Cost of health care utilization among homeless frequent emergency department users

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity

Investigating Gender Disparities in Internal Medicine Residency Awards

Background: Significant gender disparities persist in career advancement for physicians. Studies have highlighted the lack of female representation in awards from both academic institutions and professional societies; these awards play a role in promotions, making them a fundamental building block of success. Objectives: We aim to explore the gender breakdown among resident awards presented by several Internal Medicine residency programs across the United States in this pilot study. Our ultimate goals are to define disparities in award selection, determine what variables contribute to these disparities, and work to mitigate these variables. Methods/Research: We generated a survey in REDCap to collect retrospective data about resident award selection from academic Internal Medicine residency programs across the country. This survey gathered awards data from 2009-2019 and included variables such as gender breakdown of the program, gender of resident award recipients, and details about how awards are selected. Eight programs completed the survey; these programs were from six different states in various geographic regions. Overall 43.1 percent of residents were female. Across all residency programs and years, there were 51 distinct resident awards with 290 (39.7%) female winners. Of the 51 distinct awards, there were 10 which were awarded to female residents with the same or higher frequency as males; 6 of these mentioned words that have been differentially associated with women in medicine such as “ambulatory,” “community,” “compassion,” and “humanism.” In the 41 awards favoring males, there was only a single mention of the word “compassion,” and no mention of the others. Conclusions/Impact: This data shows a concerning disparity in gender of award winners. In the future we will collect data from more residency programs and perform a thorough investigation of selection mechanisms that may help mitigate bias in order to ultimately propose strategies to reduce these gender disparities.https://jdc.jefferson.edu/sexandgenderhealth/1007/thumbnail.jp

IM with Her: Fostering Career Advancement of Female Internal Medicine Residents

Background: Despite the rising number of matriculating female medical students, a gender gap favoring men exists in multiple arenas within academic medicine. Prior studies suggest that gender-specifc professional networking groups increase the likelihood of women attaining leadership positions. Objectives: Our goal was to create a multidisciplinary group with a flat hierarchy within the Internal Medicine Department in order to foster mentorship, sponsorship, allyship, and scholarship to ultimately improve professional advancement opportunities for female internal medicine residents. Methods/Research: A group named “IM with Her” was created at Thomas Jefferson University Hospital in July 2018. IM with Her is composed of internal medicine residents and faculty of all genders. The group has hosted monthly onehour conferences called “Monday Mentors” that pair a resident with a faculty member to host a discussion surrounding a topic of their choosing related to adversity and disparity faced by female physicians. Additionally, the group has held periodic evening sessions discussing topics such as salary and contract negotiation. Conclusions/Impact: The IM with Her group has made significant progress toward its goals. The pairing of a resident and faculty member for Monday Mentors discussions allows for one-on-one mentorship regarding both personal and professional topics. These sessions also provide dedicated time for networking amongst residents and faculty, facilitating sponsorship and allyship. Additionally, the sessions often lead to further initiatives spearheaded by IM with Her members including scholarly projects and examinations of institutional policies (for example those surrounding sexual harassment and lactation room accessibility). In the future, IM with Her will focus on continuing to foster mentorship, sponsorship, and allyship, on advancing research related to gender disparities in medicine, and on developing institutional changes.https://jdc.jefferson.edu/sexandgenderhealth/1008/thumbnail.jp

Immunoprecipitation of [(3)H]Dihydroartemisinin Translationally Controlled Tumor Protein (TCTP) Adducts from Plasmodium falciparum-Infected Erythrocytes by Using Anti-TCTP Antibodies

Artemisinin and its derivatives are endoperoxide-containing antimalarial drugs that appear to form adducts in situ with the Plasmodium falciparum translationally controlled tumor protein (TCTP) homolog. Immunoprecipitation with antibody to recombinant TCTP suggests that adducts may form with both monomeric and dimeric TCTP

Effect of an Internet-based Curriculum on Postgraduate Education: A Multicenter Intervention

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum