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1.
MedEdPORTAL ; 20: 11412, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38957523

RESUMO

Introduction: Medical curricula implicitly teach that race has a biological basis. Clinical rotations reinforce this misconception as race-based algorithms are used to guide clinical decision-making. This module aims to expose the fallacy of race in clinical algorithms, using the estimated glomerular filtration rate (eGFR) equation as an example. Methods: We created a 60-minute module in consultation with nephrologists. The format was an interactive, case-based presentation with a didactic section. A third-year medical student facilitated the workshops to medical students. Evaluation included pre/post surveys using 5-point Likert scales to assess awareness regarding use of race as a biological construct. Higher scores indicated increased awareness. Results: Fifty-five students participated in the module. Pre/post results indicated that students significantly improved in self-perceived knowledge of the history of racism in medicine (2.6 vs. 3.2, p < .001), awareness of race in clinical algorithms (2.7 vs. 3.7, p < .001), impact of race-based eGFR on quality of life/treatment outcomes (4.5 vs. 4.8, p = .01), differences between race and ancestry (3.7 vs. 4.3, p < .001), and implications of not removing race from the eGFR equation (2.7 vs. 4.2, p < .001). Students rated the workshops highly for quality and clarity. Discussion: Our module expands on others' work to expose the fallacy of race-based algorithms and define its impact on health equity. Limitations include a lack of objective assessment of knowledge acquisition. We recommend integrating this module into preclinical and clinical curricula to discuss the use of race in medical literature and clinical practice.


Assuntos
Algoritmos , Currículo , Taxa de Filtração Glomerular , Estudantes de Medicina , Humanos , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Medicina/psicologia , Taxa de Filtração Glomerular/fisiologia , Inquéritos e Questionários , Grupos Raciais/estatística & dados numéricos , Educação de Graduação em Medicina/métodos , Masculino , Racismo , Feminino
2.
Cureus ; 16(3): e55646, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38586717

RESUMO

At present, a substantial number of individuals in the US face limited English proficiency (LEP), posing difficulties for healthcare providers. Language barriers between healthcare providers and patients can lead to poor quality of care, especially in patients with hyperacute conditions such as stroke, myocardial infarction, acute trauma, and more. In the intensive care unit (ICU), diagnosis and rapid treatment decision-making rely on taking an accurate patient history and physical exam. While in-person interpreters are the gold standard for patients with LEP, the fast-paced nature of the ICU may require alternate modes of using interpreting services to fit ICU workflows. We present a case-based reflection of a patient with LEP who presented to our ICU after a motor vehicle accident. We present this case from the perspective of a third-year medical student caring for a patient while rotating in an ICU service. We illustrate how language interpretation impacted the patient's care. We conclude by appraising the ICU literature and providing solutions to addressing language barriers for ICU patients with LEP to deliver patient-centered, high-quality care.

3.
BMJ Open ; 14(3): e081417, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38458805

RESUMO

OBJECTIVES: To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN: Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING: The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS: Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS: Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS: These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.


Assuntos
Diabetes Mellitus , Pandemias , Adulto , Humanos , Área Carente de Assistência Médica , Pessoal de Saúde , Pesquisa Qualitativa
4.
J Electromyogr Kinesiol ; 49: 102360, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31580987

RESUMO

Although several studies have assessed core training, specific prescription recommendations remain lacking. The purpose of the present study was to determine the association between the rate of perceived exertion (RPE) and neuromuscular fatigue of the core muscles during the prone bridging endurance test. Fifteen healthy and moderately active subjects participated. Neuromuscular fatigue was assessed with surface electromyography on the rectus abdominis (RA), external oblique, internal oblique, and lumbar erector spinae. Participants rated the RPE (Borg CR 10) every 5 s. The time to failure was 123.7 ±â€¯58.1 s. From the midpoint of the time to failure, the RPE significantly increased (p < 0.05). The RA muscle showed increased neuromuscular fatigue during the second half of the time to failure (p < 0.05). The other core muscles showed increased neuromuscular fatigue during the last 30% of the time to failure (p < 0.05). The RA muscle showed a strong correlation between neuromuscular fatigue and the RPE (R2 0.85). The other core muscles showed a moderate correlation between neuromuscular fatigue and RPE (R2 0.50-0.69). The measured RPE and neuromuscular fatigue were closely linked for the RA muscle and moderately linked for the other core muscles during the prone bridging endurance test.


Assuntos
Músculos Abdominais/fisiologia , Fadiga Muscular , Esforço Físico , Adulto , Feminino , Humanos , Masculino
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