Barriers and Facilitators to Colorectal Cancer Screening in South Asian Immigrants: A Systematic Review.

OBJECTIVE: The purpose of this systematic review is to broaden our knowledge of colorectal cancer (CRC) screening in South Asian immigrants living in Canada, Hong Kong, the United Kingdom, the United States, and Australia by determining the barriers and facilitators and examining interventions for CRC screening. METHODS: A literature search of PubMed, Ovid Medline, and Google was conducted using South Asian, Asian Indians, cancer screening, colorectal neoplasm, early detection of cancer, and mass screening as search terms. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only research articles written in English from 2000 to July 2022 were collected. Inclusion criteria included all English-language articles, the South Asian population, and either reporting barriers, facilitators, interventions, or recommendations for CRC screening. Exclusion criteria included all articles that did not meet inclusion criteria or were duplicates. A total of 32 articles were deemed eligible for inclusion and were retrieved for further analysis. The countries of origin in the articles reviewed included Canada, Hong Kong, the United Kingdom, the United States, and Australia. RESULTS: In general, the studies indicated that South Asians have low CRC screening rates. The most common barriers reported were poor knowledge/awareness of CRC and CRC screening, lack of physician recommendation, psychological factors (e.g., fear, anxiety, and shame), cultural/religious factors, and sociodemographic factors (language barrier, lower income, and female gender). The most important facilitator reported was the physician's recommendation. Six intervention studies of either education or organized screening programs were shown to have a positive influence by increasing knowledge and improving attitudes toward CRC screening. CONCLUSION: Of the limited number of studies identified, the population categorized as South Asians was largely heterogeneous, including a diversity of ethnicities. Although the rates of CRC among South Asians were relatively low, there remain many cultural barriers to the awareness of and screening for CRC in this population. Further research in this population is needed to better identify the factors related to CRC in individuals of South Asian ethnicity. Recommending CRC screening by physicians and mid-level providers and educating patients with culturally sensitive programs and materials are important to increase knowledge and awareness of CRC and CRC screening.

Evaluation of Current and Former Teleradiology Systems in Africa: A Review.

Background: Teleradiology has grown tremendously across the globe, providing significant benefits to both patients and physicians. In the late 1990s, South Africa sought to lead teleradiology adoption efforts by creating a national telemedicine system through a structured and phased approach. Although initial reports of the system's effectiveness were encouraging, the present status of this project, as well as comparable efforts in surrounding developing countries, has remained uncertain. Objective: To explore the status of teleradiology adoption in Africa, identify existing barriers to adoption, and explore potential solutions to the most commonly identified barriers. Methods: A narrative literature review was conducted to find articles that discussed current and past teleradiology systems in Africa. Each item was evaluated for relevance separately based on specified inclusion and exclusion criteria and was used to field further articles if relevant to the topic, even if not found in the initial search. The search began with articles published after January 1995 and included articles through December 2021. Findings: Although teleradiology systems in Africa has shown to have a benefit in improving patient outcomes, current implementation remains limited due to feasibility projects with no singular picture archiving and communication system (PACS) being utilized at the time of writing. Conclusions: Although teleradiology has significant potential and can benefit the developing countries in Africa, further expansion, in terms of both complexity and adoption rates, remains hindered by infrastructure development, clinician and technologist support, and general sociopolitical factors.

Escape MD: Using an Escape Room as a Gamified Educational and Skill-Building Teaching Tool for Internal Medicine Residents.

Purpose To create an innovative medicine-themed escape room (EsR) and assess its feasibility as a learner-centered educational model for medical trainees. This platform could be used to teach and reinforce medical knowledge as well as enhance team-building skills. Materials and Methods We created an internal medicine (IM) themed EsR, in which participants are locked and instructed to solve a series of puzzles using both medical and nonmedical concepts to "escape" the room within a given set of time. The players must use their critical thinking and communication skills to solve puzzles consisting of complex activities (such as image identification and object matching or retrieval) linked in a nonlinear pattern. A pre-activity survey was used to collect basic demographic information and initial perceptions of the activity. A post-activity survey consisting of a modified Likert scale and free-response questions was used to assess perceived activity use and satisfaction. The activity was followed by a debriefing session with a faculty member to reflect on individual and team-based learning. This study was approved by the Institutional Review Board. Results Each week, a group of four to seven residents participated in a one-hour long EsR session, which was replicated 15 times over five weeks, for a total of 86 internal medicine residents. 76 of 86 residents completed the post-activity survey. Overall, residents expressed a high level of satisfaction with the session (x̄ = 4.89), found it fun to play (x̄ = 4.89), and felt immersed in medicine (x̄ = 3.95). Residents thought the activity was most suitable for reinforcing knowledge (x̄ = 4.26) and greatly tested their communication skills (x̄ = 4.48).  Conclusion The medical EsR experience was enjoyed by the vast majority of residents with very positive oral and survey feedback. Hence, we successfully created an active, learner-centered, gamified teaching tool that can be used for teaching/reinforcing medical concepts in a fun, competitive, and team-building format. The EsR, as a teaching tool, can be replicated with ease several times and requires very few resources to create.

Atypical Power Doppler Ultrasound Findings in Juvenile Idiopathic Inflammatory Myositis (JIIM) Flare.

Juvenile idiopathic inflammatory myositis (JIIM) is a multisystem inflammatory disease that impacts the muscles, skin, and blood vessels. Gray-scale power Doppler ultrasound is a technique that can be used to assist the diagnosis of JIIM and myositis in general. We report a case of an atypical symptomatic JIIM myositis flare that shows increased muscle echogenicity without the corresponding increase (complete absence) of Doppler flow.

Large pelvic hematoma following UroLift procedure causing renal failure requiring dialysis.

The prostatic urethral lift procedure is a minimally invasive treatment option for lower urinary tract symptoms due to benign prostatic hyperplasia, with reported benefit of less adverse effects than traditional treatments. While complications are usually minimal, our patient developed a large pelvic hematoma and the first case of organ failure after prostatic urethral lift. He required temporary dialysis during his extended postoperative admission, and his chronic kidney disease permanently progressed from stage III to stage IV. This case highlights the need for research into the safest preoperative and operative approach for prostatic urethral lift procedures in patients with comorbidities.