The Tea House Series: Striving Together to be Antiracist.

BACKGROUND: Though awareness of health care structures that are racist and oppressive is increasing among health care professionals, there is a gap in continuing education curricula focused on antiracist anti-oppressive practices, and limited faculty and staff development to guide individuals towards action. AIM: To develop, implement, and evaluate a novel antiracist faculty and staff development program called the Tea House Series. SETTING AND PARTICIPANTS: A five-part continuing education series with an accompanying online community for faculty and staff at the divisions of Hospital Medicine in one institution in the western United States. PROGRAM DESCRIPTION: The four foundational pillars integral to the Tea House Series were as follows: educational framework based on the pedagogy of Paulo Freire, local disparities data, welcoming space to establish a community of practice and accountability. Each session contained participant dialogue in small group activities. PROGRAM EVALUATION: Qualitative analysis of participant survey responses demonstrated transformation towards a hope to act with a sense of community. Quantitative analysis measured increased confidence for the program learning objectives. DISCUSSION: The Tea House Series may be used as a model for continuing education to provide the tools and the community to confront systems of racism and oppression in any institution.

Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service.

BACKGROUND: Health systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. However, 7-day readmissions have been understudied in adult hospital medicine. DESIGN: This is a retrospective study. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Mediation analysis was performed for limited English proficiency (LEP) status. Subgroup analyses were performed for patients with initial admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer. PATIENTS: We identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019. MAIN MEASURES: The primary outcome was 7-day all-cause readmission back to the discharging hospital. RESULTS: There were 18,808 patients in our dataset who were discharged between July 2016 and June 2019. A total of 1,297 (6.9%) patients were readmitted within 7 days. Following multivariable regression, patients who identified as Black (OR 1.35, 95% CI 1.15-1.58, p <0.001) and patients who identified as Asian (OR 1.26, 95% CI 1.06-1.50, p = 0.008) had higher odds of readmission compared to white patients. Multivariable regression at the subgroup level for CHF, COPD, and cancer readmissions did not demonstrate significant differences between the racial and ethnic groups. CONCLUSIONS: Black patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.

Neuroglobin expression in the cochlea of rat pups exposed to chronic very mild carbon monoxide (25ppm) in air during and after the prenatal period.

The distribution of neuroglobin (Ngb) was investigated in the normal rat cochlea using immunohistochemistry and non-radioactive insitu hybridization. We also determined whether chronic, very mild CO exposure at 25ppm in air over the gestational and postnatal period alters the expression of Ngb. Pregnant rats were exposed chronically to CO from gestational days 5-20. Four groups were made as follows: prenatal exposure to CO only; prenatal exposure to CO followed by postnatal exposure from postnatal days (5) P5 to P20; rat pups were exposed to CO from P5 to P20; controls (air without CO). In normal adult rats and control group pups, Ngb was found in spiral ganglia neurons, fibrocytes of the spiral ligament, and supporting cells of the organ of Corti. Ngb was not present in the stria vascularis and the inner and outer hair cells. At P20 Ngb immunoreactivity and transcript expression decreased in spiral ganglia neurons and the spiral ligament in the prenatal and pre- and postnatal groups. This decrease was not observed in the postnatal group. Ngb-IR did not decrease in supporting cells in any CO group. Cytochrome-C immunoreactivity followed Ngb distribution in normal controls and CO treated groups. A decrease in Ngb in spiral ganglia neurons and rat spiral ligament, but not in supporting cells, following CO exposure supports the idea that chronic, mild exposure to CO may create a vulnerable cellular environment predisposed to adverse cochlear development.