Search

Background and Objectives: Many medical schools have implemented primary care tracks to increase the number of medical students pursuing primary care. The Primary Care Program (PCP) at the Keck School of Medicine of University of Southern California is a 4-year primary care pathway that trains medical students to work in urban, underserved communities and has shown high student match rates into primary care residencies. This study evaluates the PCP graduates in residency and after residency, and assesses their career outcomes, their career characteristics, and the impact their PCP experience had on their careers., Methods: All PCP alumni who graduated between 2015 and 2022 were invited to complete a 21-item Qualtrics (Qualtrics, LLC) survey. Descriptive data analysis was conducted through Qualtrics, and open-ended data were coded for themes., Results: Seventy percent of PCP alumni (86/122) responded to the survey, with 65% (56/86) in residency/fellowship and 35% (30/86) in practice. Among those who matched into primary care residencies (61/86, 71%), the percentage that practiced or intended to practice general primary care was 70% (43/61). Respondents in practice (30) described their practice characteristics, including locations and payor mix consistent with majority underserved communities. Open-ended responses captured the impact that the PCP had on alumni's careers, with themes including mentorship, friendship/community, educational/service experiences, future career, exposure to types/kinds of practice, and social determinants of health exposure., Conclusions: PCP alumni credit this program with impacting their retention in primary care and their career trajectories. This program can serve as a model for other institutions to help increase the number of medical students who pursue primary care careers.

Importance: In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education., Objective: To recommend nutrition competencies for inclusion in medical education to improve patient and population health., Evidence Review: The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies., Findings: A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations., Conclusions and Relevance: These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations.

While a growing body of interprofessional education (IPE) literature demonstrates a positive impact on learner knowledge, there is limited data on its long-term impact on collaborative practice (CP). With the growth of the aging population globally, understanding both the long-term impact on CP and sustainability of community-based geriatric experiential IPE programs are imperative. This study explores the impact of the Interprofessional Geriatric Curriculum (IPGC), a community-based geriatric IPE program, on post-graduate clinical practice among seven health professions. This study utilized a cross-sectional descriptive design, where both qualitative and quantitative data were collected in the same online survey of health professionals' to measure their perceptions of the impact IPGC has had on their respective clinical practice 1-3 years post-graduation. Forty-six per cent of health profession graduates provided clinical care for people 65 years of age or older; 81% worked in interprofessional teams; 80% reported the IPGC experience significantly impacted their practice (N = 137), and all used validated assessment tools taught in the IPGC program in their practice. Eight themes emerged from the list of what health professionals learned from IPGC that they use regularly in their clinical practice: four themes were interprofessional in nature (i.e. teamwork and team-based care, interprofessional communication, roles/responsibilities, and personal/professional) and four themes related to geriatrics (i.e. aging, screening and assessment, medications, and didactic content). This study is one of the first to describe the sustained influence of a community-based IPE program across multiple health professional disciplines on clinical geriatric practice.

Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In the past decade, medical education has increasingly incorporated evidence-based lifestyle interventions as primary strategies for preventing and managing noncommunicable diseases. This shift embraces the growing recognition of the significant impact of lifestyle on health outcomes, driving diseases including obesity, diabetes, heart disease, and cancer. Now deemed "food is medicine" (FIM), diet-related interventions witnessed integration into healthcare systems and recognition in the United States' White House Conference on Hunger, Nutrition, and Health in 2023. As FIM gains traction, investigating optimal strategies for team-based education becomes essential. Healthcare teams need the necessary knowledge and tools to effectively administer FIM services and collaborate across disciplines, ultimately enhancing disease prevention, chronic disease management, health quality, value, and overall wellness. Culinary medicine (CM), a vital component of FIM, bridges nutrition education, pragmatic culinary skills, and conventional strategies to improve chronic disease management. CM involves experiential learning, imparts practical skills, and encourages behavior change by addressing food-related determinants of health and promoting equitable access. Teaching kitchens serve as physical or virtual learning spaces and as a didactic and experiential method (skills lab), playing a crucial role by integrating culinary, lifestyle, integrative, and conventional medicine. A growing number of medical schools in the United States and globally offer CM education via diverse methods including interest groups, electives, and specialty tracks, encompassing didactic sessions, hands-on kitchen education, and virtual teaching methods. Given the rising demand for CM programs, this article aims to describe, map, and compare existing CM education types in medical education. It provides actionable recommendations for medical schools to establish and expand CM programs by fostering service-learning partnerships, clinical innovation, and interdisciplinary research. As FIM gains prominence, cultivating a robust foundation of educational strategies is vital to ensure seamless integration into both medical education and collaborative medical practice., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: Nutrition education remains inadequate in American medical schools, and physicians often cite lack of nutrition knowledge as a barrier to counseling patients. The goal of this study was to evaluate the impact of additional nutrition curriculum on first-year medical students., Methods: We created a 1-hour nutrition lecture, delivered to first-year medical students. Using pre-, post-, and 3-month follow-up surveys, we assessed the following: (1) change in student knowledge; (2) confidence in counseling patients; (3) motivation to change their personal dietary behaviors; and (4) satisfaction with the curriculum. We assessed objectives using multiple choice questions and 10-point Likert scale questions., Results: Of the 142 students who attended the live lecture, 105 (73.9%) completed both pre- and postsurveys, and 65 (45.8%) completed the 3-month follow-up survey. Students' knowledge of the material increased from 37% to 82%, but retention dropped to 65% at the 3-month mark ( P <.001). Comfort in assessing and counseling patients improved across the three survey iterations, from 3.53 to 5.90 to 8.00 ( P <.001). Motivation to change personal behaviors was high overall at 8.04, 8.36 and 8.25 [ P <.05]). Moreover, students were satisfied with the lecture, with a rating of 8.58/10., Conclusions: This study supports the value of additional medical student nutrition education. This curriculum significantly increases student knowledge, comfort with the material, and confidence in counseling their future patients. A longitudinal curriculum that reinforces concepts over time will help improve long-term retention., (© 2024 by the Society of Teachers of Family Medicine.)

Background and Purpose: Survival is frequently assessed using Cox proportional hazards (CPH) regression; however, CPH may be too simplistic as it assumes a linear relationship between covariables and the outcome. Alternative, non-linear machine learning (ML)-based approaches, such as random survival forests (RSFs) and, more recently, deep learning (DL) have been proposed; however, these techniques are largely black-box in nature, limiting explainability. We compared CPH, RSF and DL to predict overall survival (OS) of non-small cell lung cancer (NSCLC) patients receiving radiotherapy using pre-treatment covariables. We employed explainable techniques to provide insights into the contribution of each covariable on OS prediction., Materials and Methods: The dataset contained 471 stage I-IV NSCLC patients treated with radiotherapy. We built CPH, RSF and DL OS prediction models using several baseline covariable combinations. 10-fold Monte-Carlo cross-validation was employed with a split of 70%:10%:20% for training, validation and testing, respectively. We primarily evaluated performance using the concordance index (C-index) and integrated Brier score (IBS). Local interpretable model-agnostic explanation (LIME) values, adapted for use in survival analysis, were computed for each model., Results: The DL method exhibited a significantly improved C-index of 0.670 compared to the CPH and a significantly improved IBS of 0.121 compared to the CPH and RSF approaches. LIME values suggested that, for the DL method, the three most important covariables in OS prediction were stage, administration of chemotherapy and oesophageal mean radiation dose., Conclusion: We show that, using pre-treatment covariables, a DL approach demonstrates superior performance over CPH and RSF for OS prediction and use explainable techniques to provide transparency and interpretability., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bilal A. Tahir reports financial support was provided by Yorkshire Cancer Research. Jim M. Wild reports financial support was provided by UKRI Medical Research Council., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Exercise is a pivotal tool in the prevention and management of chronic disease, a cornerstone of primary care. Yet, there is little formal exercise education in medical school and many medical students feel unprepared to effectively counsel patients about exercise. Since 2019, medical students in the Primary Care Program (PCP), a primary care-focused educational track, at the Keck School of Medicine (KSOM) of the University of Southern California (USC) have taught exercise classes to the local community as part of a service-learning experience. Students receive lectures on exercise from faculty and then deliver curated bilingual English/Spanish presentations and lead exercise classes for the community. Post participation in this program, students reported (1) increased knowledge of exercise principles, (2) increased predicted likelihood of counseling patients about exercise, (3) increased confidence in providing exercise counseling, and (4) intent to make positive changes in their own exercise habits. This curriculum provides a replicable lifestyle medicine model for other medical schools seeking to enhance exercise education and train the next generation of primary care physicians., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Background and Objectives: Primary care supports the global health care system. With an increased need for primary care physicians, medical schools must provide resources, role models, and opportunities to increase the number of medical students matching into primary care residencies. Some medical schools have developed primary care pipeline programs for students. The outcomes of one such program-the Primary Care Program (PCP)-at the Keck School of Medicine (KSOM) of the University of Southern California (USC), an urban and private academic medical training center, are evaluated here., Methods: We reviewed PCP student outcome data for students who graduated between 2015 and 2022. Data were gathered through surveys, residency match lists, and graduation records., Results: Among PCP matriculates (n=134), 70% were female and 39% were underrepresented in medicine. Thirteen percent (n=16) of PCP graduates (n=122) completed a master of public health (MPH) degree. Among PCP graduates, 70% matched into primary care residencies compared to 36% of non-PCP graduates (P&lt;.001). The most common residencies that PCP graduates matched into were family medicine (n=45, 37%), internal medicine (n=20, 16%), pediatrics (n=12, 10%), surgery (n=10, 8%), and psychiatry (n=9, 7%). A higher percentage of KSOM students matched into primary care residencies in the 8 graduation years after PCP was instituted (39%) than in the 8 graduation years before PCP was instituted (33%, P=.003)., Conclusions: The PCP data demonstrate the program's success at increasing the number of KSOM graduates matching into primary care residencies. The program provides a replicable training model.

