Musculoskeletal manifestations of syphilis in adults: secondary syphilis presenting with ankle inflammatory arthritis and bone involvement with calvarial and sternal lesions. What the rheumatologist needs to know.

Although the incidence of syphilis reached a historic low in 2000, the number of incident cases has since increased in men and women across the USA. In 2019, men who have sex with men (MSM) accounted for 57% of all primary and secondary (P&S) syphilis cases, and about half of MSM with P&S syphilis are living with human immunodeficiency virus (HIV) infection. Days after infection, Treponema pallidum disseminates and invades tissues distant from the site of inoculation. Once the spirochete disseminates, the host develops an inflammatory response; diagnosis requires a high level of suspicion since syphilis may affect the skin, musculoskeletal, cardiovascular, and central nervous systems. We report a 61-year-old man with virally suppressed HIV infection who presented with polyarthralgia, chest pain, and weight loss, diagnosed with secondary syphilis, manifesting with ankle inflammatory arthritis and bone involvement, of the calvarium and manubrium. Early and late syphilis in adults can manifest with articular and periarticular pathologies, including inflammatory arthritis, tenosynovitis, periostitis, and myositis. Higher clinical suspicion is needed for prompt diagnosis of syphilis in patients who are at risk and suspected of having an autoimmune disease. This report includes a review of the musculoskeletal manifestations of syphilis.

Reopening a Student-Run Free Clinic During the COVID-19 Pandemic to Provide Care for People Experiencing Homelessness.

PROBLEM: Student-run free clinics (SRFCs) provide health and outreach services to underserved populations while offering medical students opportunities for service and education. Many SRFCs were forced to suspend in-person operations in early 2020 due to the COVID-19 pandemic. Before March 2020, JeffHOPE, the SRFC at Sidney Kimmel Medical College at Thomas Jefferson University, operated an evening clinic at 5 locations throughout Philadelphia each week. APPROACH: JeffHOPE's response to challenges posed by COVID-19 focused on a redesign for a pilot clinic at a shelter site that expressed interest in resuming operations. The student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. They also developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant. OUTCOMES: The pilot clinic reopened in September 2020. Over the first 13 weeks of operation, 44 unique patients received care across 98 visits. Of these visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Patient visit volume was approximately 35%-40% of the pre-COVID-19 level. Of the 58 total volunteers, 11 were preclinical students who participated remotely. NEXT STEPS: Three additional JeffHOPE clinic sites have reopened since December 2020 using this hybrid telehealth model. Patient feedback, via surveys and interviews, will determine which components are retained. Other SRFCs should be encouraged to innovate and develop plans for safe resumption of services, with an appropriate approach and organizational support, despite the challenges posed by the pandemic.

Beyond the classroom walls: qualitative findings from an interprofessional student hotspotting learning collaborative.

'Hotspotting,' the use of interprofessional teams to address the needs of complex patients in the community, is an approach to reduce overuse of acute care services. While the influence of interprofessional education on student attitudes, knowledge and skills relative to collaborative practice has been a focus of evaluation, research is limited on the outcomes of interprofessional student teams in the community. This qualitative study examines the experiences of students and faculty participating in the interprofessional student Hotspotting program at Thomas Jefferson University. We used purposive sampling to conduct semi-structured interviews and focus groups with 14 students and faculty advisors participating in the program during the 2017-2018 academic year. Data were analyzed using directed content analysis. Three themes emerged: 1) addressing unmet needs in a complex system, 2) beyond the classroom walls, and 3) sitting in discomfort. Findings suggest that Hotspotting is beneficial to students and promotes their understanding of the interaction between social factors and health. This study contributes to the growing body of literature documenting the positive influence of Hotspotting on student development as a member of an interprofessional team. Future research should focus on the patient's experience working with students and the sustainability of student Hotspotting.