Understanding the Role Street Medicine Programs Play in the Career Trajectories of Student Volunteers Who Choose to Work with Underserved Populations

INTRODUCTION: Street medicine programs utilize a nontraditional healthcare model to provide care to populations experiencing homelessness. Through street medicine programs, clinicians take to the streets to offer services to individuals who are living unsheltered. Many street medicine programs offer health professional students the opportunity to volunteer and provide care to this vulnerable population. AIM: This exploratory study aimed to answer the following question: what influence does volunteering with a street medicine program have on the career trajectories of student volunteers who ultimately choose to work with medically underserved populations (MUPs)? METHODS: This study used an exploratory mixed methods approach to answering the research question. The core ideas that emerged from the qualitative data collected from street medicine student volunteers were used to inform the development of a web-based survey administered to a broader, national sample of street medicine student volunteers. The survey included closed- and opened- ended questions, as well as demographic questions. The Health Professionals’ Attitude Towards the Homeless Inventory (HPATHI; Buck et al., 2005) questionnaire was embedded into the survey to measure students’ attitudes towards the population experiencing homelessness before and after volunteering with a street medicine program. RESULTS: The results suggested that 15 (65.22%) of the 23 participants who completed the web-based survey reported that volunteering with a street medicine program influenced their decision to ultimately work with MUPs. Of the 19 participants who provided qualitative feedback, 7 (36.84%) mentioned that their decision to work with MUPs was influenced by their increased exposure and awareness to the barriers and needs of MUPs while volunteering with a street medicine program. Additionally, 6 (31.58%) participants mentioned that their previous decision to work with MUPs was reinforced while volunteering with a street medicine program. CONCLUSION: Volunteering with a street medicine program appears to help motivate students to work with MUPs. Incorporating opportunities to volunteer with a street medicine program into current health professional school curriculum has the potential to impact a greater network of students, as well as influence decisions regarding the students’ careers

On erythema nodosum and its relationship to tuberculosis: a study of one hundred and thirteen consecutive cases

The etiology of Erythema Nodosum has for many years been the subject of much discussion, and as yet, no final agreement has been reached. In the Scandinavian countries the opinion that is it in the main a tuberculous manifestation is widely held, but in this country, rheumatism is still thought by many authors to be the predominant cause.Consideration of these divergent opinions has prompted me to investigate one hundred and thirteen consecutive cases of Erythema Nodosum seen at the Cardiff Tuberculosis Dispensary with a view to ascertaining if, in this country, tuberculosis is the significant etiological factor of this important disease.The previous literature is reviewed; the present study is reported; the results of the investigation and their significance are presented, discussed and summarised

Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use : A Systematic Review

© CSIRO 2019. Open Access Article (CC BY-NC-ND)Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.Peer reviewe

Arthritis Post-Immunotherapy for Endometrial Cancer: a case report and review of literature on the acute onset of inflammatory arthritis following PD-I inhibitor therapy in a patient with recurrent endometrial cancer

Since gaining FDA approval in 2014, pembrolizumab, a PD-1 immune checkpoint inhibitor, has been utilized in the management of cancers that progress following first-line therapy.While the pathological response to pembrolizumab is favorable, immune related adverse events (irAEs) can be elicited and require prompt diagnosis and management based on grading and severity, which can include discontinuation of immunotherapy.Our case concerns a 66-year-old female with recurrent endometrial cancer who was treated with pembrolizumab, and developed inflammatory arthritis following therapy. We provide a succinct review of the pathogenesis and risk factors associated with irAEs, as well as diagnosis and management strategies

Succenturiate Placental Lobe Abruption: a placental pathology complicating a dangerous delivery

The development of a placenta is a complex process that occurs without a clinically significant issue in most pregnancies. At times, however, the process develops in a way that isolates an island of placental tissue away from the main body, connected only by unprotected vasculature within the amniotic membranes. The vessels of this succenturiate lobe of the placenta are vulnerable both to compression or laceration, threatening the antepartum period with poor weight gain or the peripartum period with fetal distress, hemorrhage or retained products of conception. A majority of the time, this pathology is undiagnosed until recognized innocuously following delivery of the placenta. A placental abruption is a premature separation of the placenta from the uterus that can result in painful bleeding and fetal distress. This increased distress of mother or baby from continued blood loss usually necessitates delivery either vaginally, if stability is maintained, or by cesarean if it isn’t. The amount of distress correlates to where and how much of the placenta is affected. While succenturiate lobes of the placenta and placental abruptions are not routinely associated with each other, the abruption of only the succenturiate lobe of the placenta in this instance minimized the severity to the fetus, by allowing the main body of the placenta to remain intact. As the bleeding coagulated at the lobe, maternal well-being was maintained allowing enough time to complete a vaginal delivery

Robotic Hysterectomy: Surgical Approach and Outcomes Among a Large Institutional Cohort

Introduction The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature. Methods Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated. Results 826 cases of rTLH were performed during the study period. 688 of these cases were included for analysis. Malignant diagnoses were found in 218 cases. The median time from skin-to-skin for the entire cohort was 28.43 minutes for benign rTLH +/- BSO (bilateral salpingo oophorectomy) and 30.23 minutes for rTLH/BSO/cancer staging. Surgical complications included vaginal laceration, vaginal bleeding, urinary tract infection, serous fluid leakage from the incision, abdominal wall abscess, pelvic abscess, surgical site infection, serosal tear, enterotomy, rectal injury, acute kidney injury, perforated diverticulitis, and incarcerated bowel through the ventral hernia. The median length of stay was 1 day. The surgical technique is illustrated step by step. Conclusion This paper describes a safe and efficient technique to perform rTLH and shows that surgical times, complication rates, and length-of-stays compare favorably to the literature. A description of the technique clarifies many of the details of this procedure which can be made routine to minimize error and surgeon discrepancies. We encourage readers to use this paper as a guide to modify their techniques for robotically assisted laparoscopic hysterectomy

