Journal of the National Medical Association最新文献

{"title":"Telehealth Transformation: A Mixed-Methods Study on Organizational Change Processes and Outcomes in Private Medical Practices","authors":"Masab A Mansoor DBA, MBA, ¸BS","doi":"10.1016/j.jnma.2024.07.087","DOIUrl":"10.1016/j.jnma.2024.07.087","url":null,"abstract":"<div><h3>Purpose</h3><p>This mixed-methods case study investigated the impacts, costs, barriers, and facilitators associated with implementing telehealth services across two private pediatric clinic systems. The research examined the effects of telehealth on provider engagement and financial performance.</p></div><div><h3>Methods</h3><p>Thirty-four clinicians, administrators, and staff across the pediatric and cardiology clinics were interviewed before and after enterprise-level telehealth adoption to examine change processes amid this innovation. Twelve months of pre- and post-implementation financial records underwent statistical analysis to assess revenue and cost dynamics. Quantitative outcome measures encompassed expenses, revenues, and telehealth visit utilization rates, while qualitative analysis of interviews and focus groups revealed key implementation themes through rigorous inductive coding of participant narratives.</p></div><div><h3>Results</h3><p>Results showed significantly increased costs (44-75%) and revenues (21-47%) at both clinics following virtual care expansion. Monthly telehealth visits per provider exponentially rose over 450% across sites. Qualitatively, 83% of providers appreciated scheduling flexibility benefits, but 68% of staff cited workflow disruptions. Interpretatively, findings demonstrated catalyzed financial and productivity transformations and nuanced perceived disruption amid pronounced appointment capacity expansions.</p></div><div><h3>Conclusions</h3><p>Interpretatively, findings demonstrated catalyzed financial and productivity transformations and nuanced perceived disruption amid pronounced appointment capacity expansions. Recommendations encompass updated care coordination protocols, enhanced training and support resources, incentivizing provider usage, and modulating implementation pacing responding to user feedback during large-scale organizational innovation.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 449"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Usage for Hidradenitis Suppurativa: Risk for Infection and Death","authors":"A Hill Marc BS, MA,&nbsp;S Jeremy Bordeaux, MD","doi":"10.1016/j.jnma.2024.07.038","DOIUrl":"10.1016/j.jnma.2024.07.038","url":null,"abstract":"<div><h3>Introduction</h3><p>Hidradenitis Suppurativa (HS) is an inflammatory skin condition that disproportionately affects young Black adult females. Antibiotics are commonly used for disease management, making it important to consider the potential complications such as infection and death. The literature has started to examine the relationship between patients with HS and Clostridium Difficile (C.diff), but only with smaller studies, and no studies have examined the death rate. This study investigates the risk for infection of C. diff and death for patients with HS.</p></div><div><h3>Methods</h3><p>A retrospective cohort study was performed utilizing the global database TriNetX. Two cohorts were assembled that were compared in their development of C.diff or death. The first cohort included patients who used various antibiotics after their HS diagnosis (n = 86,251). The second cohort served as the control and included patients with HS that did not use these antibiotics (n = 60,157). For the statistical analysis, the risk ratio was calculated. The antibiotics examined included Clindamycin, Rifampin, Tetracycline, Minocycline, and Doxycycline.</p></div><div><h3>Results</h3><p>The risk ratio and associated 95% confidence intervals for contracting C.diff or death is 2.265 (1.971, 2.604) and 1.357 (1.284, 1.434), respectively.</p></div><div><h3>Conclusion</h3><p>The results show a statistically significant increased risk of developing a C.diff infection and of dying when utilizing these antibiotics. Antibiotic usage has shown to improve HS symptoms, however, clinicians must be wary about the complications that could occur when prescribing antibiotics, such as increased risk of C.diff infection and death.