies show its significance, most physicians do not screen for different social determinants of health, including food insecurity.
Methods: A cross-sectional study of household food security status was performed on 209 patients from June to August 2021 at the University of Florida's Springhill Clinic (run by Internal Medicine) and the Equal Access Clinic, a student-run free clinic. The US Department of Agriculture's Spanish and English versions of the Household Food Security Survey were used. The χ2 tests were used to determine whether the number of respondents in each food security category varied significantly by sex, age group, primary language, presence of children in the home, insurance status, and clinic site.
Results: Among the 209 participants, food insecurity was reported by 23.4% of patients. The only statistically significant sociodemographic factors that corresponded to food security status levels were the patient's insurance status and clinic site. A total of 82.6% of insured patients were food secure, whereas only 65.2% of uninsured patients were food secure. A total of 14.5% of Equal Access Clinic patients experience severe food insecurity, whereas 0% of patients at the Springhill Clinic do. The χ2 tests determined that the number of respondents in each food security category varied significantly by insurance status (P = 0.01).
Conclusions: This study highlights the prevalence of food insecurity at primary care clinics, especially student-run clinics. Although limited by sample size and cultural barriers of the given survey, the findings emphasize the gap in standardized screening protocols for food security and the importance of physician sensitivity. Addressing this topic can improve food security and the health benefits that follow through early intervention.
Objectives: The Rio Grande Valley (RGV) is a developing clinical research region characterized by its distinctive demographic profile that offers an opportunity to investigate diverse health issues. This pilot investigation sought to evaluate the demographic and clinical characteristics linked to bone metastases and primary malignant bone neoplasms (PMBNs) in patients from the RGV and to compare the frequency of these conditions with the US general population.
Methods: This was a retrospective chart review in which data were gathered from the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018 to September 4, 2024. Various statistical analyses were performed to assess the demographic and clinical data.
Results: Individuals in the RGV are more likely to develop a PMBN (P < 0.0163) but less likely to have bone metastasis (P < 0.0015) compared with the general US population. Regarding bone metastases and PMBN, although not statistically significant, patients with bone metastasis were 10 years older on average and exhibited a lower body mass index (-1.7 kg/m2) and weight (-17.6 kg) than those with PMBN.
Conclusions: Our initial research indicates age and body weight variations among individuals with bone metastases and PMBN in the RGV, as well as differences in frequency of bone metastases and PMBN in this medically underserved region compared with the general US population. Despite the limited sample size, our results necessitate further exploration in a larger cohort to elucidate any demographic and clinical differences in bone metastases and PMBN subtypes in medically underserved areas.
Objectives: Recent literature suggests that hospitalization may lead to new-onset type 2 diabetes mellitus (NODM2). Understanding this relationship is crucial for developing interventions that could reduce long-term complications and healthcare costs associated with DM2 and major adverse cardiovascular events (MACE). This systematic review and meta-analysis aims to assess the incidence of NODM2 and MACE in patients after hospitalization.
Methods: With the assistance of the Mayo Clinic Libraries, we searched MEDLINE, Cochrane, and Scopus for medical literature reporting the incidence of NODM2 and the presence of MACE in hospitalized patients from database inception to March 2024. The systematic review and meta-analysis were performed according to the guidelines of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.
Results: Among the 168,673 patients from 25 studies, 7677 developed NODM2 after hospitalization (4.5%). The pooled incidence rate was 9.8% (95% confidence interval 5.5%-14.1%, P < 0.001). An exploratory analysis comparing patients' glycemic statuses showed a significantly increased risk of NODM2 development after hospitalization among patients with impaired glucose tolerance or stress hyperglycemia compared to normoglycemia group. Only one eligible study reported any MACE outcomes, and meta-analysis could not be performed to assess the effects of hospitalization on MACE.
Conclusions: This study highlights the high rate of NODM2 development after hospitalization. Growing evidence suggests that it may lead to long-term metabolic complications, particularly in patients who experienced dysglycemia during illness.
Objectives: Female sexual dysfunction (FSD) refers to problems with desire, arousal, orgasm, or pain, affecting approximately 12% of US women. Although FSD can be managed in primary care, most primary care clinicians do not regularly treat it. This survey of primary care clinicians practicing at a large US health system assessed perspectives on managing sexual dysfunction compared with other conditions, knowledge of prevalence of sexual dysfunction, and which specialty should be responsible for treating FSD.
Methods: We described the distribution of clinicians' survey responses. Of the 527 invited, 80 completed the survey (response rate: 15%). Most were women (68%), physicians (52%), and had >15 years of experience (43%).
Results: The majority (88%) reported treating FSD is as important as treating other conditions that affect quality of life. Two-thirds reported disorders of desire, arousal, and orgasm could be managed in primary care, and 64% believed that pain with intercourse, typically addressed by Obstetrics/Gynecology, should be handled in primary care. Most primary care clinicians believed that treating FSD was at least as important as treating other conditions, yet up to one-third believed this responsibility should be left to a different specialty.
