Assessing Medical Students' Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study.

BACKGROUND: Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals' knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician's knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum. METHODS: Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis. RESULTS: 158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm. CONCLUSION: Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students' education of the Deaf culture and community.

Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?

BACKGROUND: Metal-on-metal (MoM) total hip arthroplasties (THAs) and the head-neck and neck-body junctions in modular THA are associated with a variety of local and systemic reactions to their related wear and corrosion products. Although laboratory testing is available, the relationship between laboratory values--including serum metal ion levels--and adverse local tissue reactions (ALTRs) remains controversial and incompletely characterized. QUESTIONS/PURPOSES: (1) What is the range of serum metal levels associated with ALTR in patients who have MoM THAs or corrosion at the head-neck and neck-body junctions in metal-on-polyethylene (or ceramic-on-polyethylene) THAs? (2) How much wear occurs in patients with MoM total hips? (3) Is there evidence of a dose-response relationship between wear and ALTR? METHODS: PubMed and Embase databases were reviewed for English-language studies assessing serum metal levels in the presence of ALTR and papers describing the results of wear measurements from revised MoM implants and ALTR histopathology were systematically reviewed. Reported linear wear data were separated into groups with ALTR and without ALTR as listed in individual papers and graphed to determine whether a dose-response relationship was present between wear and ALTR. Overall, 15 studies including 338 hips with ALTR with corresponding serum metal levels were identified and analyzed. Twelve studies reported the wear depth or volume of MoM components from patients with a variety of local reactions. Two studies investigated corrosion at the head-neck and neck-body junctions in metal-on-polyethylene THA. There was a high level of variability and study heterogeneity, and so data pooling (meta-analysis) could not be performed. RESULTS: Average reported metal concentrations were elevated above established normal values in patients with ALTR (cobalt concentrations ranged from 5 to 40 ppb, and chromium levels ranged from 5 to 54 ppb). Whereas several studies demonstrated that patients with ALTR had higher average linear wear of the bearing surfaces, this finding was not made in all studies that we identified in this systematic review. Because of this high degree of variability, no clear dose-response relationship between wear and ALTR could be established. CONCLUSIONS: Serum metal level analysis and implant retrieval analysis both contribute to the understanding of ALTR. Serum metal levels generally are elevated in the presence of ALTR but should not be used in isolation for clinical decision-making. Many but not all patients with ALTR, including those with pseudotumors, demonstrate high wear, but more data and more systematic descriptions of the histopathology are needed to define the amount of wear that induces adverse reactions.