Background: Substance use is a public health crisis that requires improved education on substance use disorders (SUDs) in medical school curriculum to ensure that the future generation of physicians is prepared to care for this growing patient population., Objectives: This study evaluates how the implementation of an online and in-person addiction medicine course impacted medical students' knowledge on SUD and caring for patients with SUD., Methods: 86 third-year and fourth-year medical students participated in either an online or in-person elective course on addiction medicine. Students learned about SUDs through various modalities, such as online SUD modules, clinical encounters, movies, books, participation in support group meetings and learning evidence-based tools to screen or treat patients. To assess the impact of the course curriculum on students' knowledge in treating SUDs, a pre and post survey was administered and analyzed., Results: After completing the SUD course, students showed significant improvement ( P  < 0.01) in caring for SUD patients. Specifically, they improved in the areas of: assessing a patient with SUD, comfort and knowledge in using motivational interviewing to affect behavior change in a patient with a SUD, and knowledge of community resources related to SUD. Students also showed a significant improvement ( P  < 0.01) in the number of unique SUDs (such as opioids or alcohol) they felt knowledgeable about and in the number of treatment modalities for unique SUDs., Conclusions: Implementation of an addiction medicine course that utilizes various teaching modalities can significantly improve medical students' fundamental knowledge on SUD.

Background and Objectives: The rapid increase in the older adult population necessitates an increase in physicians who are adept at caring for the various medical comorbidities that accompany aging. To fill the gap in geriatric medical education and overcome barriers to medical student interest in geriatrics, we developed a friendly caller program that links medical students to older adults through multiple weekly phone calls. This study examines the impact of this program on geriatric care competency, a foundational skill for primary care physicians, in first-year medical students., Methods: We used a mixed-methods design to measure how medical students' self-assessed geriatric knowledge was impacted by their longitudinal interactions with seniors. We compared pre- and postsurvey data using a Mann-Whitney test. We used deductive qualitative analysis to examine themes that emerged from narrative feedback., Results: Our results demonstrated that students (n=29) showed a statistically significant increase in components of their self-assessed geriatric care competency. Qualitative analysis of student responses revealed five common themes: transformation of preconceived notions regarding older adults, relationship building, greater understanding of older adults, communication skills, and self-compassion., Conclusions: Given the shortage of physicians competent in geriatric care amid a rapidly growing older adult population, this study highlights a novel, older adult service-learning program that positively impacts geriatric knowledge in medical students.

