Efficacy of a Social Determinants of Health Training Intervention

BACKGROUND Social determinants of health (SDOH) are circumstances, such as living and work conditions, that affect patient health outcomes and contribute to health inequalities. Understanding patients’ SDOH can help physicians recognize barriers to care. Therefore, it is important that medical students learn to gather information on SDOH from patients. METHODS Standardized patient (SP) encounters with rising third-year students were analyzed to determine if an educational intervention about SDOH increased the frequency SDOH were discussed with patients. SP encounters were randomly sampled from 2017 (pre-intervention, n1 = 37) and 2018 (post-intervention, n2 = 40) video recordings of students eliciting a new patient history in a primary care setting. Discussions regarding SDOH categories were coded by question type (yes/no versus open-ended) and the language used by the student. RESULTS The post-intervention cohort more frequently discussed all SDOH topics during their encounters except discrimination (0% for both years). However, housing, mental health, and employment were the only SDOH categories discussed more than 50% of the time for either cohort. On average, students in the post-intervention cohort asked more open-ended questions rather than yes/no questions when discussing SDOH. Open-ended questions allowed patients to give more details and sparked further conversation than yes/no questions. DISCUSSION The SDOH training intervention increased the frequency that most SDOH were discussed in patient encounters, but these data suggest there are still opportunities for more students to routinely elicit this information from patients. SDOH and open-ended questioning skills can be emphasized in medical education to help address health inequalities.https://ir.library.louisville.edu/uars/1060/thumbnail.jp

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Direct and Interactive Effects of Narcissism and Power on Overconfidence

Prior research has separately examined the influence that narcissism and power have on the general concept of overconfidence. In this article we examine the influence of narcissism on overconfidence utilizing three different methods to operationalize the overconfidence construct (Studies 1–4). In addition, we examine the role that power plays in the relationship between narcissism and overconfidence (Studies 2–4). Results indicate that both narcissism and power both individually and collectively exert an influence on overconfidence. Furthermore, when individuals who score relatively high on the Narcissistic Personality Inventory are in an elevated state of power, overconfidence is significantly higher than for individuals in a low state of power. This interaction effect, however, was only evident when high levels of narcissism were overweighted in the analyses, by, for example, oversampling (Study 4). We conclude by discussing implications and avenues for future research

Evaluation of Novel Synthetic Methods for the Preparation of the Sodium Channel Inhibitor, GW273225X

The evaluation of efficient synthetic methods for the preparation of (<i>R</i>)-2,4-diamino-5-(2,3-dichlorophenyl)-6-fluoromethylpyrimidine, GW273225X (<b>1</b>), is described. The initial synthesis using ethylfluoroacetate was evaluated against three alternative routes using either nucleophilic fluorination, electrophilic fluorination, or sodium fluoroacetate

Impact of introducing procalcitonin testing on antibiotic usage in acute NHS hospitals during the first wave of COVID-19 in the UK: a controlled interrupted time series analysis of organization-level data

Background Blood biomarkers have the potential to help identify COVID-19 patients with bacterial coinfection in whom antibiotics are indicated. During the COVID-19 pandemic, procalcitonin testing was widely introduced at hospitals in the UK to guide antibiotic prescribing. We have determined the impact of this on hospital-level antibiotic consumption. Methods We conducted a retrospective, controlled interrupted time series analysis of organization-level data describing antibiotic dispensing, hospital activity and procalcitonin testing for acute hospitals/hospital trusts in England and Wales during the first wave of COVID-19 (24 February to 5 July 2020). Results In the main analysis of 105 hospitals in England, introduction of procalcitonin testing in emergency departments/acute medical admission units was associated with a statistically significant decrease in total antibiotic use of −1.08 (95% CI: −1.81 to −0.36) DDDs of antibiotic per admission per week per trust. This effect was then lost at a rate of 0.05 (95% CI: 0.02–0.08) DDDs per admission per week. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions rather than all admissions. Introduction of procalcitonin in the ICU setting was not associated with any significant change in antibiotic use. Conclusions At hospitals where procalcitonin testing was introduced in emergency departments/acute medical units this was associated with an initial, but unsustained, reduction in antibiotic use. Further research should establish the patient-level impact of procalcitonin testing in this population and understand its potential for clinical effectiveness

Diseases and Mortalities of Fishes and Other Animals In the Gulf of Mexico

Most mortality results from natural causes including red tide which is primarily restricted to West Florida and cold-kills that have greater influence in the warmer regions of South Texas and South Florida, but also kill a significant amount of fish and other animals in the northern Gulf. With the exception of red tide and other harmful algal blooms, the health of the Gulf has not been systematically studied. Mexico has only recently started to evaluate the health of its coastlines. Mortalities of marine animals, particularly fishes, in the Gulf caused by natural and anthropogenic events seem to interact with infectious disease agents and noninfectious diseases, but the mortalities are often attributed to the disease agents alone. “Events” that cause mortalities include eutrophication; hypoxia; algal blooms; temperature, salinity, and weather extremes; and chemical and sediment pollution. “Diseases” include those caused by infectious agents, parasites, neoplasms, and developmental abnormalities. Interactions of the effects of diseases and stressful events are considered important but little investigated