Exploring the Beliefs, Values, and Understanding of Quality End-of-Life Care in the Latino Community: A Spanish-Language Qualitative Study.

Context: Hospice services are underutilized by the Latino community in the United States. Previous research has identified that language is a key barrier contributing to disparities. However, very few studies have been conducted in Spanish to specifically explore other barriers to hospice enrollment or values related to end-of-life (EOL) care in this community. Here, we remove the language barrier in order to gain an in-depth understanding of what members of the diverse Latino community in one state in the USA considers high quality EOL and barriers to hospice. Methods: This exploratory semi-structured individual interview study of Latino community members was conducted in Spanish. Interviews were audio-recorded, transcribed verbatim and translated to English. Transcripts were analyzed by three researchers, using a grounded-theory approach to identify themes and sub-themes. Main Findings: Six major themes emerged: (1) concept of "a good death"-spiritual peace, family/community connection, no burdens left behind; (2) centrality of family; (3) lack of knowledge about hospice/palliative care; (4) Spanish language as critical; (5) communication style differences; and (6) necessity for cultural understanding. The central theme of "a good death" was closely linked to having the entire family physically and emotionally present. The four other themes represent interrelated, compounding barriers to achieving this "good death." Principal Conclusions: Healthcare providers and the Latino community can work together to decrease hospice utilization disparities by: actively involving family at every step; addressing misconceptions regarding hospice; conducting important conversations in Spanish; and improving provider skills in culturally sensitive care, including communication style.

Kaposi Sarcoma Associated with Tofacitinib Use in a Patient with Rheumatoid Arthritis.

Kaposi sarcoma is a rare vascular malignancy associated with HHV-8 infection. Four variants of Kaposi sarcoma have been described: Classic, African, HIV-associated, and iatrogenic. Iatrogenic Kaposi sarcoma is typically associated with immunosuppression and organ transplantation. We present a case of iatrogenic Kaposi sarcoma associated with tofacitinib therapy. A 69-year-old woman with rheumatoid arthritis receiving tofacitinib presented with multiple firm, purple-red nodules and brown plaques on the left lower extremity and a single lesion on the right medial calf. Clinicopathologic correlation confirmed a diagnosis of Kaposi sarcoma. Tofacitinib was discontinued and she was started on Alitretinoin 0.1% gel bid. The purple-red Kaposi sarcoma nodules decreased 50% in size after 4 months and resolved at 1 year off the tofacitinib and initiation of alitretinoin gel. As the use of immunomodulators and biologics continues to expand, awareness of this association is important for prompt diagnosis and management.

Craniosynostosis: Are Online Resources Readable?

OBJECTIVE: This study aims to analyze the readability of online craniosynostosis materials from the perspective of a caregiver, and to assess if readability levels conform to recommendations by the American Medical Association (AMA) and National Institutes of Health (NIH). DESIGN: This is a cross-sectional investigation in which an internet search was conducted simulating the search terms of a caregiver of a patient with craniosynostosis. The first three pages of resulting records were calculated for comprehension ease using validated readability indices. Records were also classified by author type, including hospital system, national health organization, academic journal, and other. MAIN OUTCOME MEASURES: Flesch-Kincaid Reading Grade Level, Gunning fog Index, SMOG Index, and Coleman Liau Index. RESULTS: Thirty records were identified for which the mean readability level was 12.8 ± 2.6 grade levels (range, 7.6-15.9). There were no significant differences in mean readability across readability indices or author type. None of the thirty records met levels recommended by the AMA or NIH and were 6.8 grade levels above these guidelines on average. CONCLUSIONS: Online material pertaining to craniosynostosis is written, on average, at the reading level of a first-year undergraduate student. The AMA and NIH recommend that articles be written at approximately a sixth-grade reading level to promote comprehension. Therefore, there is significant room for improvement of current online materials. Authors should consider consulting publicly available guides in preparing future resources.

Calciphylaxis and Kidney Disease: A Review.

Calciphylaxis is a life-threatening complication most often associated with chronic kidney disease that occurs as a result of the deposition of calcium in dermal and adipose microvasculature. However, this condition may also be seen in patients with acute kidney injury. The high morbidity and mortality rates associated with calciphylaxis highlight the importance to correctly diagnose and treat this condition. However, calciphylaxis remains a diagnosis that may be clinically challenging to make. Here, we review the literature on uremic calciphylaxis with a focus on its pathophysiology, clinical presentation, advances in diagnostic tools, and treatment strategies. We also discuss the unique histopathological features of calciphylaxis and contrast it with those of other forms of general vessel calcification. This review emphasizes the need for multidisciplinary collaboration including nephrology, dermatology, and palliative care to ultimately provide the best possible care to patients with calciphylaxis.

Examining the First Peer-to-Peer Mentorship Program (F1Doctors) for International Medical Students.

