Exploring the Impact of Gender Bias Among Medical Trainees.

Introduction: Research has suggested that health care providers are not immune to implicit and explicit gender bias among their own colleagues and in the treatment of patients. To date, limited research examines gender bias in trainees and how that bias might intersect with patient care. Our study focused on gendered expectations, perceived competence of medical providers, and perceived acceptability of patients who advocate for themselves. Methods: We used a 2x2x2x2 mixed design to examine the impact of participant gender, type of physical exam (vaginal vs elbow), trainee status, and gender of vignette physician. Participants read and responded to vignettes depicting various standardized clinical scenarios. The complete sample included 342 participants from a rural medical teaching hospital and a private liberal arts college in the same geographic region. Results: Findings suggested a significant interaction between physicality and gender of the participant on perceived competence. Conclusions: Although males and females had similar ratings of competence on an exam with low physicality (elbow), the data suggested that males did not recognize how errors during clinical practice may impact a hypothetical female patient. Future research might examine interventions that aim to increase awareness of gender bias among medical trainees and to explore whether interventions might improve patient care and perceptions of competence following identified errors.

Bystander Responses to Bullying and Harassment in Medical Education.

Background and Objectives: Bullying and harassment in medical education are common. The aims of this study were (a) to describe how medical trainees respond to harassment or bullying in medical settings, and (b) to determine whether trainees respond differently based on the type of harassment. Methods: Participants were medical students, residents, and fellows (N=80) recruited from a rural teaching hospital in Pennsylvania. We invited them to complete an electronic survey and react to four standardized situations that included common harassment types in graduate medical education. Results: On average, 31.6% reported that they would consult with peer colleagues, 50.6% would provide direct support to the victim, 16.3% would approach the perpetrator or intervene directly, and 19.3% would file a formal report with a supervisor or human resources. Findings indicated that respondents as bystanders would intervene significantly more often when harassment was related to inappropriate racial or ethnic comments. Conclusions: Given that a sizable portion of trainees would speak directly with a victim, training bystanders in strategies to address or mentor others on how to address harassment more effectively could be useful in graduate medical education. Future research might explore trainees' differential reactions to harassment types toward developing more comprehensive intervention programs in graduate and undergraduate medical education.

Vaccine hesitancy among college students and individuals seeking healthcare: A social norms perspective.

OBJECTIVE: Health behavior research suggests that perceived social norms impact health decisions. This study aimed to (a) examine reasons for vaccine hesitancy among a sample of college students compared to a clinical sample (b) examine the accuracy of perceptions of others' receptivity and intention to seek out the COVID-19 vaccine, and (c) determine whether greater self-other normative discrepancies (SODs) were associated with increased likelihood to seek out the COVID-19 vaccine. PARTICIPANTS: Participants included 227 students at a Northeastern private college and 140 patients seeking medical care. METHODS: College students completed an online, anonymous survey. Patients completed a paper-and-pencil survey distributed at appointment check-in. RESULTS: Compared to their perceptions of others, participants had more positive beliefs about vaccines. The most common reason prompting individuals to seek out the vaccine was to return to "normal life." CONCLUSIONS: Future research might examine use of social norms interventions to decrease vaccine hesitancy.

A scoping review to map the evidence of physical activity interventions in post-treatment adolescent and young adult cancer survivors.

PURPOSE: This scoping review describes and synthesizes previously reported data to document physical activity (PA) interventions in adolescents and young adult (AYA) cancer survivors and to explore whether PA interventions tested to date improve survivors' health outcomes. METHODS: A search of the literature was conducted in PubMed, CINAHL, EMBASE, Web of Science and Cochrane Library following the PRISMA-ScR statement. We included all original studies (n = 8) investigating PA interventions in AYA cancer survivors. RESULTS: This review showed that PA interventions were feasible and acceptable in AYA cancer survivors. PA interventions were individualized and mainly aerobic in nature. Studies examining the effects of PA interventions on survivors' health evaluated physical and mental health outcomes. CONCLUSIONS: Our scoping review maps the current evidence of PA interventions and highlights the paucity of data in this area of investigation, obviating how much work remains to be done to demonstrate the potential benefits of PA on AYA cancer survivors' health outcomes.

Returning to Sport: Female Athletes Living with and beyond Cancer.

