A Summer Research Experience to Increase Diversity in Healthcare: a 4-Year Follow-up Study.

This report describes the educational follow-up of the college coaches who participated in our Summer Research Programs from 2012 through 2019. Our program was successful as all the 45 college coaches submitted a total of 54 abstracts to a regional conference, and 100% of them were accepted for publication. On follow-up in 2023, most of the college coaches, including women and those from minority backgrounds, were enrolled or graduated from a health professional school or worked in a healthcare setting. Despite our small study population, our research program can serve as a model to increase diversity in healthcare and science fields.

Navigating Medical Care for a Young Adult with Developmental Disability.

CASE: Sam is a 20-year-old young man with intermittent gastritis, autism spectrum disorder, and intellectual disability who was admitted to the hospital because of nutritional concerns. His parents have legal guardianship and report that he has had increasing frequency of refusal to eat, resulting in a 15-pound weight loss over the past 3 months. On admission, a multidisciplinary team including specialists in gastroenterology, nutrition, feeding (behavioral and mechanical), psychiatry, palliative care, and social work was engaged to develop an evaluation and care plan. Sam's nutritional assessment was significant for severe malnutrition. An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.An upper endoscopy was performed and was without abnormalities, including signs of significant gastritis.A carefully obtained history found that Sam does not have a primary care physician. He was recently hospitalized at another facility because of his weight loss and nutritional concerns but was discharged against medical advice because of parental dissatisfaction with his care. His mother shared that she has tried many strategies to encourage Sam to eat including pushing spoons of food into his mouth, syringe feeding, and verbally pleading with Sam to take a bite, but all of these have been without success.Because of concerns that persistent attempts to verbally and physically coerce Sam to eat may be contributing to his aversion to food/eating, the feeding team provided Sam's parents with education and coaching for utilization of behavioral cues to determine when Sam wanted to eat. Despite parents expressing their understanding of the importance of avoiding physical attempts to "make" Sam eat and the team palliative care physician meeting with Sam's parents to elicit their goals for Sam's care, his nurses reported observing several instances of Sam's mother tapping a loaded spoon on his lips. Because of minimal oral intake, a nasogastric tube was placed for provision of hydration and nutrition. Sam's parents consented to the use of soft restraints and the presence of a bedside patient care assistant because of Sam becoming agitated and pulling at the tube.After 10 days of hospitalization, Sam was taking about 50% of his goal intake by mouth. Unfortunately, Sam removed his NG tube, and his parents refused to allow the tube to be replaced. Sam's parents then discharged him against medical advice, stating that they believed he would recover better at home. What are important considerations in caring for patients like Sam in the hospital setting and beyond?

COVID-19 pandemic: a catalyst for transformation of a summer online research program.

In view of limited resources during the COVID-19 pandemic, there is an urgent need to create novel programs to meet the changing demands of trainees towards developing and strengthening their skills in healthcare research. During the COVID-19 pandemic, digital learning has become an invaluable tool by providing more learning opportunities. Through the use of platforms available for distant learning, we made our pre-existing online research program more interactive. Through collaboration in small groups, the trainees developed their research and mentorship skills and were able to meet the goal of submitting their research projects as abstracts. All of the abstracts were accepted for publication.

An innovative programme for premedical students.

BACKGROUND: The worldwide shortage of doctors and the low representation of minorities in medicine outline the need for enrichment programmes that expose a diverse population of youth to health careers. This report describes the innovative Summer Premed Program run at the University of California, Irvine School of Medicine, from the perspective of our diverse group of participating high school students. METHODS: Our unique and highly interactive programme focused on providing youths with a glimpse of life in medical school. Students participated in interactive workshops such as a cadaver lab, robotics, patient interviews and bedside ultrasound. To determine the success of the programme, a feedback survey was distributed to all students at the end of the programme. RESULTS: During the summers of 2012, 2013 and 2014, 418 high-school students participated in the programme and 19.4 per cent were under-represented in medicine. Of the 418 students, 371 (89%) completed evaluations. The average rating of all the workshops ranged from 3.26 to 4.68 (out of maximum of 5) with cadaver lab, suturing workshops and patient interviews each having the highest rating of approximately 4.7. Additionally, resulting from this programme, students gave an average rating of 4.42 for comfort in interviewing patients, and 4.55 for professional development. DISCUSSION: The results reveal that the Summer Premed Program at the University of California, Irvine School of Medicine, was successful towards exposing a diverse range of youths to medical school while motivating them to pursue careers in medicine. The follow-up of participants' career choices is needed to assess the long-term effectiveness of the programme. [There is a] need for enrichment programmes that expose a diverse population of youth to health careers.

