Humanism Rounds: A Multifaceted "Back to Bedside" Initiative to Improve Meaning at Work for Internal Medicine Residents.

Introduction: Burnout is an increasingly prevalent problem among resident physicians. To address this problem, the Accreditation Council on Graduate Medical Education (ACGME) created the Back to Bedside initiative, supporting resident-driven projects focused on increasing direct interactions with patients. In 2017, Baylor College of Medicine (BCM) Internal Medicine Residency received a Back to Bedside grant to develop and implement "Humanism Rounds," a multifaceted program which sought to promote personal connections between residents and patients and foster reflection about patients' non-clinical stories, with the hopes of reducing burnout and increasing residents' sense of meaning at work. Materials and Methods: Between 2018 and 2020, internal medicine residents were instructed on and encouraged to participate in Humanism Rounds. The program included three components: taking a "human history," bedside rounds focused on non-clinical concerns, and sharing patient stories with colleagues ("celebrations"). Residents were surveyed using institutional and ACGME surveys regarding burnout, meaning at work, and the clinical learning environment. Results: Three hundred eleven institutional (response rate, 74%) and 328 AGCME (response rate, 78%) surveys were completed and analyzed. Residents who actively engaged with Humanism Rounds reported more meaning and fulfillment at work (p < 0.001). During the period of this project, ratings of the learning environment and personal callousness improved among subgroups of residents. Conclusions: Baylor College of Medicine Internal Medicine residents who engaged with Humanism Rounds reported more meaning and fulfillment in their work. This program describes a low-cost model for other specialties and institutions to strengthen human connections and improve residents' experience during training. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-024-02017-9.

Complete genome sequences of cluster F1 and cluster B1 Mycobacterium smegmatis phages Karhdo and Basato.

We present the complete genome sequences of Mycobacterium smegmatis phages Karhdo and Basato, isolated in Clark County, Nevada. The phages were isolated and annotated by students enrolled in undergraduate research courses over two semesters at the University of Nevada, Las Vegas.

A Proof of Concept Study Demonstrating the Feasibility of a Text Message Prompt for Hepatitis C Testing in the 1945-1965 Birth Cohort.

Purpose Despite national recommendations stating all individuals in the 1945-1965 "birth cohort" be tested for hepatitis C virus (HCV), testing rates remain low. The purpose of this proof of concept study was to assess the feasibility of text messaging to promote HCV testing among birth cohort patients. Methods Participants were assigned to receive a text message to promote HCV testing, or a general health message as a control. Participants were sent the message immediately prior to an upcoming appointment. Patients not enrolled in the study were in the standard-of-care group. To assess the impact of the text on HCV test orders on the appointment date participant charts were reviewed. Results The sample was largely non-Hispanic, Caucasian, and female. Of participants sent the HCV message (n = 22), 50.0% had a test ordered, compared to 41.7% and 27.5% in the control (n = 13) and standard-of-care groups (n = 69), respectively. Conclusion This proof of concept study demonstrated the feasibility of text messaging to promote HCV testing among birth cohort patients. Those receiving the HCV message were more likely to have an HCV test ordered compared to those who received no message, although this difference was not statistically significant. A larger study is needed to confirm these results.

Mobile Phones May Not Bridge the Digital Divide: A Look at Mobile Phone Literacy in an Underserved Patient Population.

PURPOSE: Mobile health (mHealth) has promise to improve patient access to disease prevention and health promotion services; however, historically underserved populations may have poor access to mobile phones or may not be aware of or comfortable using phone features. Our objectives were to assess mobile phone ownership and mobile phone literacy among low-income, predominately racial and ethnic minority patients. MATERIALS AND METHODS: We conducted a cross-sectional survey of a convenience sample of primary care patients in a publicly-funded clinic in Houston, TX. RESULTS: Of 285 participants, 240 owned a mobile phone and 129 owned a smartphone. The most common uses of phones were talk (89%) and text messaging (65%). Only 28% of smartphone owners had health apps. Younger age was significantly associated with smartphone ownership and use of smartphones for Internet browsing, social media, and apps. CONCLUSION: Our findings from a safety-net patient population represent trends in mobile phone ownership and literacy. Despite the single-site location of our study, the findings could be helpful to health promotion practitioners working with similar underserved populations. mHealth interventions should employ phone features that are accessible and familiar to the target audience to avoid denying intervention benefits to those with low mobile phone literacy and therefore widen health disparities.