Many athletes living with and beyond cancer can continue to train and, in some cases, compete during treatment. Following cancer treatment, athletes can return to competitive sport but need to learn to adapt their physical strength and training to the lingering effects of cancer. It is critical for oncology healthcare providers to use the principles of assess, refer and advise to exercise oncology programs that are appropriate for the individual. Managing side effects of treatment is key to being able to train during and immediately following cancer treatment. Keen attention to fatigue is important at any point in the cancer spectrum to avoid overtraining and optimize the effects of training. Resources are introduced for providers to reference and direct patients to information for psychosocial support and instruction. The purpose of this paper is to present exercise considerations during and after cancer treatment for athletic cancer survivors.

Vanderbilt Health Affiliated Network Statin Outreach Service.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes the design and implementation of a pharmacist-led program to improve rates of statin use among appropriate patients in high-risk populations.

Addressing Mental Health Concerns in Primary Care: Practices Among Medical Residents in a Rural Setting.

Behavioral health issues like anxiety and depression negatively impact numerous aspects of primary care, including medical regimen adherence, communication, physical well-being, and engagement in beneficial health behaviors. This study aimed to examine internal and family medicine residents': (1) patterns of addressing mental health concerns (e.g., frequency of referral for psychotherapy and/or medication), (2) self-perceptions of competency in assessment and treatment of specific mental health disorders, and (3) frequency of utilization of efficacious therapeutic strategies during clinical encounters. Self-report surveys were administered to Family Medicine and Internal Medicine residents (N = 39). Descriptive analyses indicated that 81% of the time, residents discussed mental health concerns when it was the presenting concern, and routinely offered medication and psychotherapy (71% and 68% of the time, respectively). Residents felt most competent in addressing major depressive disorder and generalized anxiety disorder, and least competent in addressing somatization disorder and bipolar disorder. Residents reported that they most often used motivational interviewing (MI), followed by Cognitive Behavioral Therapy, psychoeducation, and solution-focused strategies during medical encounters. These findings highlight a need to identify barriers to addressing mental health conditions in primary care and potential gaps in training that might address low levels of perceived competency among medical residents.

Changes in intestinal microbiota and their effects on allogeneic stem cell transplantation.

The human intestinal microbiota is essential for microbial homeostasis, regulation of metabolism, and intestinal immune tolerance. Rapidly evolving understanding of the importance of the microbiota implicates changes in the composition and function of intestinal microbial communities in an assortment of systemic conditions. Complications following allogeneic stem cell transplant now join the ever-expanding list of pathologic states regulated by intestinal microbiota. Dysbiosis, or disruption of the normal ecology of this microbiome, has been directly implicated in the pathogenesis of entities such as Clostridium difficile infections, graft-versus-host disease (GVHD), and most recently disease relapse, all of which are major causes of morbidity and mortality in patients undergoing allogeneic stem cell transplant. In this review, we elucidate the key origins of microbiotic alterations and discuss how dysbiosis influences complications following allogeneic stem cell transplant. Our emerging understanding of the importance of a balanced and diverse intestinal microbiota is prompting investigation into the appropriate treatment of dysbiosis, reliable and early detection of such, and ultimately its prevention in patients to improve the outcome following allogeneic hematopoietic stem cell transplant.

Smartphone Use and Professional Communication Among Medical Residents in Primary Care.

INTRODUCTION: The rapid integration and evolution of technology has impacted remote data access, dissemination of medical information, and use of applications (apps) for patient care and treatment. The aims of this study were to (1) describe patterns of smartphone use by residents in a rural clinical setting (both clinical and communicative patterns), (2) examine residents' perceptions of benefits of smartphone use, and (3) determine whether there is an association between smartphone use and organizational attributes. METHODS: Self-report surveys were administered to family medicine and internal medicine residents (N=39). RESULTS: Descriptive analyses indicated that primary care residents used their pagers more often for communication, but also believed smartphones were more efficient, and increased accessibility and timeliness of attending physicians. Additional analyses suggested that smartphone use was not associated with chaos, and was negatively correlated with history of culture change within the organization. CONCLUSION: Overall, use of smartphones among medical residents is relatively common, and residents believe there are numerous benefits of use. Future research might consider causal reasons why there is reduced communication among primary care practices with a history of change.

Day 14 bone marrow examination in the management of acute myeloid leukemia.

