Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study.

This study aimed to evaluate the impact of the COVID-19 pandemic on adults with opioid-treated chronic low back pain (CLBP), an understudied area. Participants in a "parent" clinical trial of non-pharmacologic treatments for CLBP were invited to complete a one-time survey on the perceived pandemic impact across several CLBP- and opioid therapy-related domains. Participant clinical and other characteristics were derived from the parent study's data. Descriptive statistics and latent class analysis analyzed quantitative data; qualitative thematic analysis was applied to qualitative data. The survey was completed by 480 respondents from June 2020 to August 2021. The majority reported a negative pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances (45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed opioids; at the same time, decreased access to medication and overall healthcare was reported by 11.3% and 61.6% of respondents, respectively. Latent class analysis of the COVID-19 survey responses revealed 2 patterns of pandemic-related impact; those with worse pandemic-associated harms (n = 106) had an overall worse health profile compared to those with a lesser pandemic impact. The pandemic substantially affected all domains of relevant health-related outcomes as well as healthcare access, general wellbeing, and financial stability among adults with opioid-treated CLBP. A more nuanced evaluation revealed a heterogeneity of experiences, underscoring the need for both increased overall support for this population and for an individualized approach to mitigate harms induced by pandemic or similar crises.

Virtual Recruitment Effects on Matched Residents in Family Medicine: Experiences From Central Pennsylvania.

Background and Objectives: As a result of the COVID-19 pandemic, interviews during the 2021 US residency match were conducted virtually, a practice again recommended and repeated by many programs in 2022. The impact of virtual interviews on recruitment and match outcomes has recently been of interest, with results showing the virtual format to be mostly well received by applicants due to cost, travel, and scheduling benefits. Few studies have looked at pre/posttransition comparisons of applicant geographic and demographic data. We compared objective match outcomes between in-person and virtual interviews across three residency programs. Methods: We conducted a retrospective cross-sectional analysis of National Residency Matching Program data between 2015-2022 across three family medicine residency programs. Primary outcomes were fill rate, average rank position, distance from program, and percentage of underrepresented in medicine demographic status for matched applicants. We compared aggregate in-person data (2015-2019) to aggregate virtual data (2020-2022) for each program using χ2, Fisher Exact test, or 2-tailed t tests to 95% confidence. Results: Saint Joseph Hospital in Reading, Pennsylvania, a 3-year community-based university affiliated program, had significantly more unfilled positions during virtual recruitment (P=.0058). Mount Nittany Medical Center in State College, Pennsylvania, a 3-year community based university-affiliated program, had a significant difference in distance of matched residents' current address (P=.048). Virtual interviews were not associated with significant differences in average position on rank list, average distance from permanent address zip code, or percentage of underrepresented in medicine (URiM) demographic status for matched applicants. Conclusions: The impact of virtual interviewing on unfilled positions and geographic data is likely site specific and generally small, as some programs had significant structural changes. Further research is needed to confirm the generalizability of these results and explore future comparisons of demographic and geographic characteristics of matched applicants pre/posttransition to the virtual format.

Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil.

BACKGROUND: The impact of COVID-19 on healthcare- associated infections (HCAI) caused by multidrug-resistant (MDR) bacteria that contribute to higher mortality is a growing area of study METHODS: This retrospective observational study compares the incidence density (ID) of HCAI caused by MDR bacteria (CRE, CRAB, CRP, MRSA and VRE) pre-COVID (2017-2019) and during the COVID-19 pandemic (2020) in overall hospitalized patients and in intensive care (ICU) units. RESULTS: We identified 8,869 HCAI, of which 2,641 (29.7%) were caused by bacterial MDR, and 1,257 (14.1%) were from ICUs. The overall ID of MDR infections increased 23% (P < .005) during COVID-19. The overall per-pathogen analysis shows significant increases in infections by CRAB and MRSA (+108.1%, p<0.005; +94.7%, p<0.005, respectively), but not in CRE, CRP, or VRE. In the ICU, the overall ID of MDR infections decreased during COVID, but that decline was not significant (-6.5%, P = .26). The ICU per-pathogen analysis of ID of infection showed significant increases in CRAB and MRSA (+42.0%, P = .001; +46.2%, P = .04), significant decreases in CRE and CRP (-26.4%, P = .002; -44.2%, P = 0.003, respectively) and no change in VRE. CONCLUSIONS: The COVID-19 pandemic correlates to an increase in ID of CRAB and MRSA both in ICU and non-ICU setting, and a decrease in ID of CRE and CRP in the ICU setting. Infection control teams should be aware of possible outbreaks of CRAB and MRSA and promote rigorous adherence to infection control measures as practices change to accommodate changes in healthcare needs during and after the pandemic.

