The Importance of Engaging in Scientific Research during Medical Training.

Many components of required skills and competencies exist, and are felt to contribute to the successful completion of training for independent practice in the medical field as a physician. These requirements are documented and detailed in a temporal fashion during the training period and used for advancement during training as well as documentation of successful completion of that training. While clinical skill development that allows optimal care and treatment of patients is of utmost importance during this training, other components of the training are important and contribute to the ideal development of a well-rounded and credentialed physician. One of these other components which is very important and needs to be recognized is the engagement of medical trainees across disciplines in academic and research scholarly activity. This engagement is an important component of medical training, and the development of skills and didactics geared toward efficient and accurate performance of research is essential.

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries.

Background: The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries. Methods: A total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2 analysis. Results: Data from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001). Conclusion: Our study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population. Level of evidence: Level III.

The Clinical Role of Cardiovascular Magnetic Resonance Imaging in the Assessment of Cardiac Diastolic Dysfunction.

Echocardiography is the gold standard clinical tool for the evaluation of left ventricular diastolic dysfunction (LVDD) and is used to validate other cardiac imaging modalities in measuring diastolic dysfunction. We examined Cardiac Magnetic Resonance Imaging (CMR) in detecting diastolic dysfunction using the time-volume curve-derived parameters compared to echocardiographic diastolic parameters. We evaluated patients who underwent both CMR and transthoracic echocardiography (TTE) within 2 ± 1 weeks of each other. On echo, Doppler/Tissue Doppler Imaging (TDI) measurements were obtained. On CMR, peak filling rate (PFR), time to PFR (TPFR), 1/3 filling fraction (1/3FF), and 1/3 filling rate (1/3FR) were calculated from the time-volume curve. Using the commonly employed E/A ratio, 44.4% of patients were found to have LVDD. Using septal E/E' and lateral E/E', 29.6% and 48.1% of patients had LVDD, respectively. Correlation was found between left atrial (LA) size and E/A ratio (R = -0.36). Using LVDD criteria for CMR, 63% of patients had diastolic dysfunction. CMR predicted LVDD in 66.7% of the cases. CMR-derived diastolic filling parameters provided a relatively easy and promising method for the assessment of LVDD and can predict the presence of LVDD as assessed by traditional Doppler and TDI methods.

Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident.

BACKGROUND: Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs. AIM: To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident (CVA) or transient ischemic attack (TIA) requires inpatient telemetry monitoring. METHODS: A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively. We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients. RESULTS: In our study population, 63 (24.5%) of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event. Of the 194 (75.5) patients that had a confirmed CVA/TIA, only 6 (2.3%) had an arrhythmia detected during their inpatient telemetry monitoring period. Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event (3.59 vs 2.61, P < 0.001). CONCLUSION: Given the low percentage of inpatient arrhythmias identified, further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA. A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.

Community Needs Assessment of Low-Income Sections of 10 Rural Villages in Karnataka and Tamil Nadu, India.

Background India's health disparities are clearly visible in the southern state of Karnataka. A community needs assessment, one of the first done in this area in over a decade, was conducted to identify unsatisfied needs. The Northwell Center for Global Health worked alongside a local boarding school, Shanti Bhavan, to conduct a needs assessment using the Center for Disease Control and Prevention's Community Assessment for Public Health Emergency Response tool. Methods A community-based cross-sectional survey design was implemented in low-income sections of 10 rural villages in Karnataka throughout February 2019. The target population for this study included people who earned less than US$2 per day. The survey instrument consisted of a questionnaire and tracking form. Results One-hundred ninety-seven (197) of 359 households participated in the survey, which encompassed a total of 1,023 individuals. Proper housing structure was the most common need (27.7 %), followed by access to transportation (16.1 %) and access to healthcare (15.2 %). Agitated behavior, sad mood, and frequent worries were the most-experienced behavioral health concerns, with a 47.7%, 41.6%, and 41.1 % prevalence, respectively. Chronic diseases (eg, high blood pressure, diabetes, asthma) were prevalent in 35 of the households (9.7%). The major disease concern in relation to mosquito-borne illness was dengue (36.0 %). Access to healthcare was an issue in 44 of the 197 households (22.3%), with financial reasons being the most common barrier. Discussion Notably, there were no expressed needs for basic necessities such as food, water, and medication. This may be due to the help of state programs or a limitation of the survey format. Respondents were most concerned with dengue but are also at risk for other vector-borne diseases, such as malaria and chikungunya, highlighting the need to increase awareness and safety measures. Additionally, mental health problems represent a significant burden of disease.

Tell Me More®: A medical student focused humanistic communication model to enhance student professional identity formation through meaningful patient encounters.

INTRODUCTION: The Tell Me More (TMM)® program provides a template for guided interviews to help providers procure an expansive social history from patients and connect with them as people beyond their illness. (TMM)® may provide a dual benefit: it improves the patient's experience with their healthcare team and the medical students' experience in developing their identity as a physician. Our aim was to characterize the impact of the patient-student conversations in TMM® on the participating medical students through analysis of their written reflections throughout the program. METHODS: Students conducted interviews with hospitalized patients using the TMM® template, Through narrative medicine and individualized posters, patients were able to highlight their unique qualities. RESULTS: Qualitative analyses of 63 journal reflections from 14 students, across 7 hospital settings, identified 6 themes. These included connection, humanism, discovery, impact, privilege, and perspective. CONCLUSION: Reflective practice as a learning pedagogy created an opportunity to enhance the medical students' awareness of empathy and compassion during the TMM® program. Documentation of reflections assured students would process the encounter as a profound learning experience and develop their professional identity formation as a student preparing to become a physician. PRACTICAL IMPLICATIONS: TMM® provides an opportunity for medical students to practice and apply their interpersonal and communication skills through authentic patient encounters.

Predictors of misperceptions, risk perceptions, and personal risk perceptions about COVID-19 by country, education and income.

Government interventions, such as mandating the use of masks and social distancing, play crucial roles in controlling the spread of pandemic infection. Adherence depends on public perceptions about pandemic risk. The goal was to explore the roles of education, income, and country on misperceptions, risk perceptions and personal risk perceptions about COVID-19. Data were extracted from 3 preregistered surveys. Binary logistic regressions were conducted to investigate the roles country, education, and income had on outcome variables. Across the USA, Canada, and UK, individuals in the highest income quartile were significantly less likely to hold misperceptions (OR=0.61, 95% CI 0.45 to 0.83) and to perceive personal risk (OR=0.38, 95% CI 0.20 to 0.75) regarding COVID-19 compared with individuals in the lowest income quartile. When comparing these income quartiles in the USA, the difference in perceived risk was heightened (OR=0.21, 95% CI 0.07 to 0.57). Citizens of the UK were more likely to have risk perceptions compared with citizens of the USA (OR=1.50, 95% CI 1.20 to 1.88). Citizens of Canada were less likely to perceive personal risk compared with US citizens (OR=0.40, 95% CI 0.23 to 0.69). Proper risk perception and understanding of COVID-19 are necessary for adherence to public health initiatives. The lowest income quartile was shown to have more misperceptions and personal risk perceptions across all 3 countries, highlighting the disproportionate impact of COVID-19 in this group. Our findings support the importance of education and income in affecting health perceptions and outcomes. Further research is needed to explore interventions to minimize misperceptions, accurately shape risk perception, and effectively communicate science.