The National Comprehensive Cancer Network (NCCN) recommends that a repeat bone marrow evaluation is carried out seven to ten days following completion of induction therapy so that if a patient's day 14 bone marrow shows residual blast cell counts of >10%, the patient would proceed early to a second cycle of induction therapy. Although blast cell counts of <5% on day 14 bone marrow is sensitive in predicting remission on day 28, various studies have found that day 14 bone marrow is highly nonspecific because a large proportion of patients with blast cell counts of >5% on day 14 bone marrow would still attain a complete remission of the disease without any further chemotherapy. Clinical decision based on day 14 bone marrow will result in some of these patients being given a second induction therapy unnecessarily. A second cycle of chemotherapy is associated with not only higher risk for treatment-related mortality but also increased use of hospital resources such as increased intravenous antimicrobials use, longer hospital stay, and higher demand for blood products. In this article, we examined the utility, discussed the shortfalls, and re-appraised the values of day 14 bone marrow in the management of patients with AML. On the basis of our review, we suggest that the practice of day 14 bone marrow examination should be re-evaluated and should probably only be carried out in the setting of clinical trials with clear questions to address its role in predicting outcome of the therapeutic intervention.

The multi-faceted potential of CD38 antibody targeting in multiple myeloma.

CD38, an adenine dinucleotide phosphate (ADP) ribose cyclase and a cyclic ADP ribose hydrolase, is widely expressed on the surface of multiple myeloma (MM) cells. It is known to play a pivotal role in the downstream pathways that mediate MM cell growth, signal transduction, and adhesion. The clinical use of CD38 monoclonal antibodies (MoAbs), such as daratumumab, either as monotherapy or in combination with other anti-MM agents, has produced impressive results in patients who have failed standard MM therapy. CD38 MoAbs exhibit several cytotoxic mechanisms on MM cells. In addition to the classical effector mechanisms associated with antibody therapy, CD38 MoAbs induce MM apoptosis and clonal T-cell expansion. Here, we summarize the results of some pivotal clinical studies using a human CD38 MoAb, daratumumab, in patients with MM, discuss the anti-MM effector mechanisms induced by CD38 MoAbs, and review the potential tumor antigens that may be suitable targets for immunotherapy of MM. Finally, we present a paradigm of immunotherapy for MM patients using CD38 MoAbs followed by GM-CSF and an immune checkpoint inhibitor in patients who have undergone high dose chemotherapy and autologous stem cell transplant. CD38 MoAbs have emerged as a novel and ultimately very promising immunotherapeutic agent for MM because of its ability to induce MM cytotoxicity through both arms of the adaptive immune responses.

High Prevalence of Obesity and High Blood Pressure in Urban Student-Athletes.

OBJECTIVES: To assess the prevalence of obesity and hypertension-level blood pressures in an urban, athletic adolescent population using preparticipation physical evaluation (PPE) data. STUDY DESIGN: The Athlete Health Organization provides free preparticipation physical evaluations to Philadelphia student-athletes via an annual mass-screening event. From 2009 to 2012, Athlete Health Organization personnel performed PPEs on more than 2700 middle school and high school athletes. The PPE included biometric information, a history, and a physical examination. Medical volunteers measured blood pressures using a manual blood pressure cuff with an aneroid manometer. The data from each PPE were collected and analyzed for prevalence of obesity, overweight, and hypertension-level blood pressure readings. RESULTS: A large percentage of student-athletes were found to be overweight (20%) or obese (24.0%). Many of these athletes also had stage 1 or 2 level blood pressure readings (14.8%), a finding which strongly correlated with elevated body mass index (P < .00001). CONCLUSIONS: The cardiovascular health of this urban adolescent athletic population is a major concern because their rates of obesity and elevated blood pressure place them at increased risk of cardiovascular complications later in life despite their participation in school athletics.

Here, There and Nowhere: Following Adult Survivors of Childhood Cancer A Case Report of Recurrent Osteosarcoma in a Young Adult.

Approximately 1 in 285 children in the United States (US) will be diagnosed with cancer before the age of 20.1 More than 80% of children diagnosed with cancer will become long-term survivors.2 As of January, 2010, there are more than 380,000 adult survivors of childhood cancer in the US.3 More than two-thirds of survivors will develop chronic conditions.4 Professional organizations have advocated for specialized risk-based care of survivors.5 Locally and nationally, lack of transition services and insurance coverage are barriers to care of these adult survivors.6 We describe one such case to illustrate these challenges and their impact. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

Transitions to Adult Care for Rhode Island Youth with Special Healthcare Needs.