Purpose of Review: This study aims to assess recent literature published on the post-acute care needs of cancer patients, specifically focusing on the acute inpatient rehabilitation setting., Recent Findings: The neurologic cancer population appears to be the most studied oncologic population in acute inpatient rehabilitation studies within the past 5 years. This finding is consistent with prior findings from the past several decades. Recent trends in inpatient cancer rehabilitation note a population with lower admission functional status and shorter lengths of stay compared to prior studies. Despite these findings, the percentage discharged to the community remains high. With new treatments yielding improved survival, cancer patients may live longer and risk accumulating more functional impairments. Physicians involved in their care must understand post-acute care needs and work in a multidisciplinary group to best determine post-acute disposition. This decision remains very individualized and should consider both oncologic and functional needs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.

Introduction: Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project., Methods: To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ 2 analysis determined significance at P <.05., Results: We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P <.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%)., Conclusions: Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship., (© 2022 by the Society of Teachers of Family Medicine.)

Training health professional students to work with older adults will improve future workforce capacity to meet growing needs. Additionally, older adults may benefit from health education and interactions with health professional students. We analyzed survey responses from older adults who had participated in an interprofessional health student education program regarding their experiences. Qualitative data were summed and averaged, and quantitative survey data were analyzed with Fisher's Exact Test. At least 60% of participants reported receiving information for health needs or making changes to physical activity, dental care, or diet. The most significant differences in lifestyle modifications were noted among racial and ethnic minorities and among speakers of different primary languages. 64% of the qualitative responses reflected positive affirmation of the program. Our data suggest that interactions with health students are meaningful experiences for older adults, are associated with healthy habit changes, and reflect demographic differences in response to health education., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objective: To obtain useful information for clinicians in evaluating patients with brain tumors for transfer to and subsequent care in inpatient rehabilitation facilities (IRFs)., Design: Retrospective chart review., Setting: Inpatient rehabilitation facility., Participants: A total of 208 adults with either initial or recurrent brain tumors who were admitted to an IRF between January 2017 and December 2018 after an acute hospitalization., Interventions: None MAIN OUTCOME MEASURES: Transfer from an IRF to an acute care hospital and mortality within 6 months from admission to an IRF., Results: Of the 208 patients who met inclusion criteria, 20.2% were transferred to an acute care hospital during the IRF stay, which was associated with prior chemotherapy, steroid use, and laterality of tumor. In total, 36.9% of patients with brain tumors died within 6 months of an IRF admission that was associated with recurrent tumor diagnosis, prior chemotherapy, prior neurosurgical intervention, prior neurostimulant use, use of steroids, isocitrate dehydrogenase and O6-methyl-guanyl-methyl-transferase biomarkers, and laterality and location of tumor., Conclusions: Patients with brain tumors have a notable potential for acute hospital transfer and mortality within 6 months of IRF stay, with several tumor- and treatment-related risk factors. This information can help identify functional goals, identify high risk patients, enable closer clinical monitoring, and facilitate focused care discussions at IRFs., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Tattoos of formerly gang-involved and incarcerated individuals can negatively impact their ability to reintegrate into society. Laser tattoo removal is essential to helping individuals obtain employment, re-cultivate positive relationships, and disengage from gangs. The objective of this study is to describe the demographics and motivations for laser tattoo removal at a large nonprofit clinic. This was a single center retrospective study conducted on patients presenting to Ya'stuvo Tattoo Removal between January 2016-December 2018 and had at least three laser tattoo removal sessions. Data was recorded on patient demographics, geographic location of residence (e.g. zipcode), comorbidities, probation/parole status, referral source, transportation mode, and motivations for receiving and removing tattoos. A representative sample of 862 patients was used to conduct our analysis. Average age at first visit was 30. 16% (n = 134) were on probation, 8% (n = 66) were on parole, and 63% (n = 544) did not report their probation/parole status. Reasons for receiving a tattoo included gangs (46%, n = 368), a current or ex-relationship (28%, n = 223), and decoration (20%, n = 159). The most common reasons for tattoo removal were employment (66%, n = 546), readiness to change life (47%, n = 392), maturity (47%, n = 392), family (43%, n = 356), and negative attention from tattoos (37%, n = 303). The current study highlights the importance of laser tattoo removal in reintegration and gang disengagement. Expanding cost efficient laser tattoo removal is paramount to meet the safety and socioeconomic needs of this population., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: A growing need exists to train physicians in population health to meet the increasing need and demand for physicians with leadership, health data management/metrics, and epidemiology skills to better serve the health of the community. This study examines current trends in students pursuing a dual doctor of medicine (MD)-master of public health (MPH) degree (MD-MPH) in the United States., Methods: We conducted an extensive literature review of existing MD-MPH databases to determine characteristics (eg, sex, race/ethnicity, MPH area of study) of this student cohort in 2019. We examined a trend in the MD community to pursue an MPH career, adding additional public health and health care policy training to the MD workforce. We conducted targeted telephone interviews with 20 admissions personnel and faculty at schools offering MD-MPH degrees in the United States with the highest number of matriculants and graduates. Interviews focused on curricula trends in medical schools that offer an MD-MPH degree., Results: No literature describes the US MD-MPH cohort, and available MD-MPH databases are limited and incomplete. We found a 434% increase in the number of students pursuing an MD-MPH degree from 2010 to 2018. The rate of growth was greater than the increase in either the number of medical students (16%) or the number of MPH students (65%) alone. Moreover, MD-MPH students as a percentage of total MPH students more than tripled, from 1.1% in 2010 to 3.6% in 2018., Conclusions: As more MD students pursue public health training, the impact of an MPH degree on medical school curricula, MD-MPH graduates, and MD-MPH career pursuits should be studied using accurate and comprehensive databases.

