Search

INTRODUCTION Team-based care, established as the gold standard model for providing care more than a decade ago, (1) allows integrated clinical teams with different and complementary skills and perspectives to [...], PURPOSE Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care. https://doi.org/10.1370/afm.3099

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, is a global public health issue; 8.6 million incident cases and 1.3 million deaths were attributed to TB in 2012 (1). A [...]

Background: Measuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution. Methods: Our study included events documented in the electronic health records (EHRs) among hospitalized patients at Denver Health Medical Center during January 1, 2017 to December 31, 2018. Multiple EHR markers (ie, opioid-related diagnostic codes, clinical assessment, laboratory results, and free-text documentation) were used to develop diagnosis-based and extended definitions for OUD, opioid misuse, and opioid poisoning. We used these definitions to estimate number of hospitalized patients with these conditions. Results: During a 2-year study period, 715 unique patients were identified solely using opioid-related diagnostic codes; OUD codes accounted for the largest proportion (499/715, 69.8%). Extended definitions identified an additional 973 unique patients (~136% increase), which includes 155/973 (15.9%) who were identified by a clinical assessment marker, 1/973 (0.1%) by a laboratory test marker, and 817/973 (84.0%) by a clinical documentation marker. Conclusions: Solely using diagnostic codes to estimate prevalence of clinically relevant ORHPs missed most patients with ORHPs. More inclusive estimates were generated using additional EHR markers. Improved methods to estimate ORHPs among a health care system's patients would more fully estimate organizational and economic burden to more efficiently allocate resources and ensure capacity to provide clinical services. [ABSTRACT FROM AUTHOR]

The current investigation evaluated body water changes and indicators of heat tolerance with 28 days of creatine (CR) or placebo (PLC) supplementation. Twenty college-aged males were assigned to receive creatine or placebo in a randomized double blind fashion. Body weight, body water, hematocrit, and body composition were measured before and after the treatment period. Additionally, heart rate and core temperature responses to 60 minutes of exercise in the heat (37°C, 25% RH) were assessed. The CR group had greater gains in total body water (p=0.050) and body weight (p=0.034) than the PLC group. The rise in core temperature during the cycle ride was attenuated by creatine supplementation in comparison to placebo consumption. Gains in total body water over the four weeks were related to the attenuation of temperature rise during the ride following supplementation (n=19; r=0.569, p=0.011). No significant differences were detected for percent body fat, hematocrit values, or heart rate response to exercise. These results suggest that body weight gains with CR supplementation may partially reflect body water changes and may help attenuate the thermal burden associated with exercise in the heat. [ABSTRACT FROM AUTHOR]

Persons identifying as Hispanic or Latino (Hispanic) represent the second largest racial/ethnic group in the United States (1), yet understanding of the impact of coronavirus disease 2019 (COVID-19) in this population is limited. To evaluate COVID-19 health disparities in the community and inform public health, health system, and community-based interventions, local public health authorities analyzed the sociodemographic characteristics of persons who were diagnosed, hospitalized, and who died with COVID-19 in Denver, Colorado. During the first 7 months of the COVID-19 epidemic in Denver (March 6-October 6, 2020) the majority of adult COVID-19 cases (54.8%), hospitalizations (62.1%), and deaths (51.2%) were among persons identifying as Hispanic, more than double the proportion of Hispanic adults in the Denver community (24.9%) (1). Systemic drivers that influence how Hispanic persons live and work increase their exposure risks: compared with non-Hispanic persons, Hispanic persons with COVID-19 in Denver reported larger household sizes and were more likely to report known exposures to household and close contacts with COVID-19, working in an essential industry, and working while ill. Reducing the disproportionate incidence of COVID-19 morbidity and mortality among Hispanic persons will require implementation of strategies that address upstream social and environmental factors that contribute to an increased risk for both infection and transmission and that facilitate improved access to culturally congruent care., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

This investigation compared how perceived memory ability or level of worry about memory related to performance on objective tests of memory and cognition. Data from 1,488 participants from the Baltimore cohort of the Epidemiologic Catchment Area study were analyzed. Significant associations were found between self-ratings of memory and each of four objective measures of cognitive functioning. Memory worry was associated with worse delayed recall but not with worse word recognition, lower current Mini-Mental State Examination (MMSE) score, or greater change in MMSE score over time. Individuals experiencing changes in cognitive function appear to have some awareness of their condition, and a simple probe of a person's perception of memory in the context of a general medical evaluation may help identify those who need further assessment.