The transitioning of youth from pediatric to adult care systems is often fraught with discontinuity, miscommunication and gaps in care. This is most significant for youth with special health care needs. A panel discussion on transitioning youth to adult care systems that was part of a learning collaborative held by The RI Care Transformation Collaborative (CTC) is presented here, illustrated by a pertinent case of a youth with type 1 diabetes. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

The Emerging Issue of Digital Empathy.

Empathy can have strong positive effects on patient outcomes, increase patient satisfaction, and reduce malpractice litigation. With modern advances in technology, however, the appropriate expression of empathy in today's age is being threatened, largely as a result of psychological processes that form online disinhibition. The digitization of health care and the corresponding decrease in the expression of empathy may be cause for concern. Because empathy is strongly correlated to positive health outcomes and is an important part of health professions in general, the construct of digital empathy should be considered for integration into health professions curricula.

Cell Phone-Related Near Accidents Among Young Drivers: Associations With Mindfulness.

Cell phone use while driving (CPWD) has been shown to significantly reduce driver safety. This is a particular concern among young drivers who possess less driving experience and tend to engage in high rates of cell phone use. The present study identified psychological predictors of near accidents related to CPWD among a sample of 385 college student drivers. Participants answered a series of questions regarding their use of a cell phone while driving and completed measures of mindfulness, polychronicity, and intrusive thinking. Students who reported talking on their phone or texting more frequently while driving reported a higher incidence of near accidents related to each behavior. However, after controlling for CPWD, multiple regression analysis indicated that those who reported experiencing more cell phone-related intrusive thoughts also experienced more near accidents. Furthermore, two facets of mindfulness--acting with awareness and nonjudging of inner experience--were negatively associated with near accidents. These findings suggest that individuals who are more aware of the present moment and accepting of their affective responses may better regulate their attention while using a cell phone behind the wheel.

Aging and random task switching: the role of endogenous versus exogenous task selection.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Task switching research typically emphasizes two robust shifting effects between competing tasks: mixing costs (MCs), which indicate less efficient performance in mixed-task versus single-task conditions, and switch costs (SCs), which reflect differences between switch trials and repetition trials within mixed-task conditions. The current study examined age-related MC and SC influenced by the method of task selection in two procedures. METHODS: Twenty-six young adults, 18 to 21 years of age (M = 18.4, SD = 1.1), and 25 older adults, 74 to 87 years of age (M = 80.3, SD = 5.4), participated as part of the Cognition, Health, and Aging Project (CHAP). Younger and older adults' performed cued and voluntary task switching, requiring a random sequence of task changes, placing demands on externally versus internally directed processes. RESULTS: Results indicated that SCs were not disproportionately larger for older adults during an exogenous switching condition, but large age differences in MCs were present beyond the degree predicted by differences in baseline speed. In an endogenous switching condition, small age differences were present both for MCs and SCs, although further age differences were evident in older adults' reduced switch rates. CONCLUSION: These findings suggest that older adults are substantially slower at updating repeated task sets during exogenous switching, but partially counter these effects by adopting a more persistent within-set mode of processing during endogenous switching.

3-trifluoromethyl-4-nitro-5-arylpyrazoles are novel K(ATP) channel agonists.

This communication describes the discovery and synthesis of a series of 3-trifluoromethyl-4-nitro-5-arylpyrazoles as potent K(ATP) channel agonists. The most potent compound reported is ca. 100-fold more potent than diazoxide and exhibits selectivity for the SUR1 K(ATP) channel subtype. The 4-nitro substitutent on the pyrazole ring was required for activity, and limited SAR suggests that the de-protonated pyrazole maybe the active species.

Synthesis and evaluation of 7-substituted-3-cyclobutylamino-4H-1,2,4-benzothiadiazine-1,1-dioxide derivatives as K(ATP) channel agonists.

A series of 7-substituted-3-cyclobutylamino-4H-1,2,4-benzothiadiazine-1,1-dioxide derivatives has been synthesized and evaluated as K(ATP) channel agonists using the inside-out excised patch clamp technique. The most active compounds were approximately 20-fold more potent than diazoxide in opening K(ATP) channels. A linear relationship exists between the potency of the compound and the sigma value of the 7-substituent with electron-withdrawing groups exhibiting higher activity. These compounds may be useful in modulating insulin release from pancreatic beta-cells and in diseases associated with hyperinsulinemia.