Person-Centered Care Starts with Community-Centered Medical Education: Medical Education Must Answer the Call for Diversity

Civil unrest is a call for realignment of values in all aspects of society, including medical education. Systematic difference in the treatment of groups of individuals concerning educational curricula has previously been highlighted in South Africa during student-led campaigns to decolonialize and diversify medical curricula1. Institutional resistance that results in a failure to account for the politics of identity or for pluralistic thinking,1 implies that the academic ‘fence of unambiguous knowledge’ not only creates an ivory tower but it may simultaneously insulate itself from community input and access. Confronting the tension between communal meaning (which sanctions a culturally relevant curriculum) and privileged meaning (which derives from a monolithic mindset) demands that educators recognize that the scientific method is only one ‘way of knowing.’ In this manuscript we ask: Who possesses authoritative medical meaning-making? And, Who confers authoritativeness to academia

Scientific productivity: An exploratory study of metrics and incentives

<div><p>Competitive pressure to maximize the current bibliometric measures of productivity is jeopardizing the integrity of the scientific literature. Efforts are underway to address the ‘reproducibility crisis’ by encouraging the use of more rigorous, confirmatory methods. However, as long as productivity continues to be defined by the number of discoveries scientists publish, the impact factor of the journals they publish in and the number of times their papers are cited, they will be reluctant to accept high quality methods and consistently conduct and publish confirmatory/replication studies. This exploratory study examined a sample of rigorous Phase II-IV clinical trials, including unpublished studies, to determine if more appropriate metrics and incentives can be developed. The results suggest that rigorous procedures will help reduce false positives, but to the extent that higher quality methods are accepted as the standard of practice, the current bibliometric incentives will discourage innovative studies and encourage scientists to shift their research to less informative studies of subjects that are already being more actively investigated. However, the results also suggest that it is possible to develop a more appropriate system of rewards. In contrast to the current bibliometric incentives, evaluations of the quality of the methods and reproducibility of the results, innovation and diversity of thought, and amount of information produced may serve as measures and incentives that maintain the integrity of the scientific literature and maximize scientific progress.</p></div

Research activity levels by study outcome.

<p>The number of papers published each year on the same topics as the studies included in the present analysis (means ± SEM). Publication years range from two years before (-2) until two years after the year the studies included in the present analysis were either completed or published (year 0). For example, even two years before the publication of the studies reporting positive results, on average, 544 ± 92 papers were already being published each year on those same topics. Two years before the publication of the studies reporting negative results, only 102 ± 56 papers were being published each year on those topics.</p

The current bibliometrics incentives model.

<p>The current bibliometrics incentives model.</p

Studies divided into 5 groups based on research activity levels.

<p>Studies divided into 5 groups based on research activity levels.</p

Success rates increase and number of topics decrease as research activity levels increase.

<p>(A) Percent successful, or positive, statistically significant results, at median activity levels for 5 equal groups (n’s = 22). (B) The number of interventions or topics of research is shown at each activity level. Symbol size indicates the number of studies being conducted on the same topic. The Y axes is inverted in this panel in order to convey the concept that, over time, only a small number of reliable findings rise to the top.</p

Sarcoidosis and Systemic Sclerosis: Strange Bedfellows

Coexistence of systemic sclerosis and sarcoidosis is rare. Both have predominant lung manifestations, each with distinctive features on computed tomography (CT) of the chest. We present herein a 52-year-old male with limited systemic sclerosis manifested primarily by sclerodactyly and subsequently by shortness of breath. A series of CT scans of the chest were reviewed. Initial CT chest one year prior to sclerodactyly onset revealed bilateral hilar and right paratracheal, prevascular, and subcarinal adenopathy. Five-year follow-up demonstrated thin-walled cysts, mediastinal lymphadenopathy, and nonspecific nodules. Due to progression of dyspnea, follow-up CT chest after one year again demonstrated multiple cysts with peripheral nodularity and subpleural nodules, but no longer with hilar or mediastinal adenopathy. Diagnostic open lung biopsy was significant for noncaseating granulomas suggestive of sarcoidosis. This is the first known case of a patient with systemic sclerosis diagnosed with sarcoidosis through lung biopsy without radiographic evidence of hilar or mediastinal lymphadenopathy at the time of biopsy. A review of cases of concomitant sarcoidosis and systemic sclerosis is discussed, including the pathophysiology of each disease with shared pathways leading to the development of both conditions in one patient

Atypical manifestations of sarcoidosis in a Hispanic male

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that can present with nonspecific features, often resulting in delayed diagnosis. The diagnosis requires the demonstration of non-caseating granulomas on biopsy. While the prevalence of sarcoidosis in the USA is rare, the disease is rarer yet in Hispanics. It is for this reason that we report herein the case of a Hispanic gentleman with a unique clinical manifestations of sarcoidosis. With what began as a two-month history of joint pain and skin rash, this 55-year-old man was hospitalized with multiple joint pain, weight loss, fatigue and a pruritic rash with leonine facies in the setting of anemia, leukopenia, hypercalcemia, elevated serum creatinine, and urine Bence-Jones proteinuria. CT imaging of the chest was nonspecific, but skin biopsy revealed non-caseating granulomatous disease. After completing an infectious and malignancy evaluation, the patient was diagnosed with sarcoidosis, which was treated successfully with low-dose steroid therapy

Drivers of Satisfaction With Care for Patients With Lupus

Objective. Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE. Methods. A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA-SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors. Results. The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC. Conclusion. Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient\u2019s external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes