The impact of skin color and tone on histamine iontophoresis and Doppler flowmetry measurements as a pharmacodynamic biomarker.

The phenotypical manifestations of asthma among children are diverse and exhibit varying responses to therapeutic interventions. There is a need to develop objective biomarkers to improve the characterization of allergic and inflammatory responses relevant to asthma to predict therapeutic treatment responses. We have previously investigated histamine iontophoresis with laser Doppler flowmetry (HILD) as a potential surrogate biomarker that characterizes histamine response and may be utilized to guide the treatment of allergic and inflammatory disease. We have identified intra-individual variability of HILD response type among children and adults with asthma and that HILD response type varied in association with racial classification. As laser Doppler flowimetry may be impacted by skin color, we aimed to further validate the HILD method by determining if skin color or tone is associated with observed HILD response type differences. We conducted an observational study utilizing quantification of skin color and tone obtained from photographs of the skin among participants during HILD assessments via the RGB color model. We compared RGB values across racial, ethnic, and HILD response type via the Kruskal-Wallis test and calculated Kendall rank correlation coefficient to evaluate the relationship between RGB composite scores and HILD pharmacodynamic measures. We observed that RGB scores differed among racial groups and histamine response phenotypes (p < 0.05). However, there was a lack of correlation between the RGB composite score and HILD pharmacodynamic measures (r values 0.1, p > 0.05). These findings suggest that skin color may not impact HILD response variations, necessitating further research to understand previously observed differences across identified racial groups.

Language in the Teaching Operating Room: Expressing Confidence Versus Community.

OBJECTIVE: Previous work has analyzed residency letters of recommendation for agentic and communal language, but this has not been applied to spoken language. Our objective was to analyze intraoperative spoken language by attending and resident surgeons for the use of agentic and communal language. DESIGN: We completed a linguistic inquiry and word count (LIWC) analysis on 16 operating room transcripts (total time 615 minutes) between attendings and resident surgeons for categories associated with agentic and communal speech. Wilcoxon signed rank and Mann-Whitney U tests were used to compare attending versus resident and male versus female speech patterns for word count; "I," clout, and power (agentic categories); and "we," authentic, social (communal categories). SETTING: Midwestern academic university teaching hospital. PARTICIPANTS: Sixteen male (9 attendings, 7 residents) and 16 female (7 attendings, 9 residents) surgeons, from 6 surgical specialties, most commonly from General Surgery. RESULTS: Attending surgeons used more words per minute than residents (40.01 vs 16.92, p < 0.01), were less likely to use "I" (3.18 vs 5.53, p < 0.01), and spoke more language of "clout" (75.82 vs 55.47, p < 0.01). There were no significant differences between attendings and residents in use of analytic speech (23.72 vs 24.67, p = 0.32), "causation" (1.20 vs 1.08, p = 0.72), or "cognitive processing" (10.20 vs 10.54, p = 0.74). Residents used more speech with "emotional tone" (92.91 vs 79.92, p = 0.03), "positive emotion" (4.98 vs 3.86, p = 0.04), more "assent" language (4.89 vs 3.09, p < 0.01), and more "informal" language (9.27 vs 6.77, p < 0.01). There were no gender differences, except for male residents speaking with greater certainty than female residents, although by less than 1% of the total word count. CONCLUSIONS: In the operating room, attending surgeons were more likely to use agentic language compared to resident surgeons based on LIWC analysis. These differences did not depend on gender and likely relate to surgeon experience and confidence, learning versus teaching, and power dynamics.

Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis.

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.

A Cross-Sectional Study of Graduate Medical Education in Radiological Fellowships using Accessible Content.

Graduate medical education in radiology serves an imperative role in training the next generation of specialists. Given the regularity of virtual interviews, the website of a fellowship programs remains a critical first-line source of information of applicants. The aim of this study is to systematically evaluate 7 radiology fellowship programs utilizing a systematic process. A cross-sectional descriptive 286 graduate medical education fellowship programs in radiology were screened from the Fellowship and Residency Electronic Interactive Database (FREIDA). Extracted data was evaluated for comprehensiveness using 20 content criteria, and a readability score is calculated. The mean comprehensiveness among all fellowship program websites was 55.8% (n = 286), and the average FRE among the program overview sections was 11.9 (n = 214). ANOVA revealed no statistical significance in program website comprehensiveness between radiology fellowships (P = 0.33). The quality of a program's website data continues to serve an important role in an applicant's decision-making. Fellowship programs have improved in their content availability overtime, but content reevaluation needs to be continued for tangible improvement.