Bowel Perforation Resulting in Necrotizing Soft-Tissue Infection of the Abdomen, Flank, and Lower Extremities.

BACKGROUND: Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites. OBJECTIVE: To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia. METHODS: We describe a characteristic case and summarize findings from 67 reported cases. RESULTS: The causes of bowel injury included trauma (29%), perforated appendicitis (23%), perforated diverticulitis (16%), and perforation of a gastrointestinal tract cancer (16%). The symptomatic prodrome is indolent and nondescript. Most patients have polymicrobial infections and require antibiotic therapy combined with serial surgical debridements. Because the presentation differs from that of typical Fournier's gangrene, recognition of NSTI was delayed in the reported cases, and the associated bowel perforation often was overlooked, leading to delayed surgical treatment. As a result, the mortality rate was >33%, far exceeding that of typical Fournier's gangrene. Delays in diagnosis or surgical intervention predict a poor outcome. CONCLUSIONS: An NSTI resulting from bowel perforation can present in an atypical fashion carrying significant morbidity and mortality rates. Delayed diagnosis and treatment of this condition is associated with a poor outcome.

Morphological and dimensional characteristics of dental arch in children with beta thalassemia major.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the arch dimensions of beta thalassemia major patients in comparison with normal individuals. MATERIALS AND METHODS: Dental arch dimensions were compared between thalassemic patients and normal individuals in the age group of 12-16 years in the maxillary and mandibular arch corresponding to each other regarding age, sex and Angle's molar relationship. A total number of sixty cases in each group were taken. Maxillary and mandibular impressions were made with alginate for all the sixty participants in each group and poured with die stone. Measurement of inter incisor, inter canine, inter premolar and intermolar arch width, arch depth, right anterior, right posterior, left anterior, and left posterior arch length was carried out from each cast using digital Vernier caliper. RESULTS: Unpaired t-test was used for comparison between the two groups. Statistically, a significant difference was found between the case and control groups in the maxillary arch in intercanine width, inter premolar width, intermolar width, right anterior arch length, right posterior arch length, and left anterior arch length. However, no statistically significant difference was found between the groups in inter incisor width, left posterior arch length, and arch depth in the maxillary arch. In the mandibular arch, statistically significant difference was found between the case and control groups in inter canine width, inter premolar width, inter molar width, and left anterior arch length. However, no statistically significant difference was found between the case and control groups in the mandibular arch in interincisor width, right anterior arch length, right posterior arch length, and left posterior arch length. CONCLUSION: Dental arch widths and arch lengths were significantly reduced in thalassemic patients as compared to normal individuals for the maxillary and mandibular arches.

The Role of Text Messages in Patient-Physician Communication about the Influenza Vaccine.

BACKGROUND: Racial and ethnic minorities face disparities in receiving the influenza vaccination. A text message intervention could deliver personalized and timely messages to counsel patients on asking their physician for the vaccination. AIMS: We assessed whether patients would be receptive to influenza vaccination text messages. METHODS: Participants were recruited from a sample of low-income, racial and ethnic minority primary care patients. Participants completed a self-administered survey. Descriptive statistics were used to analyze the data. RESULTS: There were 274 patients who participated and answered the questions of interest, of whom 70% were racial and ethnic minorities and 85% owned a cell phone. Thirty-six percent reported they had never received an influenza vaccination recommendation from their physician. However, 84% would be comfortable asking their physician for the influenza vaccination. Of cell phone-owning participants who would be comfortable asking their physician about the influenza vaccination, 80% would also be comfortable receiving a text message reminder. CONCLUSION: Text messages may be an acceptable channel to prompt patients to discuss the annual influenza vaccination with their physicians. Text messaging is a feasible tool to engage patients in their health and improve annual influenza vaccination rates among low-income, racial and ethnic minority patients.

Pretesting mHealth: Implications for Campaigns among Underserved Patients.

BACKGROUND: For health campaigns, pretesting the channel of message delivery and process evaluation is important to eventual campaign effectiveness. We conducted a pilot study to pretest text messaging as a mHealth channel for traditionally underserved patients. AIMS: The primary objectives of the research were to assess 1) successful recruitment of these patients for a text message study and 2) whether recruited patients would engage in a process evaluation after receiving the text message. METHODS: Recruited patients were sent a text message and then called a few hours later to assess whether they had received, read, and remembered the sent text message. RESULTS: We approached twenty patients, of whom fifteen consented to participate. Of these consented participants, ten (67%) engaged in the process evaluation and eight (53%) were confirmed as receiving, reading, and remembering the text message. CONCLUSION: We found that traditionally underserved and under-researched patients can be recruited to participate in a text message study, and that recruited patients would engage in a process evaluation after receiving the text message.