Enhancing condom use experiences among young men to improve correct and consistent condom use:Feasibility of a Home-Based Intervention Strategy (HIS-UK)

Background: Condoms remain the main protection against sexually transmitted infections (STIs) when used correctly and consistently. Yet, there are many reported barriers to their use such as negative attitudes, reduced sexual pleasure, fit-and-feel problems and erection difficulties. The UK Home-Based Intervention Strategy (HIS-UK) is a behaviour change condom promotion intervention for use among young men (aged 16-25 years) designed to increase condom use by enhancing enjoyment of condom-protected intercourse. The objective of this feasibility study was to test HIS-UK for viability, operability and acceptability. Along with an assessment of the recruitment strategy and adherence to the intervention protocol, the study tested the reliability and suitability of a series of behavioural and condom use outcome measures to assess condom use attitudes, motivations, self-efficacy, use experience, errors and problems, and fit-and-feel.Methods: The HIS-UK intervention and associated assessment instruments were tested for feasibility using a single-arm, repeated measures design with baseline measurement and two follow-up measurements over three months. A three-month target of 50 young men completing the baseline questionnaire was set. Twenty process and acceptability evaluation interviews with participants and health promotion professionals were conducted post trial. Results: Of the 61 young men who registered for the study, 57 completed the baseline questionnaire and 33 met with the study researcher to receive the HIS-UK condom kit. Twenty-one young men remained for the duration of the study (64% retention). The Cronbach’s alpha scores for the condom use outcome measures were 0.84 Attitudes, 0.78 Self-efficacy, 0.83 Use experience, 0.69 Errors and problems, and 0.75 Fit-and-feel. Participant and health professional feedback indicated strong acceptability of the intervention. Conclusions: The feasibility study demonstrated that our recruitment strategy was appropriate and the target sample size was achieved. Adherence was favourable when compared to other similar studies. The condom use measures tested proved to be fit-for-purpose with good internal consistency. Some further development and subsequent piloting of HIS-UK is required prior to a full randomised-controlled trial, including the feasibility of collecting STI biomarkers, and assessment of participant acceptance of randomisation.Trial Registration: Research registry, RR2315, 27th March 2017 (retrospectively registered)<br/

Complications and Hospital Admissions among Pregnant Women with Substance Abuse

In recent times, there has been an increase in drug abuse in not only the general population, but in women of reproductive age. Our objectives were to identify, classify, and describe the spectrum of complications, the average number of admissions, and length of hospital stay that occur among pregnant women with substance abuse. The aim was to obtain better understanding of complication prevalence to improve management in this ever-growing population. A retrospective chart review was conducted of pregnant women ages 18-45 with a history of substance abuse from 2013-2018 in the tri-state area of West Virginia, Ohio, and Kentucky. We collected the following data: demographics, medical history, specific substances abused, inpatient admission dates and diagnoses, and delivery information. A total of 411 patients met the inclusion criteria, with a total of 525 pregnancies. Out of 525 pregnancies, 71.6 % used buprenorphine (i.e., Subutex), 43.4% used opiates, excluding heroin, and 35% of patients used heroin. Out of the 525 pregnancies, there were 714 inpatient antepartum admissions. Of these, 376 were admissions due to withdrawal symptoms (52.7%). A total of 263 pregnancies had at least one admission for withdrawal, drug abuse, overdose, or buprenorphine/methadone conversion (50%). The average length of hospital stay for withdrawal admissions was 3.4 days (SD). There were 62 admissions for infectious causes, 24 of these being due to pyelonephritis (38.7%). The findings highlight multiple areas for future studies as well as areas for quality improvement in the management of this population

N- to C-sulfonyl photoisomerisation of dihydropyridinones : a synthetic and mechanistic study

The authors thank the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007–2013) ERC Grant Agreement no. 279850 (CF and JET) and EPSRC grant number EP/J018139/1 (DSBD) for funding. ADS thanks the Royal Society for a Wolfson Research Merit Award.The scope and limitations of a photoinitiated N- to C-sulfonyl migration process within a range of dihydropyridinones is assessed. This sulfonyl transfer proceeds without erosion of either diastereo- or enantiocontrol, and is general across a range of N-sulfonyl substituents (SO2R; R = Ph, 4-MeC6H4, 4-MeOC6H4, 4-NO2C6H4, Me, Et) as well as C(3)-(aryl, heteroaryl, alkyl and alkenyl) and C(4)-(aryl and ester) substitution. Crossover reactions indicate an intermolecular step is operative within the formal migration process, although no crossover from C-sulfonyl products was observed. EPR studies indicate the intermediacy of a sulfonyl radical and a mechanism is proposed based upon these observations.Publisher PDFPeer reviewe

Boss competence and worker well-being

Nearly all workers have a supervisor or “boss.” Yet little is known about how bosses influence the quality of employees’ lives. This study offers new evidence. First, the authors find that a boss’s technical competence is the single strongest predictor of a worker’s job satisfaction. Second, they demonstrate using longitudinal data, after controlling for fixed-effects, that even if a worker stays in the same job and workplace, a rise in the competence of a supervisor is associated with an improvement in the worker’s well-being. Third, the authors report a variety of robustness checks, including tentative instrumental variable results. These findings, which draw on U.S. and British data, contribute to an emerging literature on the role of “expert leaders” in organizations