This 6-year prospective study describes the impact on student attitudes of an innovative, interprofessional geriatrics curriculum (IPGC) focused on team-based care with older adults in a home-based community setting. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams each led by faculty members from all of the professions. The curriculum consisted of five, four-hour sessions over one academic year. Teams met with a community-dwelling older adult three times. Students completed the Geriatric Assessment Scale (GAS) before and after the IPGC experience. At the conclusion, improvements in attitudes toward older adults in the GAS and its four domains - social value, medical care, compassion, and societal resources-were observed across a wide spectrum of students. Students with the lowest initial attitudes improved the most, as did the scores of the youngest students. Older students improved more than younger students in the social value domain (i.e., the perceived social value of older adults). Among disciplines, occupational therapy and social work students improved the most in the social value domain. This study demonstrates improvement in attitudes toward older adults from student involvement in IPGC that combines didactic and experiential learning through community partnerships in a home-based setting.

This study describes and provides qualitative analysis of an innovative, inter-professional (IP) geriatrics curriculum focused on team-based care with healthy older adults in a home-based community setting. The curriculum consisted of five, four-hour didactic and experiential sessions over one academic year. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams led by IP faculty from each health professional school. Teams met with a community-dwelling older adult three times. At the program's conclusion, students responded to the reflective question "What is the most important learning experience you expect to take away from the geriatric inter-professional training? A qualitative analysis of student responses revealed four common themes from all five professions aligning with curricular goals: (1) health professional roles/scope of practice, (2) geriatric care and health outcomes, (3) team communication/collaboration, and (4) advocating for one's own profession. As sites for institutional clinical training become scarcer for health professions' trainees, this study offers both a novel, IP, geriatrics curriculum with didactic/experiential learning through community partnerships in a home-based setting and a reflective evaluation., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma., Objective: To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM)., Design: A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score., Setting: A single, freestanding inpatient rehabilitation hospital., Patients: Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria., Interventions: Not applicable., Main Outcome Measure: The primary outcome measures were differences in functional outcomes as measured by FIM scores., Results: There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home., Conclusions: This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation., (© 2020 American Academy of Physical Medicine and Rehabilitation.)