Health Literacy Analytics of Accessible Patient Resources in Cardiovascular Medicine: What are Patients Wanting to Know?

Introduction: There remains an increasing utilization of internet-based resources as a first line of medical knowledge. Among patients with cardiovascular disease, these resources often are relied upon for numerous diagnostic and therapeutic modalities. However, the reliability of this information is not fully understood. The aim of this study was to provide a descriptive profile on the literacy quality, readability, and transparency of publicly available educational resources in cardiology. Methods: The frequently asked questions and associated online educational articles on common cardiovascular diagnostic and therapeutic interventions were investigated using publicly available data from the Google RankBrain machine learning algorithm after applying inclusion and exclusion criteria. Independent raters evaluated questions for Rothwell's Classification and readability calculations. Results: Collectively, 520 questions and articles were evaluated across 13 cardiac interventions, resulting in 3,120 readability scores. The sources of articles were most frequently from academic institutions followed by commercial sources. Most questions were classified as "Fact" at 76.0% (n = 395), and questions regarding "Technical Details" of each intervention were the most common subclassification at 56.3% (n = 293). Conclusions: Our data show that patients most often are using online search query programs to seek information regarding specific knowledge of each cardiovascular intervention rather than form an evaluation of the intervention. Additionally, these online patient educational resources continue to not meet grade-level reading recommendations.

Radiation Monitoring Using Personal Dosimeter Devices in Terms of Long-Term Compliance and Creating a Culture of Safety.

Introduction Radiation-emitting devices are commonplace in the hospital with their ability to produce imaging for diagnoses, However, they hold a risk for device operators due to radiation exposure. Hospital systems have programs where physicians exposed to radiation are required to wear dosimeters to help record total radiation over time. Dosimetry readings over standardized recommendations can lead to hospital image issues and disciplinary action for physicians. This study aimed to discover the true values recorded on dosimeters with radiation exposure and discuss effective ways to encourage compliance with dosimeter usage. Methodology The study was completed over a course of 12 months with physicians from three different hospitals. Selection criteria included physicians considered to be "radiation workers" including those who operate x-ray machines, fluoroscopy units, unsealed and sealed isotopes, or those exposed to other sources of gamma or high-energy beta radiation. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle was the first six months of the study and the second cycle was the second six months of the study. The first PDSA cycle had planned dosimeter reading check-ins every month. After this cycle ended, physicians were sent a survey anonymously asking if they had ever intentionally left behind their dosimeter. In the second PDSA cycle, a planned policy change was put into action where penalties for physicians who went over the recommended dosage were stopped. A monthly educational meeting where a discussion on the risks of radiation as well as protective mechanisms was implemented instead. The same monthly check-ins for dosimeter reading monitoring were employed again with the same survey regarding dosimeter adherence and usage being sent out at the end of the second cycle. Run charts were created to determine whether the policy change showed statistically significant differences in dosimetry readings. Results Protocol changes led to statistically significant (p<0.05) differences in radiation exposure recorded throughout the hospital systems. The primary PDSA cycle readings showed that hospital systems one (n=118), two (n=71), and three (n=32) had readings of 3.90 mSv, 2.55 mSv, and 2.02 mSv, respectively, which were all under the annual recommended dose limit of 10 mSv maximum per six months. However, an average of 94.4% (n=221) of physicians across all hospitals admitted to not using the dosimeter. In the second PDSA cycle after the policy change, the radiation doses were higher with an increase in the average cumulative dose at hospital system one of 255%, 328% at system two, and 323% at system three. Hospital systems one and two were both over the yearly limit of 20.0 mSv (7.70 mSv over for system one and 1.86 mSv over for system two) while system three remained under. The number of physicians who stated they always used the dosimeter during the second PDSA cycle increased to 83.9% in-hospital system one, 90.2% in-hospital system two, and 93.8% in-hospital system three. Conclusion Creating a culture of safety is critical for physician compliance. A comfortable work environment without unreasonable consequences creates an environment where physicians can focus on their health and safety while also doing what is in the workplace's best interest. This culture can best be made with more collaboration between administrative staff and workers to create a trustworthy experience in hospital systems.

