Pressure Injuries: Prevention, Evaluation, and Management.

Pressure injuries are localized damage to skin or soft tissue. They commonly occur over bony prominences and often present as an intact or open wound. Pressure injuries are common and costly, and they significantly impact patient quality of life. Comprehensive skin assessments are crucial for evaluating pressure injuries. Staging of pressure injuries should follow the updated staging system of the National Pressure Injury Advisory Panel. Risk assessments allow for appropriate prevention and care planning, and physicians should use a structured, repeatable approach. Prevention of pressure injuries focuses on assessing and optimizing nutritional status, repositioning the patient, and providing appropriate support surfaces. Treatment involves pressure off-loading, nutritional optimization, appropriate bandage selection, and wound site management. Pressure injuries and surrounding areas should be cleaned, with additional debridement of devitalized tissue and biofilm if necessary. All injuries should be monitored for local infection, biofilms, and osteomyelitis. Appropriate wound dressings should be selected based on injury stage and the quality and volume of exudate.

Approach to Elevated Liver Enzymes.

Abnormal liver tests are one of the most common challenges in the primary care setting. Primary care practitioners order these tests for numerous reasons, including investigating abdominal signs and symptoms or suspected alcohol-use disorder, or to determine medication adverse effects. Evaluation should be guided by both the clinical presentation and the pattern of injury. In this article, we will focus on the epidemiology, pathophysiology, clinical presentation, diagnostic work-up, and management of elevated liver enzymes, with an emphasis on the most common causes of abnormal liver testing.

Integrating Social Determinants of Health Into Clinical Training During the COVID-19 Pandemic.

INTRODUCTION: Social determinants of health (SDOH) are often incorporated to some degree within preclinical medical education, but no validated curriculum exists for the incorporation of SDOH and the competencies necessary to address nonclinical contributors to health, within clinical educational programming. The COVID-19 pandemic provided an opportunity to implement this programming in a virtual setting. METHODS: Using pedagogy developed by Freire and Dewey, we created a service-learning curriculum supported by reflection sessions, workshops on implicit bias, and journal clubs. We used flipped classroom and adult-learning theory to develop and implement this curriculum. RESULTS: Learners showed significant enthusiasm for this novel curriculum, identifying the incorporation of SDOH and related competencies in clinical education as unique and imperative, requesting that the content be further integrated within the clinical experience of State University of New York Downstate Health Sciences University. CONCLUSION: We developed a service-based curriculum that succeeded in developing further understanding of how patients experience their health in Central Brooklyn, and provided a space for students to generate emotional and interpersonal expertise that is important for the growth of clinicians in caring for patients in underserved and underresourced communities.

Development of a Health Policy Elective for Medical Students During the COVID-19 Pandemic: A Pilot Study.

INTRODUCTION: In Central Brooklyn, Downstate Health Sciences University (DHSU) serves a diverse population that has experienced worsening rates of chronic disease and elevated rates of morbidity and mortality related to the COVID-19 pandemic. The medical community has shown an interest in addressing clinical and nonclinical disparities impacting patients' health and safety. As such, health policy knowledge is of special importance during a time of social and political unrest. Health policy and advocacy are listed in medical education guidelines, but there is a lack of standardized guidelines for implementation of a robust health policy curriculum within the rigors of clinical education. METHODS: Faculty from the Department of Family Medicine and the Department of Health Policy and Administration devised a health policy curriculum to be delivered virtually in the wake of COVID-19-related quarantine. To assess the effectiveness of the curriculum, we administered pre- and postsurveys composed of learning objectives placed on a 5-point Likert scale, at each learning session. RESULTS: The results of these surveys showed an increase in confidence in the learning objectives of each educational session. CONCLUSION: This pilot study warrants further research to fully assess the effect of a health policy curriculum on students' confidence in health policy knowledge and skills."Education is the most powerful weapon which you can use to change the world."-Nelson Mandela.

The role of rural communities in the recruitment and retention of women physicians.

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.

The Crossroads of Health Policy and Academic Medicine: An Early Introduction to Health Policy Skills to Facilitate Change.

Introduction: Despite significant health care reform in the past 10 years, health disparities persist in marginalized and low-resource communities. Although there are a lot of reasons for health disparities, many of which are not related to health care, changes in health policy can lead to improved health equity. Redefining health policy as an important aspect of medical education could popularize the teaching and application of health policy competencies within academic health centers. Methods: The Kern model was applied to develop a workshop to educate medical students on basic health policy concepts and opportunities for them to apply a health policy framework to facilitate organizational change. Specifically, the workshop helped trainees to define common concepts in health policy, to understand a framework for developing policy initiatives, and to identify areas of overlap between health policy and academic medicine. Instructional methods included a PowerPoint presentation, vignette-based small-group discussion, and career reflection. Results: The workshop was implemented at three national conferences with a total of 144 participants. Comparing pre- and postworkshop survey responses, participants felt health policy work was compatible with an academic medicine career. Over 95% of respondents agreed or strongly agreed that each objective had been met. Discussion: By viewing health policy through the lens of academia, trainees were able to develop a new appreciation for how health policy activities can contribute to peer-reviewed publications, teaching, and leadership opportunities. Participants were better situated to integrate health policy skills in their academic or nonacademic careers.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

INTRODUCTION: The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. METHODS: Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. RESULTS: Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. CONCLUSIONS: Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Rural Women Family Physicians: Strategies for Successful Work-Life Balance.

PURPOSE: Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS: Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS: The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS: Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities.

Hispanic Medical Organizations' Support for LGBT Health Issues.

Hispanics represent the fastest growing ethnic segment of the lesbian, gay, bisexual, and transgender (LGBT) community in the United States and are disproportionately burdened by LGBT-related health issues and limited political support from Hispanic medical organizations. Recently, the Latino Medical Student Association, the National Hispanic Medical Association, and the Hispanic Serving Health Professions Schools, representing over 60,000 Hispanic students and providers and 35 institutions, collaborated to support a resolution opposing discrimination based on sexual orientation or gender identity and recognizing the obstacles encountered by LGBTQ Hispanics. The resolution provides an important framework for organizational members and leaders to address LGBT health issues and serve to support a more positive sociopolitical climate for the Hispanic LGBT community nationally and internationally.