This commentary reflects the professional life story of a respected editor, poet, and champion of medical humanities, Johanna Shapiro. A psychologist by training, Johanna's work in medical humanities is well known and respected by health professionals in multiple venues. It is within family medicine that Johanna found her professional home. Her work has focused on the value of storytelling as a vehicle of healing, helping health professionals at all levels of training better understand their patients' experiences of illness and healing. The understanding helps patients more deeply connect to their illness and wellness. This commentary offers a tribute to Johanna's professional life and her contributions to family and narrative medicine. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.

For women diagnosed with breast cancer, healthy weight and enhanced nutrition may improve outcomes. The goal of this study is to examine the nutrition education services available on National Cancer Institute (NCI)-Designated Cancer Centers' websites. In 2017, websites of all 61 NCI-Designated Cancer Centers that provide adult clinical care were reviewed at least twice. Websites were analyzed for the existence and type of expert-directed nutrition education services for breast cancer survivors. Of the 61 websites analyzed, 49 (80%) provided information about nutrition education. Twenty (33%) included only nutrition counseling, three (5%) only nutrition classes, and 26 (42%) both counseling and classes. Forty-six websites included information about nutrition counseling; of these, 39 had an easily identifiable description. Thirty-seven class options were offered, 22% were specific to breast cancer, 16% to subgroups such as young women, 41% were nutrition-only classes, and 24% included skills education. Nutrition services are an important part of breast cancer treatment. This study demonstrated that most NCI-designated cancer centers offered counseling. However, the type of information that was offered varied and services were not always specific to patients with breast cancer. Further research is needed to confirm the presence of services, assess patient access, and demonstrate their efficacy in promoting optimal survivor outcomes.

Objective: The objective of this study was to determine whether a sleep education intervention improves knowledge of sleep, sleep behaviors, and depression in high school freshmen., Methods: We recruited student volunteers at a single magnet high school in Los Angeles, California through their health class. Twenty-four freshmen participated and 18 students (17 female, 1 male) completed pre- and postsurveys. Curriculum consisted of 4 hours of after-school interactive lectures emphasizing sleep physiology, benefits of sleep, what impacts sleep, and methods to improve sleep, followed by a 9-week sleep behavior change journal. Pre- and postsurveys measuring both sleep behaviors and knowledge, and a Patient Health Questionnaire-9 depression screening were administered to participants prior to and after the intervention. We used t tests and χ 2 tests to analyze knowledge and behavior change., Results: Subjects improved in average sleep hours per night (preintervention 6.9 hours to postintervention 7.8 hours, P =.0134), and average weekend night bedtime (11:36 pm to 10:54 pm, P =.0307)., Conclusions: This school sleep behavior intervention demonstrated students' average sleep hours per night and weekend bedtime improved after the lecture and sleep journal intervention. This suggests a sleep education intervention may benefit this population. Further studies are needed to demonstrate effectiveness of this education over time, across sexes, and in high-risk students., (© 2019 by the Society of Teachers of Family Medicine.)

Objective: To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos., Methods: Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey., Results: Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner., Conclusions: Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language., Clinical Implications: Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.

Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urologic conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of nonunion fractures, and joint disease including avascular necrosis. The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels. Complications from ESWT are rare but include 2 reported cases of injury to bone and Achilles tendon rupture in older adults using focused shockwave. Collectively, studies suggest ESWT is generally well-tolerated treatment strategy for multiple musculoskeletal conditions commonly seen in clinical practice. LEVEL OF EVIDENCE: III., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate representation by gender among recipients of physician recognition awards presented by the American Academy of Neurology (AAN)., Methods: We analyzed lists of individual recipients over the 63-year history of the AAN recognition awards. Included were awards intended primarily for physician recipients that recognized a body of work over the course of a career. The primary outcome measures were total numbers and proportions of men and women physician award recipients., Results: During the period studied, the proportion of women increased from 18% (1996) to 31.5% (2016) among AAN US neurologist members and from 18.6% (1992) to 35% (2015) in academia, and the AAN presented 323 awards to physician recipients. Of these recipients, 264 (81.7%) were men and 59 (18.3%) were women. During the most recent 10-year period studied (2008-2017), the proportion of women increased from 24.7% (2008) to 31.5% (2016) among AAN US neurologist members and from 28% (2009) to 35% (2015) in academia, and the AAN presented 187 awards to physician recipients, comprising 146 men (78.1%) and 41 women (21.9%). Although it has been more than 2 decades since the proportion of women among US neurologist members of the AAN was lower than 18%, 1 in 4 AAN award categories demonstrated 0% to 18% representation of women among physician recipients during the most recent decade. Moreover, for highly prestigious awards, underrepresentation was more pronounced., Conclusion: Although the reasons why are not clear, women were often underrepresented among individual physician recognition award recipient lists, particularly for highly prestigious awards., (© 2018 American Academy of Neurology.)

Importance: Most pediatricians are women; however, women pediatricians are underrepresented in academic leadership positions such as department chairs and journal editors and among first authors of original research articles published in pediatric journals. Publication of all types of articles, particularly in high-impact specialty journals, is crucial to career building and academic success., Objective: To examine the gender-related profile associated with authors of perspective-type articles in the 4 highest-impact general pediatric journals to determine whether women physicians were similarly underrepresented., Design and Setting: Cross-sectional study of perspective-type articles published between 2013 and 2017 in the 4 highest-impact general pediatric journals: Academic Pediatrics, JAMA Pediatrics, The Journal of Pediatrics, and Pediatrics., Main Outcomes and Measures: The primary outcome measure was the number and percentage of first-author women physicians as compared with men physicians. Secondary outcome measures included number and percentage of all men and all women among last authors and coauthors associated with physician first authors., Results: A total of 425 perspective-type articles were identified, with physicians listed as the first author on 338 (79.5%). Women were underrepresented among physician first authors of known gender (140 of 336 [41.7%]), particularly among physician first authors of article categories described as scholarly (range, 15.4%-44.1%) vs categories described as narrative (range, 52.9%-65.6%) in nature. Women were also underrepresented among last authors and coauthors of articles attributed to both men and women physician first authors, although the underrepresentation of women among last authors and coauthors was more pronounced if a man physician was the first author., Conclusions and Relevance: Because perspective-type articles provide an opportunity for authors to express their opinions, provide insights that may influence their field, and enhance their academic resumes, there is a need for pediatric journal editors and leaders of medical societies who are associated with these journals to ensure the equitable inclusion of women in medicine. A hallmark of best practices for diversity and inclusion in academic medicine is transparency with regard to reporting of gender disparities in all areas of scholarship attribution and credit.

The Energy Modeling Forum (EMF) 32 study on carbon tax scenarios analyzed a set of illustrative policies in the United States that place an economy-wide tax on fossil-fuel-related carbon dioxide (CO 2 ) emissions, a carbon tax for short. Eleven modeling teams ran these stylized scenarios, which vary by the initial carbon tax rate, the rate at which the tax escalates over time, and the use of the revenues. Modelers reported their results for the effects of the policies, relative to a reference scenario that does not include a carbon tax, on emissions, economic activity, and outcomes within the U.S. energy system. This paper explains the scenario design, presents an overview of the results, and compares results from the participating models. In particular, we compare various outcomes across the models, such as emissions, revenue, gross domestic product, sectoral impacts, and welfare.

Objective: Determine representation by gender for individual recognition awards presented to physicians by the Association of Academic Physiatrists (AAP)., Design: Cross-sectional survey was used. Lists of individual recognition award recipients for the 27-yr history of the AAP awards (1990-2016) were analyzed. The primary outcome measures were the total numbers of men versus women physician award recipients overall and for the past decade (2007-2016)., Results: No awards were given to women physicians for the past 4 yrs (2013-2016) or in half of the award categories for the past decade (2007-2016). No woman received the outstanding resident/fellow award since its inception (2010-2016). There was a decrease in the proportion of awards given to women in the past decade (2007-2016, 7 of 39 awards, 17.9%) as compared with the first 17 yrs (1990-2006, 10 of 46 awards, 21.7%). Furthermore, compared with their proportional membership within the specialty, women physicians were underrepresented for the entire 27-yr history of the AAP awards (1990-2016, 17 of 85 awards, 20%). According to the Association of American Medical Colleges, the proportion of full-time female physical medicine and rehabilitation faculty members was 38% in 1992 and 41% in 2013., Conclusions: Women physicians have been underrepresented by the AAP in recognition awards. Although the reasons are not clear, these findings should be further investigated.