Why Physicians Don't Ask: Interpersonal and Intrapersonal Barriers to HIV Testing-Making a Case for a Patient-Initiated Campaign.

In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons.

mHealth is an Innovative Approach to Address Health Literacy and Improve Patient-Physician Communication - An HIV Testing Exemplar.

Low health literacy is a barrier for many patients in the U.S. Patients with low health literacy have poor communication with their physicians, and thus face worse health outcomes. Several government agencies have highlighted strategies for improving and overcoming low health literacy. Mobile phone technology could be leveraged to implement these strategies to improve communication between patients and their physicians. Text messaging, in particular, is a simple and interactive platform that may be ideal for patients with low health literacy. We provide an exemplar for improving patient-physician communication and increasing HIV testing through a text message intervention.

Thyroid Disease Is Prevalent and Predicts Survival in Patients With Idiopathic Pulmonary Fibrosis.

BACKGROUND: A significant minority of patients with idiopathic pulmonary fibrosis (IPF) display features of autoimmunity without meeting the criteria for overt connective tissue disease. A link between IPF and other immune-mediated processes, such as hypothyroidism (HT), has not been reported. In this investigation, we aimed to determine whether HT is associated with IPF and if outcomes differ between patients with IPF with and without HT. METHODS: A retrospective case-control analysis was conducted. Of 311 patients referred to the University of Chicago Interstitial Lung Disease Center with an initial diagnosis of IPF, 196 met the inclusion criteria and were included in the final analysis. Each case was matched 1:1 by age, sex, and race to a control subject with COPD. RESULTS: HT was identified in 16.8% of cases and 7.1% of control subjects (OR, 2.7; 95% CI, 1.31-5.54; P = .01). Among patients with IPF, HT was associated with reduced survival time (P < .001) and was found to be an independent predictor of mortality in multivariable Cox regression analysis (hazard ratio, 2.12; 95% CI, 1.31-3.43; P = .002). A secondary analysis of two IPF clinical trial datasets supports these findings. CONCLUSIONS: HT is common among patients with IPF, with a higher prevalence than in those with COPD and the general population. The presence of HT also predicts mortality in IPF, a finding that may improve future prognostication models. More research is needed to determine the biologic link between IPF and HT and how the presence of thyroid disease may influence disease progression.

Mitigating HIV health disparities: the promise of mobile health for a patient-initiated solution.

The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient-physician communication, improve HIV testing, and increase use of mHealth.

Using text messages to improve patient-doctor communication among racial and ethnic minority adults: an innovative solution to increase influenza vaccinations.

Despite the 2010 CDC recommendation that all adults receive influenza vaccinations, in the 2013-2014 influenza season, only 35% of Blacks and 37% of Hispanics were vaccinated, compared to 40% of Whites. This disparity could be due to poor patient-doctor communication, among other barriers. Doctors provide more health information to active communicators; unfortunately, they perceive minority patients to be poor communicators. A novel way to prompt minority patients to better communicate with their doctors is through mHealth. Text messaging is a simple, low cost, mHealth platform widely-used among racial and ethnic minorities. A text message campaign could be effective in providing vaccine education and prompting patients to converse with their doctors about influenza vaccinations. Text prompts could improve patient communication, thus increasing their likelihood of vaccination. This campaign could accomplish Healthy People 2020 goals: increase influenza vaccination, improve patient-doctor communication, increase use of mHealth, and reduce health disparities.

The identification and characterization of breast cancer CTCs competent for brain metastasis.