The relationship between structural racism and COVID-19 related health disparities across 10 metropolitan cities in the United States.

INTRODUCTION: Black, Hispanic, and Indigenous groups have carried the burden of COVID-19 disease in comparison to non-marginalized groups within the United States. It is important to examine the factors that have led to the observed disparities in COVID-19 risk, morbidity, and mortality. We described primary health care access within large US metropolitan cities in relation to COVID-19 rate, race/ethnicity, and income level and hypothesized that observed racial/ethnic disparities in COVID-19 rates are associated with health care provider number. METHODS: We accessed public city health department records for reported COVID-19 cases within 10 major metropolitan cities in the United States and also obtained publicly available racial/ethnic demographic median income and primary health care provider counts within individual zip codes. We made comparisons of COVID-19 case numbers within zip codes based on racial/ethnic and income makeup in relation to primary health care counts. RESULTS: Median COVID-19 rates differed by race/ethnicity and income. There was an inverse relationship between median income and COVID-19 rate within zip codes (rho: -0.515; p<0.001). However, this relationship was strongest within racially/ethnically non-marginalized zip codes relative to those composed mainly of racially/ethnically marginalized populations (rho: -0.427 vs. rho: -0.175 respectively). Health care provider number within zip codes was inversely associated with the COVID-19 rate. (rho: -0.157; p<0.001) However, when evaluated by stratified groups by race the association was only significant within racially/ethnically marginalized zip codes(rho: -0.229; p<0.001). DISCUSSION: COVID-19 case rates were associated with racial/ethnic makeup and income status within zip codes across the United States and likewise, primary care provider access also differed by these factors. However, our study reveals that structural and systemic barriers and inequities have led to disproportionate access to health care along with other factors that require identification. CONCLUSION: These results pose a concern in terms of pandemic progression into the next year and how these structural inequities have impacted and will impact vaccine distribution.

Orthopedic Surgery Referral Pattern Analysis per Demographic Factors Among Patients Diagnosed With Severe Peripheral Artery Disease in Terms of Partial or Total Limb Amputation.

INTRODUCTION: Peripheral artery disease (PAD) signifies the obstruction of blood vessels in the lower extremities due to harmful buildup of fatty material. Patients may present to their primary care provider complaining of lower extremity pain, especially during exercise. Primary care providers must weigh the severity of patients' disease process to determine if an orthopedic surgery referral is needed based on an extensive history as well as analysis of demographic factors that may influence their risk of morbidity and mortality. We aimed to objectively present these demographic factors with numeric values in terms of influence. METHODS: We utilized the Cerner Health Facts database to analyze 63 million unique patient encounters from 2000 to 2018. The database is categorized as Institutional Review Board (IRB) exempt due to its de-identified presentation. In an outcome-based approach, we were able to calculate referral patterns based on entered demographic parameters. RESULTS: A patient's age, census region, marital status, previous history of PAD/critical limb ischemia (CLI), history of surgeries, race, facility type, and urban/rural status presented as predictors of seeing a surgeon during a patient encounter. CONCLUSION: Our results found numerous aforementioned demographic factors to be associated with orthopedic surgery referral patterns. This is significant as proper reconciliation of these factors may help reduce patient morbidity in terms of amputation reduction and reduce patient mortality associated with this surgery or complications.

Gastroesophageal Reflux Disease-Associated Chronic Cough: A Population-Based Analysis of Patient Presentations in the United States.

Gastroesophageal reflux disease is an extremely prevalent illness in the United States; however, clinicians report that its association with chronic cough is often overlooked and undiagnosed. We used the CERNER Health Facts® database to analyze the statistical prevalence. Our findings indicate that there is a minority of patients who are untreated for this common complaint. We propose considering this on the differential diagnosis and following current treatment guidelines with proton pump inhibitors to effectively treat this complaint.