Gender Identity and Pronoun Usage in Standardized Patient Encounters

The standardized documentation clinicians use to record evaluations of a patient are called Subjective, Objective, Assessment, and Plan (SOAP) notes. Consistent pronoun documentation and usage in these notes is especially important for affirming transgender and gender non-conforming patients as this population experiences significant health disparities linked to medical mistrust. A sample of SOAP notes (n=286) was taken from standardized patient encounters at the University of Louisville School of Medicine in 2017 (n=137) and 2018 (n=149). There were five case iterations of the standardized patient based on gender identity. The notes were coded using the software Dedoose for the following themes: pronouns clearly established, consistent pronoun usage, no pronoun usage, and disregard for established pronouns. Pronouns were clearly established in only 27.27% of the notes (n=78/286). Non-cisgender patients were more likely to have pronouns that were clearly established (41% vs 5%). Consistent pronoun usage was most often observed among the notes of cisgender patients. Inconsistent pronoun usage and disregard for established pronouns was observed most often for genderqueer patients (16%, n=14). Complete absence of pronoun use occurred in the notes of trans women (7%, n=3), genderqueer patients (8%, n=7), and cisgender women (3%, n=2) patients. These notes demonstrate a lack of rigor in recording pronouns accurately and consistently for patients, which can be profoundly detrimental to non-cisgender patient care. These discrepancies can be remedied by including training about gender-affirming care and interacting with non-cisgender patients in the clinical skills curriculum

Gender Identity and Pronoun Usage in Standardized Patient Encounters

One of the most common documentation frameworks clinicians use for patient evaluations are Subjective, Objective, Assessment, and Plan, (SOAP) notes. The clinician will usually record medical, family, social, etc. history as “subjective” information. Temperature, blood pressure, lab work, etc. would be considered “objective” information. An evaluation of the patient’s health and possible medical issues would be considered the “assessment,” and their intentions for current and future treatment would be the “plan” within these notes. Trainees often write SOAP notes after completing a standardized patient (SP) encounter—an educational practice used in medical schools to simulate real-world physician-patient interactions in order to develop and assess clinical reasoning skills. A standardized patient is employed to act as a patient, memorizing and reciting previously delineated information provided by medical educators

Comparing Medical Student Nonverbal Behavior With Cisgender And Transgender Standardized Patients

BACKGROUND It is essential for medical students to effectively communicate with patients of all gender identities. Nonverbal behaviors such as eye contact and nodding are key communication skills. Evaluating nonverbal behavior is one way to assess the quality of patient care, and examining providers’ behaviors while working with cisgender and transgender patients can identify potential biases linked to patient identity. METHODS To evaluate nonverbal behavior, we analyzed video-recorded training sessions with medical students interviewing standardized patients who identified as cisgender or transgender women. All students identified as cisgender men or cisgender women. Ten nonverbal behaviors were rated from 1-7 using adapted nonverbal communication scales. We also observed whether nonverbal cues were perceived to detract from the encounter. RESULTS Average scores for nonverbal behaviors were similar between students working with cisgender and transgender patients. Nodding frequency showed the largest difference between cisgender (m=5.65) and transgender (m=4.93) patients. When considering student gender identity, men had lower facial expressivity and smiling frequency scores on average but higher scores for unnecessary silence compared to women across encounters. Detracting behaviors that negatively impacted the patient encounters were most likely to be self-touching/unpurposive movements (41%) and unnecessary silences (26%). DISCUSSION The consistency in nonverbal behavior during encounters with cisgender and transgender patients is encouraging. It is possible that LGBTQ health training in medical education contributed to this outcome; however, differences in verbal communication could be more important to health disparities for transgender patients. Additional practice with unpurposive movements and unnecessary silences could improve nonverbal communication skills.https://ir.library.louisville.edu/uars/1056/thumbnail.jp

Surface activated chemical ionization - Electrospray mass spectrometry in the analysis of urinary thiodiglycolic acid