Utility of Point of Care Ultrasound in Humanitarian Assistance Missions.

INTRODUCTION: Point of care ultrasound (POCUS) is increasingly used in primary care in the USA and has been shown to provide significant benefit to care in deployed military settings and during disaster relief efforts. It is less studied as a tool during humanitarian assistance missions. We sought to determine the utility of POCUS in a humanitarian assistance setting during the February 2019 joint U.S.-Brazilian hospital assistance mission aboard the Hospitalar Assistance Ship Carlos Chagas along the Madeira River in the Brazilian Amazon. MATERIALS AND METHODS: Point of care ultrasound was offered as a diagnostic modality to primary care physicians during the course of a month-long mission. A handheld IVIZ ultrasound machine was loaned for use during this mission by Sonosite. A P21v phased array (5-1 MHz) or an L38v linear (10-5 MHz) transducer was used for scanning. Requests for POCUS examinations, their findings, and changes in patient management were recorded. RESULTS: Point of care ultrasound examinations were requested and performed in 24 of 814 (3%) outpatient primary care visits. Ten of these studies (42% of POCUS examinations, 1.2% of all patient visits) directed patient management decisions, in each case preventing unnecessary referral. CONCLUSIONS: In this austere setting, POCUS proved to be an inexpensive, effective tool at preventing unnecessary referrals. Future medical humanitarian assistance missions may likewise find POCUS to be a primary care force-multiplier.

Mock Trial as a Learning Tool in a Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Mock trials have been used to teach medical learners about malpractice litigation, ethics, legal concepts, and evidence-based practice. Although 5.2% of family physicians are sued for malpractice annually, there is no formal requirement nor curriculum for educating our residents about malpractice, and mock trial has not been reported as an education modality in a family medicine residency. We developed a mock trial experience to educate family medicine residents about malpractice litigation and evaluated the resident experience over 3 years. METHODS: This is a retrospective, single-site study evaluating resident experience in our mock trials. We assessed perceived value using a 5-point Likert scale; and we assessed knowledge with free-text answers to both open and closed questions. We used descriptive statistics to describe data. RESULTS: Residents found the mock trial effective and engaging, giving the experience an overall evaluation of 4.9/5±0.3; 86.4% identified the importance of documentation as a learning outcome; 72.7% of residents identified negligence as necessary to justify a lawsuit, but they demonstrated limited mastery of the four elements of negligence, with 45.5% correctly listing harm, 40.9% causation, 13.6% breach of duty, and 0% duty owed. CONCLUSIONS: Mock trial is an enjoyable and effective tool to engage residents and provide a general understanding of malpractice litigation. It is less effective in conveying nuanced details of negligence. It may also be effective in teaching practice management techniques.

A Curriculum to Increase Resident Scholarly Activity.