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 427"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disproportionate Racial Impact against Hepatic Cancer Patients: NIS 2020","authors":"Narathorn Kulthamrongsri MD,&nbsp;Kanthajan Tatchaya MD,&nbsp;Kulthamrongsri Narathorn MD,&nbsp;Prasitsumrit Vitchapong MD","doi":"10.1016/j.jnma.2024.07.055","DOIUrl":"10.1016/j.jnma.2024.07.055","url":null,"abstract":"<div><h3>Introduction</h3><p>Hepatobiliary cancer is the second leading cause of cancer-related death worldwide. Prior data showed mixed results against racial impact in this population group, with limited specific results regarding clinical outcomes. We aim to utilize a large national database to provide comprehensive data on the clinical outcomes of hepatobiliary cancer about race.</p></div><div><h3>Method</h3><p>The 2020 National Inpatient Sample was utilized in this study. patients with hepatobiliary cancer were selected by ICD-10 CM code. Inpatient mortality and associated complications, including acute kidney injury (AKI), heart failure, and mechanical ventilation use were analyzed. Logistic regression analysis was used to assess the association between race and complications.</p></div><div><h3>Results</h3><p>We surveyed 20,670 hospitalizations with hepatobiliary cancer. Caucasians accounted for 60.7%, whereas African Americans accounted for 12%. The mean age was 65.38 years, with 66% being male. African Americans had a significantly higher inpatient mortality rate (aOR 1.61, 95%CI (1.10, 2.35), p &lt;0.005) as well as higher odds of acute kidney injury (aOR 1.22; 95%CI (1.10-1.35), p&lt;0.005) compared to Caucasians. We found increased, but not statistically significant in other clinical outcomes compared to Caucasians.</p></div><div><h3>Conclusion</h3><p>African Americans are at a higher risk of experiencing worsening clinical outcomes and mortality rates. Future longitudinal studies could shed light on these long-term connections.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 435"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Case-Based Social Determinants of Health Curriculum for Graduate Medical Education","authors":"Brittany C Flemming MD,&nbsp;Duane D. Kim MD,&nbsp;Sean P. Meagher MD,&nbsp;Dimas C. Espinola MD","doi":"10.1016/j.jnma.2024.07.033","DOIUrl":"10.1016/j.jnma.2024.07.033","url":null,"abstract":"<div><h3>Introduction</h3><p>Social Determinants of Health (SDOH) are conditions in environments where people live, learn, work, play, worship, and age that affect a wide range of health, functional, and quality-of-life outcomes and risks, contributing to health disparities and inequities. Several agencies endorse the importance of SDOH, but limited data is available on effective teaching tools for incorporating SDOH into Graduate Medical Education (GME). We developed a case-based curriculum to increase comfort of trainees and faculty in identifying, researching, and educating on SDOH, and utilized it to promote and assess commitment to clinical practice change.</p></div><div><h3>Methods</h3><p>Kern's six-step methodology guided development of the curricular framework. A selected resident-faculty pair reviewed a subspecialtyspecific case through the lens of an assigned SDOH domain using evidence-based medicine. The pair created an interactive learning module to discuss the case, review evidence, investigate whether the standard of care addresses the SDOH domain, and provide a relevant clinical toolkit item.</p></div><div><h3>Results</h3><p>Pre-curriculum assessments showed gaps between resident-perceived SDOH education frequency and staff comfort with SDOH education. Qualitative feedback demonstrated that the curriculum improved resident-perceived education and comfort of faculty in educating on subspecialty-specific SDOH. Nearly 50 commitment-to-clinical practice change goals were created.</p></div><div><h3>Conclusion</h3><p>Integrated SDOH instruction in GME is a priority, but residents report insufficient instruction and faculty feel ill-equipped to provide such education. Our case-based SDOH curriculum presents a dynamic, sustainable, and clinically relevant solution to bridge both gaps and a unique opportunity for programs to reimagine SDOH education and foster a cadre of healthcare professionals equipped to deliver SDOH-competent care.