In this study, we report international medical students in the United States and conduct an analysis of the first, peer-to-peer, national mentorship program for international medical students and international pre-med applicants in the US (F1Doctors). We used analyzed survey data collected through F1Doctors and the Association of American Medical Colleges yearly matriculation reports. Results indicated that the average college grade point average (GPA) and Medical College Admission Test score (MCAT) of international applicants was higher than that of all applicants. Additionally, non-US applicants reported facing numerous unique challenges such as limited access to extracurricular opportunities and difficulty finding mentors who are familiar with the application process. International applicants have the potential to increase the diversity of healthcare professionals, and F1Doctors is the first platform to support international healthcare applicants in the US.

An Analysis of Information Sources of YouTube Videos Pertaining to Tattoo Removal: Cross-Sectional Study.

Background: The American Academy of Dermatology and the Food and Drug Administration recommend consultation with a dermatologist prior to undergoing laser tattoo removal. However, non-health care professionals offer tattoo removal. Understanding the information available on the internet for patients regarding tattoo removal is important given that individuals are increasingly consulting digital sources to make decisions regarding skin care. Prior research has identified that YouTube contains misinformation on dermatologic health. Objective: Here, we present a cross-sectional study that determined the sources of information in YouTube videos that discuss tattoo removal and described the content presented to viewers. Methods: Using the query "tattoo removal," we reviewed English-language YouTube videos that explicitly discussed tattoo removal. The following data were recorded: profession of the presenter, tattoo removal method discussed, whether an explicit recommendation to see a dermatologist or physician was present in the video, and number of views. Results: We analyzed 162 YouTube videos. We found that the majority were presented by non-health care professionals (n=125, 77%), with only 4 (3.7%) records of this subset recommending viewers to seek consultation from a dermatologist to ensure safe and adequate tattoo removal. Conclusions: Based on our findings, we recommend that dermatologists and other health care professionals provide high-quality, evidence-based information to viewers on tattoo removal and encourage dermatology societies to share via their social media platforms information about the importance of consulting a dermatologist for tattoo removal.

Delayed medical care due to transportation barriers among US children with atopic dermatitis.

Our objective was to examine the prevalence and predictors of delayed medical care due to transportation barriers among children with atopic dermatitis (AD) living in the United States (US). We analyzed data from the 1998-2018 National Health Interview Survey, a nationally representative survey of US households. In 2018, transport-delayed care was reported for 3.4% of US children with AD, representing approximately 279,000 children annually given the National Health Interview Survey's weighted survey design, and was more common among patients of lower socioeconomic status. Targeted interventions aimed at reducing transportation barriers to healthcare among at-risk AD patients may reduce health disparities related to AD.

Pembrolizumab-induced Toxic Epidermal Necrolysis in a Patient with Metastatic Esophageal Adenocarcinoma.

Adverse cutaneous reactions associated with the immune checkpoint inhibitor (ICI) pembrolizumab are well documented, yet life-threatening reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are infrequent.1,2 We present a case of pembrolizumab-induced TEN in a patient with metastatic esophageal adenocarcinoma who was successfully treated with cyclosporine and systemic corticosteroids.

Confidence and knowledge in emergency management among medical students across Colombia: A role for the WHO basic emergency care course.

INTRODUCTION: Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. METHODS: A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. RESULTS: Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8-62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1-61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (p<0.0001). CONCLUSION: Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

Trends in clinical presentation of children with COVID-19: a systematic review of individual participant data.

BACKGROUND: There are sparse patient-level data available for children with novel coronavirus disease (COVID-19). Therefore, there is an urgent need for an updated systematic literature review that analyzes individual children rather than aggregated data in broad age groups. METHODS: Six databases (MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, medRxiv) were searched for studies indexed from January 1 to May 15, 2020, with MeSH terms: children, pediatrics, COVID-19, SARS-CoV-2. 1241 records were identified, of which only unique papers in English with individual patient information and documented COVID-19 testing were included. This review of 22 eligible studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines. RESULTS: A total of 123 patients from five countries were identified. 46% were females. The median age was 5 years (IQR = 8). At presentation, 62% had a fever, 32% had a cough, 58% had a single symptom, and 21% were asymptomatic. Abnormal chest imaging was seen in 62% (65/105) of imaged and 76.9% (20/26) of asymptomatic children. A minority of children had elevated platelets, CRP, lactate dehydrogenase, and D-dimer. CONCLUSION: Data from this independent participant data systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. IMPACT: This systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. By using an independent participant data approach, this analysis underscores the challenge of diagnosing COVID-19 in pediatric patients due to the wide variety of symptoms and seemingly poor correlation of imaging findings with symptomatic disease. The data presented from individual patients from case series or cohort studies add more granularity to the current description of pediatric COVID-19.