Cultural competency education in the medical curriculum to overcome health care disparities.

Background: Our increasingly diverse population demands the adoption of transcultural approaches to health care delivery. Training courses in medical education have been developed across the country for cultural competency, but have not been standardized or incorporated consistently. This study sought to formulate an educational intervention in medical training using the concepts of cultural competency and humility to improve understanding of cultural disparities in health care. Methods: This study used three domains of Tools for Assessing Cultural Competence Training (TACCT) by the Association of American Medical Colleges. Participants included 106 fourth-year medical students and 19 internal medicine residents at Louisiana State University in Shreveport in 2022. The training session included a lecture introducing cultural and structural competency for 30 minutes followed by three workshops based on the TACCT domains of key aspects of cultural competence, understanding the impact of stereotyping on medical decision-making, and cross-cultural clinical skills. The participants were given a pre- and postsession questionnaire. Results: After the session, 68% of students rated their understanding of cultural competency as excellent. For methods of teaching-lecture versus workshop versus both-66% rated the combination as excellent. Conclusion: The rudimentary understanding of cultural competency and cultural humility improved after the session.

Evaluation of gender trends in first authorship in nephrology publications in four major US journals in the last decade.

BACKGROUND: To date, no data exist on gender-related publication biases in nephrology. This study was conducted to determine whether gender differences exist in the current literature published in high-ranking US nephrology journals, and how they may have changed over time. METHODS: The PubMed search was performed using the easyPubMed package in R, which extracted all articles indexed in PubMed from 2011 to 2021 from the US nephrology journals with the highest impact factors, i.e., Journal of the American Society of Nephrology (JASN), American Journal of Nephrology (AJN), American Journal of Kidney diseases (AJKD), and the Clinical Journal of the American Society of Nephrology (CJASN). Gender with predictions > 90% were accepted and the remaining were manually identified. Descriptive statistical analysis was carried out on the data. RESULTS: We identified 11,608 articles. On average, the ratio of male to female first authors decreased from 1.9 to 1.5 (p < 0.05). Additionally, in 2011, women accounted for 32% of first authors, a number that rose to 40% in 2021. All but the American Journal of Nephrology showed a variation in the ratio of men to women first authors. For the JASN, the ratio changed from 1.81 to 1.58, p = 0.001, for CJASN, the ratio declined from 1.91 to 1.15, p = 0.005 and for AJKD, the ratio declined from 2.19 to 1.19, p = 0.002. DISCUSSION AND CONCLUSIONS: Our study shows that gender biases in publications continue to exist in first-author publications in high-ranking Nephrology journals published in the US; the gap is however closing. We hope this study lays the groundwork to continue following and evaluating gender trends in publication.

Safety of total dose iron dextran infusion in geriatric patients with chronic kidney disease and iron deficiency anemia.

There are limited data on total dose infusion (TDI) using iron dextran in geriatric chronic kidney disease (CKD) patients with iron-deficiency anemia (IDA). Our goal was to evaluate the safety of TDI in this setting. We conducted a retrospective chart review spanning a 5 year period (2002-2007), including all patients with CKD and IDA who were treated with iron dextran TDI. Patient demographics were noted, and laboratory values for creatinine, hemoglobin and iron stores were recorded pre- and post-dose. TDI diluted in normal saline was administered intravenously over 4-6 hours after an initial test dose. One hundred fifty-three patients received a total of 250 doses of TDI (mean ± SD=971 ± 175 mg); age was 69 ± 12 years and creatinine 3.3 ± 1.9 mg/dL. All stages of CKD were represented (stage 4 commonest). Hemoglobin and iron stores improved post-TDI (P<0.001). None of the patients experienced an anaphylactic reaction or death. Adverse events (AEs) were noted in 8 out of 250 administered doses (3.2%). The most common AEs were itching, chills and back pain. One hundred and ten doses of high molecular weight (HMW) iron dextran produced 6 AEs (5.45%), whereas 140 doses of low molecular weight (LMW) iron dextran produced 2 AEs (1.43%), a non-significant trend (P=0.1433 by Fishers Exact Test). Iron dextran TDI is relatively safe and effective in correcting IDA in geriatric CKD patients. Fewer AEs were noted with the LMW compared to the HMW product. LMW iron dextran given as TDI can save both cost and time, helping to alleviate issues of non-compliance and patient scheduling.

Integrin engagement regulates monocyte differentiation through the forkhead transcription factor Foxp1.

The precise signals responsible for differentiation of blood-borne monocytes into tissue macrophages are incompletely defined. "Outside-in" signaling by integrins has been implicated in modulation of gene expression that affects cellular differentiation. Herein, using differential display PCR, we have cloned an 85-kDa forkhead transcription factor (termed Mac-1-regulated forkhead [MFH] and found subsequently to be identical to Foxp1) that is downregulated in beta(2)-integrin Mac-1-clustered compared with Mac-1-nonclustered monocytic THP-1 cells. MFH/Foxp1 is expressed in untreated HL60 cells, and its expression was markedly reduced during phorbol ester-induced monocyte differentiation, but not retinoic acid-induced granulocyte differentiation. Overexpression of MFH/Foxp1 markedly attenuated phorbol ester-induced expression of c-fms, which encodes the M-CSF receptor and is obligatory for macrophage differentiation. This was accompanied by decreased CD11b expression, cell adhesiveness, and phagocytosis. Using electromobility shift and reporter assays, we have established that MFH/Foxp1 binds to previously uncharacterized sites within the c-fms promoter and functions as a transcriptional repressor. Deficiency of Mac-1 is associated with altered regulation of MFH/Foxp1 and monocyte maturation in vivo. Taken together, these observations suggest that Mac-1 engagement orchestrates monocyte-differentiation signals by regulating the expression of the forkhead transcription repressor MFH/Foxp1. This represents a new pathway for integrin-dependent modulation of gene expression and control of cellular differentiation.