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 425"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting MACE Through Systemic Inflammation Response Index: NHANES Based Analysis","authors":"Chutawat Kookanok MD,&nbsp;Methavee Poochanasri MD,&nbsp;Tatchaya Kanthajan MD,&nbsp;Voramol Rochanaroon MD,&nbsp;Sethapong Lertsakulbunlue MD,&nbsp;Irin Jariyayothin MD,&nbsp;Nicha Wareesawetsuwan MD,&nbsp;Vitchapong Prasitsumrit MD,&nbsp;Vichayut Chayapinun MD,&nbsp;Nisha Wanichwecharungruang MD,&nbsp;Tulaton Sodsri MD,&nbsp;Adivitch Sripusanapan MD,&nbsp;Kamonluk Rodsom MD,&nbsp;Urairat Chuenchaem MD,&nbsp;Ekamol Tantisattamo MD, MPH","doi":"10.1016/j.jnma.2024.07.058","DOIUrl":"10.1016/j.jnma.2024.07.058","url":null,"abstract":"<div><h3>Purpose</h3><p>Inflammation is widely recognized for its significant association with major adverse cardiovascular events (MACE). Our study aims to evaluate this relationship and predictive efficacy using the Systemic Inflammation Response Index (SIRI).</p></div><div><h3>Method</h3><p>In our study, we analyzed 9,450 adults aged 18 years and older from NHANES 2017-2018. We evaluated inflammatory status using the Systemic Inflammation Response Index (SIRI) and conducted ROC analysis to determine its predictive ability. Additionally, we employed three logistic regression models to assess the association of SIRI with Major Adverse Cardiovascular Events (MACE). The first model considered SIRI alone, the second model combined SIRI with hs-CRP and ferritin, and the third model included additional factors such as age, gender, race, education, asthma, diabetes, hypertension, and estimated glomerular filtration rate.</p></div><div><h3>Result</h3><p>ROC analysis was used to determine the SIRI cut-off points for predicting non-fatal myocardial infarction, stroke, angina, and heart failure, yielding values of 1.1195 (AUC=0.639, 95% CI: 0.606-0.672), 1.0594 (AUC=0.583, 95% CI: 0.549-0.616), 0.9882 (AUC=0.524, 95% CI: 0.506-0.543), and 1.1074 (AUC=0.646, 95% CI: 0.607-0.685), respectively. Despite various influencing factors in Model 3, SIRI showed significant associations with each MACE. These events included myocardial infarction (AOR=1.979, 95% CI: 1.537-2.548), stroke (AOR=1.399, 95% CI: 1.093-1.790), angina (AOR=1.979, 95% CI: 1.537-2.548), and heart failure (AOR=2.586, 95% CI: 1.742-3.837).</p></div><div><h3>Conclusion</h3><p>SIRI shows strong associations with all outcomes but only predicts non-fatal MI and heart failure. Despite this limitation, its cost-effectiveness and accessibility indicate potential as an early screening tool for improving risk assessment and intervention in high-risk individuals.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 436"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects","authors":"Andrew Foell ,&nbsp;Kyle A. Pitzer ,&nbsp;Von Nebbitt ,&nbsp;Margaret Lombe ,&nbsp;Mansoo Yu ,&nbsp;Melissa L. Villodas ,&nbsp;Ngozi Enelamah ,&nbsp;Husain Lateef","doi":"10.1016/j.jnma.2024.07.005","DOIUrl":"10.1016/j.jnma.2024.07.005","url":null,"abstract":"<div><p>Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 390-402"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0027968424000865/pdfft?md5=b5fc5ceb3b0a6ef3361f9d8cef37fac1&pid=1-s2.0-S0027968424000865-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who declines “opt-out” HIV/HCV testing? Experience of an internal medicine resident continuity clinic serving a predominantly Black adult population in South Carolina.","authors":"Jodian Pinkney ,&nbsp;Yao Tong ,&nbsp;Susanne Hoeppner ,&nbsp;Caroline Derrick ,&nbsp;Gregg Talente ,&nbsp;Rocio Hurtado ,&nbsp;Christina Psaros ,&nbsp;Bisola O. Ojikutu ,&nbsp;Laura M. Bogart ,&nbsp;Helmut Albrecht ,&nbsp;Divya Ahuja ,&nbsp;Emily Hyle","doi":"10.1016/j.jnma.2024.07.009","DOIUrl":"10.1016/j.jnma.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>Universal “opt-out” human immunodeficiency virus (HIV) or hepatitis C virus (HCV) testing involves testing individuals for HIV or HCV regardless of symptoms, unless they decline. Little is known about the characteristics of individuals who decline.