Brain metastatic breast cancer (BMBC) is uniformly fatal and increasing in frequency. Despite its devastating outcome, mechanisms causing BMBC remain largely unknown. The mechanisms that implicate circulating tumor cells (CTCs) in metastatic disease, notably in BMBC, remain elusive. We characterize CTCs isolated from peripheral blood mononuclear cells of patients with breast cancer and also develop CTC lines from three of these patients. In epithelial cell adhesion molecule (EpCAM)-negative CTCs, we identified a potential signature of brain metastasis comprising "brain metastasis selected markers (BMSMs)" HER2+ / EGFR+ / HPSE+ / Notch1+. These CTCs, which are not captured by the CellSearch platform because of their EpCAM negativity, were analyzed for cell invasiveness and metastatic competency in vivo. CTC lines expressing the BMSM signature were highly invasive and capable of generating brain and lung metastases when xenografted in nude mice. Notably, increased brain metastatic capabilities, frequency, and quantitation were detected in EpCAM- CTCs overexpressing the BMSM signature. The presence of proteins of the BMSM CTC signature was also detected in the metastatic lesions of animals. Collectively, we provide evidence of isolation, characterization, and long-term culture of human breast cancer CTCs, leading to the description of a BMSM protein signature that is suggestive of CTC metastatic competency to the brain.

Case reports: periurethral bulking agents and presumed urethral diverticula.

Urethral bulking agents are a commonly employed modality utilized for treatment of female stress urinary incontinence. These primarily collagen-based agents are placed in the proximal urethra to facilitate mucosal coaptation during increases of intra-abdominal stress. Several known complications of these agents exist, including urethral prolapse, retention, and urinary infection. Herein, we report two cases diagnosed as urethral diverticuli which were ultimately determined anatomic aberration secondary to prior bulking agent therapy. Recognition of this potential sequela of bulking agent placement is important for the female pelvic surgeon to recognize to avoid the morbidity of potential invasive interventions.

Interventions aimed at decreasing obesity in children younger than 2 years: a systematic review.

OBJECTIVE: To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and references from relevant articles. STUDY SELECTION: Included were published studies that evaluated an intervention designed to prevent or reduce overweight or obesity in children younger than 2 years. DATA EXTRACTION: Extracted from eligible studies were measured outcomes, including changes in child weight status, dietary intake, and physical activity and parental attitudes and knowledge about nutrition. Studies were assessed for scientific quality using standard criteria, with an assigned quality score ranging from 0.00 to 2.00 (0.00-0.99 is poor, 1.00-1.49 is fair, and 1.50-2.00 is good). DATA SYNTHESIS: We retrieved 1557 citations; 38 articles were reviewed, and 12 articles representing 10 studies met study inclusion criteria. Eight studies used educational interventions to promote dietary behaviors, and 2 studies used a combination of nutrition education and physical activity. Study settings included home (n = 2), clinic (n = 3), classroom (n = 4), or a combination (n = 1). Intervention durations were generally less than 6 months and had modest success in affecting measures, such as dietary intake and parental attitudes and knowledge about nutrition. No intervention improved child weight status. Studies were of poor or fair quality (median quality score, 0.86; range, 0.28-1.43). CONCLUSIONS: Few published studies attempted to intervene among children younger than 2 years to prevent or reduce obesity. Limited evidence suggests that interventions may improve dietary intake and parental attitudes and knowledge about nutrition for children in this age group. For clinically important and sustainable effect, future research should focus on designing rigorous interventions that target young children and their families.

Parental understanding of infant health information: health literacy, numeracy, and the Parental Health Literacy Activities Test (PHLAT).

OBJECTIVE: To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT). METHODS: Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academic medical centers. Literacy and numeracy skills were assessed with previously validated instruments. Parental health literacy was assessed with the new 20-item PHLAT. Psychometric analyses were performed to assess item characteristics and to generate a shortened, 10-item version (PHLAT-10). RESULTS: A total of 182 caregivers were recruited. Although 99% had adequate literacy skills, only 17% had better than ninth-grade numeracy skills. Mean score on the PHLAT was 68% (standard deviation 18); for example, only 47% of caregivers could correctly describe how to mix infant formula from concentrate, and only 69% could interpret a digital thermometer to determine whether an infant had a fever. Higher performance on the PHLAT was significantly correlated (P < .001) with education, literacy skill, and numeracy level (r = 0.29, 0.38, and 0.55 respectively). Caregivers with higher PHLAT scores were also more likely to interpret age recommendations for cold medications correctly (odds ratio 1.6, 95% confidence interval 1.02, 2.6). Internal reliability on the PHLAT was good (Kuder-Richardson coefficient of reliability = 0.76). The PHLAT-10 also demonstrated good validity and reliability. CONCLUSIONS: Many parents do not understand common health information required to care for their infants. The PHLAT and PHLAT-10 have good reliability and validity and may be useful tools for identifying parents who need better communication of health-related instructions.