Understanding medical students' attitudes towards and experiences with persons with disabilities and disability education.

BACKGROUND: In the United States, approximately one quarter of individuals are living with disabilities and receiving healthcare services. The undergraduate medical school curriculum provides an opportunity to improve the attitudes and skills of physicians working with persons with disabilities (PWD). OBJECTIVE/HYPOTHESIS: The purpose of this study was to gain an understanding about fourth-year medical students' self-reported attitudes towards and experiences with PWD and disability education. We hypothesized that medical students would recall having education about disabilities, would be able to identify a pivotal disability education experience, and would report being less comfortable working with PWD than persons without disabilities. METHODS: This mixed methods observational study was conducted via an online survey distributed to medical students during Winter 2020/2021. It contained an adapted instrument and a few short answer questions. RESULTS: Our survey had 44 respondents, a 28% response rate. Though 98% of students reported receiving disability education during one or more courses, 80% felt their disability education during medical school has been inadequate. Additionally, 64% reported having an influential learning experience involving PWD. Despite their attitudes, education, and experiences, respondents reported feeling less comfortable obtaining a history, performing a physical exam, and establishing a differential diagnosis when working with PWD. CONCLUSIONS: This study highlights the need for continued development of disability curricula, which likely extends beyond the studied institution. Additional educational elements could be added to humanities sessions, as well as other courses and clerkships.

Serum Electrolyte Levels and Outcomes in Patients Hospitalized with Hepatic Encephalopathy.

INTRODUCTION AND AIMS: Serum electrolyte derangements are common in patients with decompensated cirrhosis hospitalized for hepatic encephalopathy. There are limited data describing the association between electrolyte levels and outcomes in hepatic encephalopathy. We assessed the association between initial serum electrolyte values and outcomes in patients with hepatic encephalopathy. MATERIAL AND METHODS: A total of 385 consecutive patients hospitalized with encephalopathy were included in the study. Baseline electrolyte levels (sodium, potassium, chloride, bicarbonate, calcium and phosphorus) were measured at the time of admission and assessed for association with outcomes, which included survival, admission to the intensive care unit, requirement for mechanical ventilation, and length of hospital stay. P-values ≤ 0.0083 were considered significant after adjustment for multiple testing. RESULTS: In unadjusted analysis, significant associations were identified regarding both bicarbonate and phosphorus (admission to intensive care unit), and calcium (mechanical ventilation); however these findings weakened and no longer approached statistical significance when adjusting for confounding variables. No other significant associations between serum electrolyte measurements and outcomes were observed. CONCLUSIONS: Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.