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There are sex-related differences in the epidemiology, presentation, diagnostic testing, and management of ischemic heart disease in women compared with men. The adjusted morbidity and mortality are persistently higher, particularly in younger women and Blacks. Women have more angina but less obstructive coronary artery disease, which affects delays in presentation and diagnosis and testing accuracy. The nonbiological factors play a significant role in access to care, ischemic heart disease management, and guideline adherence. Future research focus includes sex-specific outcomes, characterization of the biological differences, and implementation science around quality of clinical care.

Older individuals encounter the greatest racial/gender biases. It is unknown whether younger generations, who often lead culture shifts, have racial and gender biases against older populations. Using Amazon’s Mechanical Turk’s crowdsourcing, we identified how an individual’s race and gender are associated with perceptions of individuals aged mid-60s. Participants were asked to rate photograph appearances on Likert Scale (1–10). Interactions between participant and photograph race and gender were assessed with mixed effects models. Delta represents rating differences (positive value higher rating for Whites or women, negative value higher rating for African-Americans or men). Among 1563 participants (mean 35 years ± 12), both non-Hispanic White (WP) and all Other race/ethnicity (OP) participants perceived African-American photos as more trustworthy [Delta WP -0.60(95%CI–0.83, − 0.37); Delta OP − 0.51(− 0.74,-0.28), interaction p = 0.06], more attractive [Delta non-Hispanic White participants − 0.63(− 0.97, − 0.29); Delta Other race/ethnicity participants − 0.40 (− 0.74, − 0.28), interaction p

Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are clinically and molecularly heterogeneous clonal myeloid disorders with a poor prognosis especially in the relapsed refractory setting and in patients above the age of 60. While allogeneic hematopoietic stem cell transplantation (ASCT) is a potentially curative approach, high relapse, morbidity, and mortality rates necessitate the development of alternative therapies. Immune checkpoint inhibitors unmask tumoral immune tolerance and have demonstrated efficacy in the treatment of chemotherapy-resistant hematologic and solid malignancies. The rationale for the investigation of those agents in AML and MDS is supported by an observed increased expression of programmed cell death 1 protein (PD-1) and ligand 1 (PD-L1) in the hematopoietic microenvironment of AML and MDS, and its association with low TP53 and a poor prognosis. Early clinical experience in combination with a hypomethylating agent has shown encouraging responses; however, larger clinical trials are needed to determine the role of checkpoint inhibition in myeloid malignancies.

Importance Racial bias is associated with the allocation of advanced heart failure therapies, heart transplants, and ventricular assist devices. It is unknown whether gender and racial biases are associated with the allocation of advanced therapies among women. Objective To determine whether the intersection of patient gender and race is associated with the decision-making of clinicians during the allocation of advanced heart failure therapies. Design, Setting, and Participants In this qualitative study, 46 US clinicians attending a conference for an international heart transplant organization in April 2019 were interviewed on the allocation of advanced heart failure therapies. Participants were randomized to examine clinical vignettes that varied 1:1 by patient race (African American to white) and 20:3 by gender (women to men) to purposefully target vignettes of women patients to compare with a prior study of vignettes of men patients. Participants were interviewed about their decision-making process using the think-aloud technique and provided supplemental surveys. Interviews were analyzed using grounded theory methodology, and surveys were analyzed with Wilcoxon tests. Exposure Randomization to clinical vignettes. Main Outcomes and Measures Thematic differences in allocation of advanced therapies by patient race and gender. Results Among 46 participants (24 [52%] women, 20 [43%] racial minority), participants were randomized to the vignette of a white woman (20 participants [43%]), an African American woman (20 participants [43%]), a white man (3 participants [7%]), and an African American man (3 participants [7%]). Allocation differences centered on 5 themes. First, clinicians critiqued the appearance of the women more harshly than the men as part of their overall impressions. Second, the African American man was perceived as experiencing more severe illness than individuals from other racial and gender groups. Third, there was more concern regarding appropriateness of prior care of the African American woman compared with the white woman. Fourth, there were greater concerns about adequacy of social support for the women than for the men. Children were perceived as liabilities for women, particularly the African American woman. Family dynamics and finances were perceived to be greater concerns for the African American woman than for individuals in the other vignettes; spouses were deemed inadequate support for women. Last, participants recommended ventricular assist devices over transplantation for all racial and gender groups. Surveys revealed no statistically significant differences in allocation recommendations for African American and white women patients. Conclusions and Relevance This national study of health care professionals randomized to clinical vignettes that varied only by gender and race found evidence of gender and race bias in the decision-making process for offering advanced therapies for heart failure, particularly for African American women patients, who were judged more harshly by appearance and adequacy of social support. There was no associated between patient gender and race and final recommendations for allocation of advanced therapies. However, it is possible that bias may contribute to delayed allocation and ultimately inequity in the allocation of advanced therapies in a clinical setting.

In a review of the antenatal-postnatal records of 6062 patients attending the prenatal clinic at a large university perinatal center during 1980, 8.3% of the pregnant patients seen were Rho(D) negative and 91.7% were Rho(D) positive. Through routine antibody screening of all patients, 115 were found to have irregular antibodies which would otherwise not have been detected. Fifteen of these patients were Rho(D) negative, but they would have been included for antibody screening due to their Rho(D) negative status. Of the remaining 100 Rho(D) positive patients, clinically significant antibodies were observed in six patients; however, no maternal morbidity or hemolytic disease of the newborn was reported. Antecedent maternal risk factors for development of irregular antibodies were not sufficiently selective for predicting outcomes of such pregnancies. Furthermore, the only four patients with irregular antibodies requiring blood transfusion were cross-matched without difficulties. Findings suggest that screening all patients for irregular antibodies cannot be justified due to the prohibitive costs involved. However, because of the racially homogeneous population studied, variations in the frequency of red blood cell genotypes between racial groups, and the irregular pattern of occurrence of irregular antibodies, the authors believe that further studies on the clinical impact and cost-effectiveness of screening all antenatal patients for presence of irregular antibodies are necessary.

The relationship of prenatal care to perinatal outcome was studied in a racially and socioeconomically homogeneous population. All patients who were delivered at the E. H. Crump Women's Hospital and Perinatal Center from July 1 to December 31, 1979, were divided into two groups, based on the amount of prenatal care received. One group of 1,102 patients had 0 to 3 prenatal visits (average 1.43); the second group, consisting of 2,027 patients, had four or more visits (average 12.78). Both groups were similar with respect to age, marital status, previous obstetric history, and initial risk assessment. However, the group with inadequate prenatal care had significantly higher fetal, neonatal, and perinatal mortality rates.

Go~o~~~~~isacommunicable,endemicdisease transmitted almost exclusively through sexual exposure to an infected partner. Infection confers no immunity and repeated infections are, therefore, not uncommon. Depending on the population screened, prevalence rates of 2.75% to 7.5% have been reported among pregnant patients.’ Treatment of prenatal patients with positive screening tests is mandatory. Despite this, or because of this, the prevalence of gonorrhea during the intrapartum periods remains unknown. In order to test the hypothesis that a significant prevalence of gonococcal infection persists during the intrapartum period despite screening and treatment during the early antenatal period, a l-month surveillance for gonorrhea among pregnant patients during the intrapartum period was undertaken in a large city-county