BACKGROUND AND OBJECTIVES: Scholarly activity (SA) is an Accreditation Council of Graduate Medical Education (ACGME) requirement for family medicine residents. Engaging residents in scholarly activity can be challenging. Naval Hospital Jacksonville Family Medicine Residency (NHJ) pioneered a curriculum that led to a dramatic, sustained increase in resident SA. We sought to implement the curriculum in other family medicine residency programs. METHODS: The curriculum was implemented at two additional family medicine residencies. Three curricular interventions were identified: a 3-hour case report workshop, a written practical guide to scholarly activity, and a resident peer research leader. One program implemented all three elements. The other implemented the workshop and written guide, but did not identify a resident peer leader. SA was measured using the annual ACGME program director report and compared the intervention year to the previous 3 years of SA using a 2-sample test for equality of proportions with continuity correction. We used pre- and postintervention surveys to evaluate resident attitudes about SA. RESULTS: The program implementing all three interventions increased residents' conference presentation 302% (n=34, P<.001). The program that did not identify a resident peer leader had no significant change in SA as reported to the ACGME. CONCLUSIONS: The curriculum was implemented in two additional residencies with promising results. We recommend further implementation across multiple sites to determine the extent to which the results are generalizable.

Health Characteristics of the Madeira Riverine Population.

INTRODUCTION: The Amazon River Basin is the largest and the most complex fluvial system in the world. The Brazilian government provides dental and medical care to the riverine populations in this region in part through medical assistance missions, conducted by four hospital ships. The Brazilian Navy invited U.S. Navy medical personnel to join the February 2019 mission aboard Navio de Assistência Hospitalar (NAsH) Carlos Chagas to provide care along the Madeira River. MATERIALS AND METHODS: In the course of providing primary care services, demographic, health, and dental data of the Madeira Riverine population were collected. Descriptive statistics were used to generate average health and dental data. Chi-square tests were used to compare population prevalence data. Linear regression was used to evaluate dental caries per patient with proximity to nearest large population center and village population. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. RESULTS: The Madeira Riverine population has similar dental health to Brazilians living in urban centers. Their prevalence of hypertension and diabetes compared favorably with the U.S. averages (17.7% vs. 34.3% [P < 0.001] and 3% vs. 9.4% [P < 0.001], respectively). Based on the most prevalent ICD-10 code diagnoses, future missions can expect high volumes of patients with intestinal parasites, hypertension, common skin infections, women's health concerns, and musculoskeletal complaints. CONCLUSIONS: This study adds to the limited health data currently available on Brazilian Riverine populations. It demonstrates the effectiveness of the Hospital Assistance missions in providing dental care and documents some unique aspects of Riverine health that warrant further study.

Health Characteristics of the Wayuu Indigenous People.

INTRODUCTION: The identified number of isolated populations with unique medical characteristics is growing. These populations are difficult to study. Civil-military humanitarian operations are part of our medical force readiness training, and are also a venue through which unique populations can be simultaneously served and evaluated. Continuing Promise 2017 was a collaborative effort between the US Navy, non-governmental organizations, and the Colombian Ministry of Health, Navy and Army to provide primary medical care to the Wayuu indigenous people in the La Guajira Department of Colombia. MATERIALS AND METHODS: In the course of providing primary care services, demographic and health data of the Wayuu people were collected. Descriptive statistics were used to generate averages, and t-tests were used to compare Wayuu means with age and gender matched US means for weight and age in children and blood pressure in adults. Observational data on skin afflictions and arthritis were also collected. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. RESULTS: Although the Wayuu live in an arid desert with chronic sun exposure, they have no apparent affliction from squamous cell carcinoma or melanoma. They live almost exclusively through manual labor, yet rarely develop osteoarthritic joint disease. Their incidence of hypertension is 35% lower than their US age and gender matched cohort. Although their region is known for extreme poverty and malnutrition, their weight-for-age curve from 2 months through 17 years is similar to their US cohort. CONCLUSIONS: This study is the first to document the general health characteristics of the Wayuu people. It demonstrates that in addition to providing important readiness training to our own personnel, humanitarian missions can provide medical care and explore unique, isolated populations. Although retrospective and limited in size, it can be used to shape future medical missions to their region, and will hopefully stimulate formal research into their remarkable characteristics.