ABSTRACT
Acute otitis externa is an inflammatory condition that affects the external ear canal. It is usually of rapid onset and is generally caused by bacterial infection. The primary bacterial infections are Pseudomonas aeruginosa and Staphylococcus aureus. Acute otitis externa presents with pain (otalgia), redness, and swelling of the canal. It is more common in children and young adults. Tenderness on movement of the pinna or tragus is the classic finding. Analgesics and topical antibiotics are the mainstays of therapy. Topical medications include acetic acid 2%, aminoglycosides, polymyxin B, and quinolones with and without corticosteroids. There is no evidence that any one preparation is clinically superior to another, and the choice of treatment is based on factors such as cost, whether the tympanic membrane is intact, and patient adherence. Oral antibiotics are indicated only if evidence of cellulitis occurs outside of the ear canal or if associated conditions such as immunocompromise, diabetes mellitus, or conditions that would not allow for the use of topical treatment are found. Duration of topical treatment is usually seven to 10 days. Keys to prevention include avoiding injury to the ear canal and keeping it free of water.
Subject(s)
Otitis Externa , Child , Humans , Young Adult , Acetic Acid/therapeutic use , Acute Disease , Analgesics/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ear Canal , Otitis Externa/diagnosis , Otitis Externa/drug therapy , Otitis Externa/microbiologyABSTRACT
Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. There is currently a diagnostic tool that is still being validated to assist with diagnosing adjustment disorder. The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies.
Subject(s)
Adjustment Disorders , International Classification of Diseases , Humans , Adjustment Disorders/diagnosis , Adjustment Disorders/psychology , Adjustment Disorders/therapy , Diagnostic and Statistical Manual of Mental Disorders , Prevalence , Primary Health CareABSTRACT
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic accelerated virtual residency interview adoption. The impact of virtual interviews on program directors' (PD) National Residency Matching Program (NRMP) Match satisfaction, their future interview plans, and their perceptions about virtual interviews' influence on bias are unknown. We report the results of a survey of family medicine (FM) PDs about these topics after mandatory virtual interviews in 2020-2021. METHODS: A national survey of all FM PDs was conducted in April 2021 (n=619). The response rate was 46.37% (n=287). Questions asked whether PDs conducted virtual interviews, as well as PDs' general perceptions of virtual interviews' impact on administrative burden, diversity and bias; PD's ability to communicate program culture and assess applicants' alignment with program values; PD's satisfaction with Match results; and plans for interview structure postpandemic. RESULTS: Two hundred forty-four (93.1%) respondents performed only virtual interviews; 83.9% (n=220) conducting virtual interviews were satisfied with Match results, with no difference between programs with all virtual interviews vs others (OR 1.2, P=.994). PDs who communicated program values and involved residents in virtual interviews experienced higher Match satisfaction (OR 7.6, P<.001; OR 4.21, P=.001). PDs concerned about virtual interviews increasing bias against minorities before 2020 were still concerned after (OR 8.81, P<.001) and had lower Match satisfaction (OR 0.24, P=.001). CONCLUSIONS: Most FM PDs conducted entirely virtual interviews in 2020 and were satisfied with the Match. Interview processes including residents and conveying residency culture increased Match satisfaction. PDs are concerned about bias in virtual interviews, but more investigation about bias is needed.
Subject(s)
COVID-19 , Internship and Residency , Humans , Bias, Implicit , Pandemics , Surveys and QuestionnairesSubject(s)
Acetamides , Drug-Related Side Effects and Adverse Reactions , Keratosis, Actinic/drug therapy , Morpholines , Pyridines , Skin Ulcer , Acetamides/administration & dosage , Acetamides/adverse effects , Acetamides/economics , Comparative Effectiveness Research , Cost-Benefit Analysis , Drug Costs , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/etiology , Enzyme Inhibitors/administration & dosage , Enzyme Inhibitors/adverse effects , Enzyme Inhibitors/economics , Humans , Morpholines/administration & dosage , Morpholines/adverse effects , Morpholines/economics , Pyridines/administration & dosage , Pyridines/adverse effects , Pyridines/economics , Skin Ulcer/chemically induced , Skin Ulcer/diagnosis , Treatment OutcomeABSTRACT
Although social justice is an integral component of medical professionalism, there is little discussion in medical education about how to teach it to future physicians. Using adult learning theory and the work of Brazilian educator Paulo Freire, medical educators can teach a socially-conscious professionalism through educational content and teaching strategies. Such teaching can model non-hierarchical relationships to learners, which can translate to their clinical interactions with patients. Freirian teaching can additionally foster professionalism in both teachers and learners by ensuring that they are involved citizens in their local, national and international communities.