Conclusions: Educational interventions targeting primary care clinicians may increase the number who take on FSD management.
Objectives: Hospital rounding practices have shifted away from being conducted at the patient's bedside to favor rounding in workrooms. Prior studies assessing learner attitudes toward bedside rounds largely focused on its educational value for residents, with less attention paid to medical students or other relevant domains in the learner experience. We sought to comprehensively capture resident and medical student perceptions of bedside rounds and their effects on various key domains, as well as elucidate common barriers to bedside rounding.
Methods: All residents and medical students who participated in teaching rounds in Internal Medicine at one large academic medical center in 2024 were invited to complete a voluntary anonymous survey. Participants also had the opportunity to partake in structured qualitative interviews, which were analyzed using a constructivist grounded theory approach to examine learners' perspectives on the impact of rounding setting on each of the key domains.
Results: Seventy-seven residents and 112 medical students completed the survey (response rates of 45% and 39%, respectively), and 18 interviews were conducted (10 residents and 8 medical students). Overall, both residents and medical students had a majority preference for either table or hybrid rounding over bedside rounding in nearly every domain.
Conclusions: Medical students overall identified more positive aspects of bedside rounding, particularly in regard to its potential to introduce opportunities for teaching or improved patient care. These findings may help institutions develop guidelines and faculty development practices for improving learner receptivity and engagement with bedside rounds.
Objectives: Racism is a public health crisis, and it is imperative that healthcare providers act to dismantle it. Although social determinants of health have been incorporated into graduate medical education, few longitudinal antiracism curricula exist. We evaluated a longitudinal antiracism curriculum for Internal Medicine (IM) residents, hypothesizing that participation would increase racism awareness and comfort with skills necessary to combat it.
Methods: We conducted four 1-hour antiracism educational didactic sessions and three 45-minute interactive small-group sessions for IM residents between 2021 and 2022. The curriculum was grounded in a governmentally commissioned regional racial inequality report. Curricular themes included structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Participants completed pre-postsurveys with two validated measures: the Antiracism Behavioral Inventory scale and the Color-Blind Racial Attitudes scale. We used McNemar or Wilcoxon signed rank tests to compare participants' pre-posttest scores.
Results: Eighty-three of 157 IM residents responded to the presurvey (response rate 53%) and 62 to the postsurvey (response rate 39%). Thirty-four residents representing postgraduate years 1-3 levels of training were eligible for response matching. We found statistically significant increases in awareness of racism/racial dynamics per overall Color-Blind Racial Attitudes scores (P < 0.001) and subcategories of racial privilege (P < 0.001) and blatant racial issues (P < 0.001). We also found an increase in individual advocacy (P = 0.008) per Anti-Racism Behavioral Inventory scores.
Conclusions: Our study indicates that this community-based longitudinal antiracism curriculum promotes increased racism awareness and antiracist behaviors across varying graduate medical education levels and may serve as a stepping stone for future antiracist curricula.
Objectives: Cardiac tumors affect fewer than 1 in 2000 people. This study is a retrospective review of diagnostic procedures, surgical management, and outcomes in patients treated for tumors of the heart at our institution. We compare our management approaches, clinical, and surgical outcomes with those reported in the literature.
Methods: The study population includes patients 7 to 79 years old who presented to our institution for tumors of the heart from July 2004 to January 2023. With institutional review board approval, subjects for this study were identified by searching the hospital's database on Current Procedural Terminology codes for tumors of the heart (benign neoplasm of the heart or malignant tumor). All of the data were stored on REDCap.
Results: There were 23 men and 29 women in the patient group. The average patient age was 54 years old. The most common presentation symptoms were dyspnea and fatigue. The most common diagnosis methods were transthoracic echocardiogram, transesophageal echocardiogram, cardiac magnetic resonance image, and computed tomography scan. Operative treatment was offered to 52 people; 47 had resection and 5 had biopsy only. The most common postoperative complication was respiratory insufficiency (22) and sepsis (2). Forty-eight patients were diagnosed as having a benign neoplasm of the heart and 4 diagnosed as having a malignant tumor. There were 49 primary tumors and three secondary tumors. The most common location of the tumor was the left atrium. The most common diagnosed cell type for the cardiac tumors was myxoma (61.5%). The average length of stay in the hospital was 12.5 days. Thirty-nine patients were discharged home in a stable condition. The study population had one operative mortality (death within 30 days after surgery). Forty-four of the 52 patients treated are alive after 2 years.
Conclusions: Data from this study strongly suggest that surgical removal is a viable and largely successful treatment approach for cardiac tumors. Clinical outcomes such as discharge status, postoperative condition, and length of survival after procedures are similar to those from other referral centers for such conditions. Complete resection was possible in 90% of our study cases; 85% of patients in this study surgically treated for cardiac tumors are alive after 2 years.
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