RATIONALE Thiodiglycolic acid (TDGA) is a urinary metabolite of the oxazaphosphorine class of chemotherapeutics, in particular of ifosfamide. Ifosfamide metabolism generates chloroacetaldehyde (CAA), a toxic compound associated with neurotoxicity, nephrotoxicity, urotoxicity and cardiotoxicity. CAA, in turn, interacts with cellular thiol groups leading to GSH depletion, cell death and generation of thiodiglycolic acid (TDGA), as a final product. TDGA is mainly excreted in the urine. The ability to accurately measure TDGA in urine, therefore, will be a useful way of monitoring the ifosfamide exposure during chemotherapy. METHODS TDGA in urine samples was measured with liquid chromatograpy coupled to mass spectrometry (LC-MS) by means of a novel Surface Activated Chemical Ionization - Electrospray (SACI-ESI) or a classical ESI ion source alone. RESULTS The SACI - ESI and ESI alone based methods for analysis of urinary TDGA were optimized and compared. A strong reduction in matrix effect together with enhanced quantification performances was obtained with the SACI \u2013 ESI when compared with the ESI. In particular, an increase in quantification precision (from 85 to 95%) and accuracy (from 59 to 90%) were observed, which allowed for optimal detection of TDGA. CONCLUSIONS The LC-SACI-ESI-MS approach provides a very sensitive and quantitative method for the analysis of TDGA. Thanks to sensitivity enhancement and matrix effect reduction, the SACI \u2013 ESI enables the use of a relatively low cost ion-trap mass spectrometer in the analysis of this toxicity biomarker in urine. Due to these characteristics, this approach would constitutes an invaluable tool in the clinical laboratory, for measuring TDGA and other toxicity related biomarkers of chemotherapy with proper sensitivity and accuracy

The Nature and Frequency of the Gas Outbursts in Comet 67P/Churyumov-Gerasimenko observed by the Alice Far-ultraviolet Spectrograph on Rosetta

Alice is a far-ultraviolet imaging spectrograph onboard Rosetta that, amongst multiple objectives, is designed to observe emissions from various atomic and molecular species from within the coma of comet 67P/Churyumov-Gerasimenko. The initial observations, made following orbit insertion in August 2014, showed emissions of atomic hydrogen and oxygen spatially localized close to the nucleus and attributed to photoelectron impact dissociation of H2O vapor. Weaker emissions from atomic carbon were subsequently detected and also attributed to electron impact dissociation, of CO2, the relative H I and C I line intensities reflecting the variation of CO2 to H2O column abundance along the line-of-sight through the coma. Beginning in mid-April 2015, Alice sporadically observed a number of outbursts above the sunward limb characterized by sudden increases in the atomic emissions, particularly the semi-forbidden O I 1356 multiplet, over a period of 10-30 minutes, without a corresponding enhancement in long wavelength solar reflected light characteristic of dust production. A large increase in the brightness ratio O I 1356/O I 1304 suggests O2 as the principal source of the additional gas. These outbursts do not correlate with any of the visible images of outbursts taken with either OSIRIS or the navigation camera. Beginning in June 2015 the nature of the Alice spectrum changed considerably with CO Fourth Positive band emission observed continuously, varying with pointing but otherwise fairly constant in time. However, CO does not appear to be a major driver of any of the observed outbursts.Comment: 6 pages, 4 figures, accepted for publication in the Astrophysical Journal Letter

Response to comment on "Human-specific gain of function in a developmental enhancer"

Duret and Galtier argue that human-specific sequence divergence and gain of function in the HACNS1 enhancer result from deleterious biased gene conversion (BGC) with no contribution from positive selection. We reinforce our previous conclusion by analyzing hypothesized BGC events genomewide and assessing the effect of recombination rates on human-accelerated conserved noncoding sequence ascertainment. We also provide evidence that AT → GC substitution bias can coexist with positive selection

Temperature dependence of surface reconstructions of Au on Pd(110)

Surface reconstructions of Au film on Pd(110) substrate are studied using a local Einstein approximation to quasiharmonic theory with the Sutton-Chen interatomic potential. Temperature dependent surface free energies for different coverages and surface structures are calculated. Experimentally observed transformations from $(1\times1)$ to $(1 \times 2)$ and $(1 \times 3)$ structures can be explained in the framework of this model. Also conditions for Stranski-Krastanov growth mode are found to comply with experiments. The domain of validity of the model neglecting mixing entropy is analyzed.Comment: 7 pages, REVTeX two-column format, 3 postscript figures available on request from [email protected] To appear in Phys. Rev. Letter