</p></div><div><h3>Methods</h3><p>We conducted a retrospective, medical record review of adults evaluated at an outpatient clinic in South Carolina. “Opt-out” HIV/HCV testing was implemented in Feb 2019; we reviewed medical records of individuals evaluated in May - July 2019. We excluded individuals who did not meet age-based screening criteria (HIV: 18–65 years; HCV: 18–74 years), had a prior HIV/HCV diagnosis, were tested for HIV/HCV within the preceding 12 months, and whose “opt-out” decision was not documented. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CI) for “opt-out” decision, with age, sex, race/ethnicity, insurance status, visit type, and genitourinary vs. non-genitourinary chief complaints as predictors.</p></div><div><h3>Results</h3><p>The final analyses included 706 individuals for HIV and 818 for HCV. Most individuals were non-Hispanic Black (77 % and 78 %) and female (66 % and 64 %). The mean ages were 49.1 (±11.9) and 51.9 (±13.2). Nearly one-third of individuals declined HIV and HCV testing (31 % and 30 %). Black males were more likely to decline HIV and HCV testing than Black females (aOR = 1.61 [95 % CI. 1.08 - 2.40] and aOR = 1.50 [95 %CI. 1.04 - 2.16]).</p></div><div><h3>Conclusion</h3><p>Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.</p></div><div><h3>Main Point</h3><p>Despite HIV/HCV testing being the standard of care, approximately one-third of eligible individuals may decline testing, the demographic characteristics of whom may overlap with individuals who are traditionally unaware of their status.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 351-361"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0027968424000841/pdfft?md5=3b3bcd6e6cd9ab775c7f339be186660d&pid=1-s2.0-S0027968424000841-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breathing Life Into Learning About Air Quality","authors":"Katie Hoskins Degrees MLS, Med,&nbsp;Molla Fahad BS","doi":"10.1016/j.jnma.2024.07.025","DOIUrl":"10.1016/j.jnma.2024.07.025","url":null,"abstract":"<div><h3>Background</h3><p>The San Joaquin Valley (SJV) comprises diverse populations that are medically underserved and experience significant air pollution.</p></div><div><h3>Objective</h3><p>Provide education to health careers pathway high school students on hazards of air pollution to respiratory health, steps they can take to protect their health, and how to access the National Library of Medicine resources for reliable health information.</p></div><div><h3>Methods</h3><p>Two-hour interactive outreach sessions were provided at three local high schools in Fresno and Madera to students in health careers pathways. Librarians and student doctors from a local osteopathic medical school guided high school students in health professions pathways through activities to understand the causes of poor air quality in the SJV, describe the different parts of the respiratory system and how air pollutants impact it, identify steps they can take to monitor the air quality and adjust their activities to protect their health, and how zip code is a fairly accurate predictor of health, and to access National Library of Medicine resources for reliable health information.</p></div><div><h3>Results</h3><p>A comparison of pre- and post-surveys showed a significant improvement in understanding the air quality index (AQI), how air pollutants impact different body systems, and lifestyle modifications to reduce the health impacts of air pollution. Outreach sessions to high school students can effectively increase knowledge of environmental health issues.</p></div><div><h3>Conclusions</h3><p>This sample population showed a positive result between pre- and post-surveys following education on a focused health topic.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 421"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black Hairstyles in Radiological Imaging: A Pilot Study","authors":"Angela Udongwo MPH,&nbsp;Jariatu Kamara BA,&nbsp;Candrice R. Heath MD,&nbsp;Alex Kleinmann,&nbsp;Alex Sandberg BS,&nbsp;Gary Cohen MD,&nbsp;Hillel S. Maresky MD","doi":"10.1016/j.jnma.2024.07.099","DOIUrl":"10.1016/j.jnma.2024.07.099","url":null,"abstract":"<div><h3>Background</h3><p>Hairstyles common in Black communities, braids, twists, locs present as artifacts, posing unique diagnostic challenges in interpreting radiological imaging, though limited research has been conducted on the current climate of their interpretation.</p></div><div><h3>Purpose</h3><p>Present a review of hairstyles as hair artifacts in literature and investigate the comfortability and familiarity of physicians and radiology technicians in assessing braids, twists, and locs as hair artifacts on radiological imaging.