This commentary reflects the professional life story of a prolific and well-published poet, Howard Stein. An anthropologist by training, Howard's poetry is well known and well respected by family physicians. It is within family medicine that Howard found his professional home, and in his 45-plus-year career he has shared the value of "patient story"; the value of the doctor-patient relationship; and the art of listening deeply to self, colleagues, and patients. This commentary offers a tribute to Howard's professional life and his contributions to family and narrative medicine. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Complex regional pain syndrome (CRPS) is thought to have an auto-immune component. One such target recently proposed from the effects of auto-immune IgGs on Ca(2+) transients in cardiac myocytes and cell lines is the α1-adrenoceptor. We have tested whether such IgGs exerted comparable effects on nociceptive sensory neurons isolated from rat dorsal root ganglia. Depolarisation-induced [Ca(2+)]i transients were generated by applying 30 mM KCl for 2 min and monitored by Fura-2 fluorescence imaging. No IgGs tested (including 3 from CRPS patients) had any significant effect on these [Ca(2+)]i transients. However, IgG from one CRPS patient consistently and significantly reduced the K(+)-induced response of cells that had been pre-incubated for 24h with a mixture of inflammatory mediators (1 μM histamine, 5-hydroxytryptamine, bradykinin and PGE2). Since this pre-incubation also appeared to induce a comparable inhibitory response to the α1-agonist phenylephrine, this is compatible with the α1-adrenoceptor as a target for CRPS auto-immunity. A mechanism whereby this might enhance pain is suggested., (Copyright © 2015. Published by Elsevier Inc.)

Globally, 15.5 million km(2) of land are currently identified as protected areas, which provide society with many ecosystem services including climate-change mitigation. Combining a global database of protected areas, a reconstruction of global land-use history, and a global biogeochemistry model, we estimate that protected areas currently sequester 0.5 Pg C annually, which is about one fifth of the carbon sequestered by all land ecosystems annually. Using an integrated earth systems model to generate climate and land-use scenarios for the twenty-first century, we project that rapid climate change, similar to high-end projections in IPCC's Fifth Assessment Report, would cause the annual carbon sequestration rate in protected areas to drop to about 0.3 Pg C by 2100. For the scenario with both rapid climate change and extensive land-use change driven by population and economic pressures, 5.6 million km(2) of protected areas would be converted to other uses, and carbon sequestration in the remaining protected areas would drop to near zero by 2100.

Purpose: To determine whether there are differences in retear rates among arthroscopic single-row, double-row, and suture bridge rotator cuff repair., Methods: The literature was systematically reviewed for clinical outcome studies assessing arthroscopic single-row, double-row, or suture bridge rotator cuff repair. All included studies indicated the imaging-diagnosed retear rate stratified by preoperative tear size at a minimum of 1 year of follow-up, and retears were diagnosed with either magnetic resonance imaging, ultrasound, or arthrogram. Only studies with comprehensive surgical methods were included, and the repair type was confirmed by the number of rows of fixation and suture configuration. Studies from journals with an impact factor below 1.5 were excluded. Retear rates were grouped and statistically compared using χ(2) tests., Results: Thirty-two studies met the inclusion criteria, yielding a total of 2,048 repairs. Double-row repair (DR) and suture bridge repair (SB) both had significantly lower retear rates than single-row repair (SR) for tears sized 1 to 3 cm (DR, P < .001; SB, P < .001), less than 3 cm (DR, P < .001; SB, P = .004), greater than 3 cm (DR, P = .016; SB, P = .003), and greater than 5 cm (DR, P = .003; SB, P = .003), as well as total retear rates (DR, P = .024; SB, P = .022). DR and SB did not differ significantly from each other in any tear size category., Conclusions: Both DR and SB have lower retear rates than SR in most tear size categories. No differences in retear rates were found between DR and SB., Level of Evidence: Level IV, systematic review of Level I through IV studies., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)