A novel enrichment program using cascading mentorship to increase diversity in the health care professions.

The authors describe an innovative summer enrichment program based on a cascading mentorship model to transfer knowledge and skills from faculty to medical students to undergraduate students and finally to high school students. The program was designed to give high school students a glimpse of life in medical school and enhance the teaching and leadership skills of underrepresented undergraduate and medical students. Started in 2010 with 30 high school students and 9 college and medical student coaches, the University of California, Irvine, School of Medicine Summer Premed Program expanded rapidly over the next two summers and enrolled a total of 253 high school students, 48 college students, and 12 medical students. The college and medical student coaches, the majority of whom were underrepresented in medicine (URIM), reported that the program enhanced their teaching and leadership skills and self-confidence, motivated them toward careers in academic medicine, and raised their awareness about the importance of cultural diversity. The authors present the details of this interactive, structured program and describe how URIM student empowerment, near-peer teaching, science socialization, and support from the institution's leadership and faculty members provided a climate that fostered belonging, a sense of personal transformation, and professional development among students from different levels of education and diverse backgrounds. Long-term follow-up of the participants' career choices is needed.

Medical students' perspectives on clinical empathy training.

CONTEXT: There is a need for studies specifically addressing the barriers to empathy training from the perspective of medical students. The objective of this study was to evaluate attitudes of 3rd and 4th year medical students regarding their training in clinical empathy at a public teaching hospital and medical school. METHODS: A questionnaire assessing students' satisfaction with, and opinions on, empathy training, as well as barriers to training, was distributed during the last quarter of the year. RESULTS: Of 188 eligible participants, 157 (84%) responded. Approximately one-half of the respondents said empathy could be taught. Eighty-one percent of respondents felt that their empathy had increased or stayed the same during their training. When asked about barriers for learning empathy, the majority of respondents chose time pressure and lack of good role models. Respondents rated breaking bad news, talking to patients about medical mistakes and taking care of dying or demanding patients as areas in need of more empathy-related training. CONCLUSIONS: Although the majority of students were satisfied with their training of clinical empathy, our study highlights the need for innovative methods to address concerns regarding barriers to practicing empathy, as well as the need for more training in how to demonstrate empathy in challenging clinical situations.

What would pediatric infectious disease consultants recommend for management of culture-negative acute hematogenous osteomyelitis?

OBJECTIVE: To assess the opinion of pediatric infectious disease (PID) specialists regarding the management of culture-negative acute hematogenous osteomyelitis. METHODS: A questionnaire that included a hypothetical case scenario of a 4-year-old boy with culture-negative osteomyelitis was distributed via a Web-based system to PID specialists across the United States. RESULTS: Of 481 eligible participants surveyed, 147 (31%) responded. For initial therapy of osteomyelitis, 37% of respondents chose a beta-lactam, 24% chose clindamycin, 10% chose vancomycin as the sole therapy, and 29% chose a combination of these. The initial choice of antibiotics was correlated with the reported incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the institution (P < 0.01). In areas where the prevalence of CA-MRSA was intermediate (between 25% and 50%), the choice of antibiotics was more heterogeneous. For change from intravenous to oral therapy, approximately 70% of respondents would change to oral therapy sooner than 3 weeks depending on clinical, laboratory, and social factors. After significant clinical and laboratory (sedimentation rate and C-reactive protein) improvements, most respondents (69%) chose to treat for a total duration (intravenous and oral) of 3 to 4 weeks. CONCLUSIONS: This study illustrates that the empiric choice of antibiotics for treatment of acute hematogenous osteomyelitis was driven by the local prevalence of CA-MRSA. When the prevalence of CA-MRSA was intermediate, the recommendations for management of bone infections were more heterogeneous. Clinical trials are needed to compare the effect of different management strategies on outcome, side effects, and costs. LEVEL OF EVIDENCE: Level V.

Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.

Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.

The effect of an interventional program on adherence to the american academy of pediatrics guidelines for palivizumab prophylaxis.

OBJECTIVE: To determine the effect of an interventional program designed to improve adherence to American Academy of Pediatrics (AAP) guidelines for palivizumab prophylaxis. METHODS: The study was carried out at the Children's Hospital, University of California, Irvine Medical Center and its affiliated clinics. An interventional program focusing on education of health care workers on AAP guidelines, updating health care providers about respiratory syncytial virus (RSV) activity, as well as designating a single clinic with effective screening of referrals for administration of palivizumab, was implemented during the summer of 2004. The medical records of infants who had received at least 1 dose of palivizumab or were eligible to receive palivizumab during the 2003-2004 and the 2004-2005 RSV seasons at the University of California, Irvine Medical Center were reviewed. The proportion of patients who received injections according to AAP guidelines was compared. RESULTS: After the intervention, the proportion of patients who received palivizumab injections according to AAP recommendations increased from 39% to 61% (P < 0.0001). The program decreased the proportion of unnecessary injections significantly (140/525, or 27%, in 2003-2004 to 33/323, or 10%, in 2004-2005; P < 0.0001) but did not change the proportion of missing injections. The program resulted in a significant drop (14% to 2%; P < 0.0001) in proportion of palivizumab injections that were given too late, when RSV activity had subsided. RSV hospitalization rates did not change as a result of the intervention. CONCLUSIONS: Our interventional program improved adherence to AAP guidelines mainly by decreasing the unnecessary palivizumab injections.

Linezolid for the treatment of methicillin-resistant Staphylococcus aureus infections in children.

BACKGROUND: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are becoming increasingly prevalent. Linezolid is effective and well-tolerated in the treatment of adults with MRSA infections. OBJECTIVE: To evaluate the clinical efficacy and safety of iv/oral linezolid in children with MRSA infections. METHODS: Data were obtained from two independent clinical trials. In an outpatient trial children (5 to 17 years of age) with uncomplicated skin and skin structure infections (SSSIs) were treated with linezolid or cefadroxil. In an inpatient trial hospitalized children (0 to 11 years of age) with pneumonia, bacteremia or complicated SSSI caused by resistant Gram-positive pathogens were administered iv linezolid with the option to switch to oral suspension (patients >90 days of age) or iv vancomycin. A subset of patients with MRSA infections from the two clinical trials is analyzed herein. RESULTS: In the outpatient trial children with skin infections caused by MRSA were treated with linezolid (15 patients) and cefadroxil (10 patients). In the microbiologically evaluable population, the clinical cure rate was 92.3% in the linezolid group and 85.7% in the cefadroxil group (P = 0.64). The pathogen eradication rate for MRSA was 92.3 and 85.7% in the linezolid and cefadroxil groups, respectively (P = 0.64). There were very few adverse events or drug-related adverse events and no serious adverse events in the outpatient trial. In the inpatient trial 20 children treated with linezolid and 14 treated with vancomycin had infections caused by MRSA. In the microbiologically evaluable population, the clinical cure rate was 94.1% in the linezolid group and 90.0% in the vancomycin group (P = 0.69). Pathogen eradication rates were 88.2 and 90.0% for the linezolid and vancomycin groups, respectively (P = 0.89). Susceptibility patterns of the MRSA isolates showed distinct patterns between the outpatient and inpatient trials. In the inpatient trial fewer patients in the linezolid group had drug-related adverse events than did those in the vancomycin group (20% vs. 43%; P = 0.15). CONCLUSIONS: Intravenous/oral linezolid is effective and well-tolerated in children with MRSA infections.