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.

Teaching during Consults: Effects of Multiple Educational Interventions on Satisfaction with Consultant Interactions among Internal Medicine Residents.

OBJECTIVE: To evaluate the effect of an educational intervention on Internal Medicine residents' satisfaction with the inpatient consultation process. METHODS: We hosted an optional workshop for Internal Medicine residents on placing and responding to consults using two memory aid tools. We then provided copies of these memory aids to residents on inpatient Medicine and Infectious Diseases teams, and later surveyed all of the residents who were finishing their inpatient Medicine rotation. Surveys assessed residents' participation in the workshop, receipt of the memory-aid tools, and satisfaction with Infectious Diseases consultation using a 5-point Likert scale. Residents were organized into the following groups: group 1 residents were exposed to the workshop and both memory aid tools; group 2 residents were exposed only to the "responding to consults" memory aid tool; group 3 residents were exposed to the workshop and the "placing consults" memory aid tool; and group 4 residents were not exposed to any interventions. We compared the percentage of satisfied residents among groups. RESULTS: A total of 36 out of 69 residents answered our survey (response rate of 52%). Among survey respondents, 7 (19.4%) were in group 1, 8 (22.2%) in group 2, 10 (27.8%) in group 3, and 11 (30.6%) in group 4. Group 4 residents had lower satisfaction with the overall consultation process (36.4% residents satisfied vs 90%-100% in the intervention groups, P < 0.001), the consultant's professionalism (54.5% vs 100%, P = 0.002), communication between the primary team and the consultant (54.5% vs 90%-100%, P = 0.01), and teaching received from the consultant (18.2% vs 57.1%-80.0%, P = 0.02). CONCLUSIONS: An educational workshop and use of structured memory aids can lead to improved resident satisfaction with the consultation process.

Who calls the shots? The ethics of adolescentself-consent for HPV vaccination.

While the human papillomavirus (HPV) vaccine is medically indicated to reduce the risk of genital warts and certain types of cancer, rates of HPV vaccination repeatedly fall short of public health goals. Individual-level factors contributing to low vaccination rates are well documented. However, system-level barriers, particularly the need for parental consent, have been less explored. To date, there is no legal or ethical consensus in the USA regarding whether adolescents might permissibly self-consent to the HPV vaccine. Consequently, there is considerable variability in medical practice at the provider and state level. In this essay, we explore the ethical acceptability of vaccinating adolescents for HPV without parental consent. We argue that the same ethical considerations that justify permitting minors to consent to treatment for sexual and reproductive health care-namely, public health benefit and adolescents' developing autonomy-similarly justify permitting minors to consent to HPV vaccination. Based on this analysis, we conclude that allowing adolescents to self-consent to the HPV vaccine is ethically justifiable and should be reflected in US state policies.

Erosive effects of pediatric liquid medicinal syrups on primary enamel: An in vitro comparative study.

CONTEXT: The use of liquid medicinal syrups in childhood is high owing to the reasons that children suffer from illness quite often. The acidic component in the formulations may cause erosion to the dental tissues. AIMS: The aim of this study is to evaluate the erosive potential of pediatric liquid medicinal syrups on the deciduous teeth. SUBJECTS AND METHODS: A total of sixty extracted/exfoliated noncarious deciduous molars were used. Four medical syrups were used (viz., 1 - artificial saliva [control], 2 - Ferium XT, 3 - Crocin syrup, 4 - Ambrolite-D) and the teeth were equally divided into the four groups (n = 15) for the immersion cycle, following which the teeth were examined for surface microhardness at 7, 14, 21, and 28 days. STATISTICAL ANALYSIS USED: ANOVA and post hoc analysis were applied. RESULTS: The time and immersion media interaction demonstrated that antitussives produced a significant and gradual loss of surface microhardness on all days (viz., 7, 14, 21, and 28 days), but a statistically significant difference was seen only between 7th and 28th day (P < 0.05). CONCLUSIONS: The knowledge of the erosive potential of commonly used syrups is mandatory as erosion in children teeth may be associated with dental hypersensitivity, loss of the occlusal vertical dimension, eating difficulties, poor esthetics, pulp exposure, and abscesses. Mouth rinsing with water after taking the medication; addition of calcium, fluoride, or phosphate to formulations; and consumption of the medication at meal times have been recommended to avoid tooth damage that is caused by the regular use of medication.

Assessment of nickel release from various dental appliances used routinely in pediatric dentistry.