</p></div><div><h3>Methods</h3><p>Cross-sectional study was conducted in an academic hospital using an online platform to assess the experiences and awareness of hairstyles on imaging. Responses were collected between April 2023 through August 2023 and included demographic information, career length, how often they came across hair artifacts in imaging, comfort and familiarity with Black hairstyles as artifact, and a quiz to distinguish pathology from hair artifact on chest x-ray images.</p></div><div><h3>Results</h3><p>46 participants from Temple Radiology (41.3%), Temple Emergency Medicine (21.7%), Temple Jeanes Campus (26.1%), and St. Lukes Bethlehem Radiology Group (2.2%), with the Radiologist cohort of an average experience of 9.40 years (SD=12.41), Emergency Medicine cohort 7.11 years (SD=7.08), and the Intern cohort had 0.5 years (SD=0.71). Career length (Row Factor: [9.8]; p &lt; 0.0001) and patient load (Row Factor: [3.1], p = 0.029; p &lt; 0.05) significantly affected self-reported scores, with longer careers and larger loads associated with higher score of comfort and familiarity among study participants.</p></div><div><h3>Conclusions</h3><p>Longer career lengths and a higher number of patients per day improved awareness of how Black hairstyles presents in medical imaging. This study highlighted a radiological phenomenon lacking in medical literature and provided valuable insights into the impact of experience on physicians' ability to identify and interpret radiological images affected by styles that can mimic pathology. An emphasis is put on the need for education earlier in training.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 455"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Equity Implications of People Living With HIV","authors":"Jareese Stroud MPH,&nbsp;Maisha Standifer MPH, PhD,&nbsp;Evan Martin LMSW,&nbsp;Jammie Hopkins DrPH,&nbsp;Allyson Belton MPH,&nbsp;Donrie Purcell PhD,&nbsp;Eric Warren","doi":"10.1016/j.jnma.2024.07.048","DOIUrl":"10.1016/j.jnma.2024.07.048","url":null,"abstract":"<div><h3>Introduction</h3><p>HIV diagnosis rates are not evenly distributed and significantly impact black men and women residing in Georgia and Louisiana. Additionally, reporting in these specific states demonstrate late HIV diagnosis and a failure to link patients to care.</p></div><div><h3>Methods</h3><p>In response to this alarming issue, the “End the Epidemic” initiative l addresses structural barriers in HIV care impacting Black communities in Georgia, Louisiana by implementing: 1) Conduct asset mapping to examine the health systems gaps that prevent healthcare utilization for PLWHA. Train diverse healthcare professionals, learners and leaders, on the social/political determinants of health to develop sustainable and solutions-driven policies towards the achievement of health equity for PLWHA. 2) Assess jurisdictional policies which exacerbate/alleviate gaps in the HIV care continuum impacting PLWHA. Convene an HIV Equity Task Force to develop health equity strategies for retaining PLWHA. 3) Increase HIV data availability on the Health Equity Tracker to improve access to data for individuals and organizations. Provide technical assistance and policy assessments to jurisdictions concerning data practices, including tracking and measuring health inequities for PLWHA. Develop high-quality communications resources for community members, leaders, and influencers on HIV inequities. This initiative will apply a mixed methods approach to the data collection and analysis component of the project, as well as a process evaluation.</p></div><div><h3>Conclusion</h3><p>This novel approach will 1) Increase access and utilization of culturally competent healthcare to Black people impacted by the HIV epidemic 2) Gain insight into the disruption of the healthcare delivery system due to COVID-19 in the Black community and realign HIV service for PLWHA 3) Influence clinical provider training in HIV and 4) Initiate early engagement with experienced clinicians practicing in Black communities in the aforementioned cities.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Pages 431-432"},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}