CONTEXT: The use of nickel-containing alloys in dentistry has been questioned because of the biological liabilities of nickel and the release of nickel ions from dental appliances into the oral cavity. The potential health hazards of nickel and chromium and their compounds have been the focus of attention for more than 100 years. It has established that these metals could cause hypersensitivity. AIMS: To assess the nickel release from various dental appliances used in pediatric dentistry. SETTINGS AND DESIGN: It is a in vitro study. MATERIALS AND METHODS: The study was undertaken to analyze in vitro biodegradation of space maintainers and stainless steel crowns made out of stainless steel materials from different manufacturers. The leaching effect simulating the use of clinical practice was studied by keeping the respective number of Stainless Steel Crowns and space maintainers in the artificial saliva incubating at 37°C and analyzing for nickel release after 1,7,14,21 and 28 days using atomic absorption spectrophotometer. STATISTICAL ANALYSIS: The results were statistically analyzed by using One way ANOVA and repeated measures of ANOVA was applied at different time intervals i.e. 1,7,14,21,28 days. The critical value for statistical significance was set at P = 0.05. RESULTS: Results showed that there was measurable release of nickel which reached maximum level at the end of 7 days which was statistically significant (P < 0.05). CONCLUSIONS: The release of nickel and chromium very much below when compared with the average dietary intake of nickel (200-300 ppm/day) which were not capable of causing any toxic effects.

In vivo anticancer synergy mechanism of doxorubicin and verapamil combination treatment is impaired in BALB/c mice with metastatic breast cancer.

The development of resistance to anticancer drugs is a major unsolved problem in the chemotherapy treatment of metastatic breast cancer. We have shown that increased expression of P-glycoprotein (P-gp) prevented nuclear entry of the doxorubicin molecules into murine breast cancer cells (4T1-R) leading to doxorubicin chemoresistance. This study was performed to test whether inhibition of P-gp using verapamil could overcome doxorubicin chemoresistance and eliminate multiorgan metastasis 4T1-R cells in BALB/c mouse. The 4T1-R cells were treated with doxorubicin alone, verapamil alone, and a combination of both. Multiorgan metastasis of 4T1-R cells in the presence and in the absence of combination treatment was determined in the BALB/c mouse model. Verapamil induced nuclear translocation of doxorubicin, G2-phase growth arrest and synergistically induced 100% cytotoxicity in 4T1-R cells in culture. However, the combination treatment using verapamil and doxorubicin did not improve the overall survival of BALB/c mice with metastatic breast cancer. Our results indicate that the combination treatment of verapamil and doxorubicin did not inhibit tumor growth in the lungs and liver indicating that the anticancer synergy mechanism of verapamil and doxorubicin is impaired in vivo in BALB/c mouse model with metastatic breast cancer. We propose that understanding the mechanisms as to why the combination of doxorubicin and verapamil treatment was impaired in the mouse model should allow novel approaches to improve chemotherapy response of metastatic breast cancer.

Fabrication of a novel biomaterial with enhanced mechanical and conducting properties.

Conducting polymers have the combined advantages of metal conductivity with ease in processing and biocompatibility; making them extremely versatile for biosensor and tissue engineering applications. However, the inherent brittle property of conducting polymers limits their direct use in such applications which generally warrant soft and flexible material responses. Addition of fillers increases the material compliance, but is achieved at the cost of reduced electrical conductivity. To retain suitable conductivity without compromising the mechanical properties, we fabricate an electroactive blend (dPEDOT) using low grade PEDOT:PSS as the base conducting polymer with polyvinyl alcohol as filler and glycerol as a dopant. Bulk dPEDOT films show a thermally stable response till 110 °C with over seven fold increase in room temperature conductivity as compared to 0.002 S cm-1 for pristine PEDOT:PSS. We characterize the nonlinear stress-strain response of dPEDOT, well described using a Mooney-Rivlin hyperelastic model, and report elastomer-like moduli with ductility ∼ fives times its original length. Dynamic mechanical analysis shows constant storage moduli over a large range of frequencies with corresponding linear increase in tan(δ). We relate the enhanced performance of dPEDOT with the underlying structural constituents using FTIR and AFM microscopy. These data demonstrate specific interactions between individual components of dPEDOT, and their effect on surface topography and material properties. Finally, we show biocompatibility of dPEDOT using fibroblasts that have comparable cell morphologies and viability as the control, which make dPEDOT attractive as a biomaterial.