Journal of the National Medical Association最新文献

{"title":"Symptomatic Management of MEN Type 1 at a Community Hospital","authors":"Max Steinhauer OMS, Kristine Nguyen OMS, Dai-An Vo-Ba DO, MS, Kiersti Winters DO, MS, Keaton Maguire DO, Kevin Yu DO, C. Dean Milne DO, FACOI, FACP, Scott Silver DO, FACOI","doi":"10.1016/j.jnma.2025.08.040","DOIUrl":"10.1016/j.jnma.2025.08.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary disorder characterized by tumors in the parathyroid glands, pancreas, and pituitary gland. These tumors can lead to a wide range of symptoms, making it difficult to identify which aspects of the disease are primarily manifesting. Gastrointestinal (GI) complaints are a common, but nonspecific presentation of MEN1 that could be attributed to any of the three affected glands. Pancreatic neuroendocrine tumors produce excessive hormones causing acid reflux, peptic ulcers, diarrhea, and abdominal pain. A classic example is Zollinger-Ellison syndrome, associated with gastrin-producing tumors. Other functional pancreatic tumors in MEN1 include insulinomas and glucagonomas, the latter of which causes abdominal cramping and diarrhea. Parathyroid hormone (PTH) secretion from parathyroid adenomas can indirectly cause nausea, abdominal pain, and constipation due to hypercalcemia. Pituitary tumors can also be indirect culprits due to altered appetite and digestion.</div><div>Diagnosis can involve imaging, biopsies, or endocrine-specific labs that may not be routinely performed at smaller hospitals. Once diagnosis is established, standard of care for MEN1 includes monitoring hormone levels and tumor progression. Medical management may include proton pump inhibitors (PPIs), somatostatin analogs, dopamine agonists, or calcium binders to manage hormone-related symptoms. The definitive solution can be surgical tumor resection, often requiring otolaryngologists or endocrine surgeons. In settings without these resources, it can be challenging for clinicians to manage this disease. Our case examines GI manifestations of MEN1, demonstrating a multimodal approach with the resource limitations of a small community hospital.</div></div><div><h3>Methods</h3><div>Our case describes a 40-year-old male with MEN1 with intractable nausea/vomiting, heartburn, abdominal pain, and diarrhea. Although imaging did not demonstrate clear pancreatic or pituitary masses, initial lab results showed primary hyperparathyroidism with hypercalcemia, prolactinemia, and dramatically elevated gastrin levels, raising concern for multiple functional tumors. Identifying the extent of disease was complicated by the nonspecific presentation, paucity of medical records, and logistic constraints. Our facility lacked the capability for more specialized studies, such as positron emission tomography, parathyroid sestamibi scans, or MRIs with dynamic pituitary protocol. Otolaryngology and endocrine surgery were not available to definitely address any underlying masses. Meanwhile, the patient remained severely symptomatic. It required a multidisciplinary team and multiple medications for adequate symptomatic control to facilitate discharge.</div></div><div><h3>Results</h3><div>Ultimately, symptomatic control was achieved by combining PPIs and sucralfate to target effects of a likely gastrinoma, metoclopramide for ","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 19-20"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989847","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":"Take My Breath Away, A Rare Case of Pulmonary Hypertension: A Case Report and Literature Review","authors":"Michele A. Mack MD, Rochenarda Joseph DO","doi":"10.1016/j.jnma.2025.08.042","DOIUrl":"10.1016/j.jnma.2025.08.042","url":null,"abstract":"<div><h3>Introduction/Background</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare condition in which there is elevated blood pressure in the pulmonary arteries caused by chronic blood clots (thromboembolic), which obstruct the free flow of blood through the lungs. When presented, chronic thromboembolic pulmonary hypertension presents considerable management difficulties.</div></div><div><h3>Objectives</h3><div>This report aims to illustrate the management of chronic thromboembolic pulmonary hypertension.</div></div><div><h3>Case presentation</h3><div>33 y.o. male with history of PE/DVT (2019), HTN, and Burkitt Lymphoma (in remission for over 10 years), presented to the ED with complaints of shortness of breath. Symptoms occurred for one week with associated dry cough. Patient's dyspnea was constant, occurred at rest, and worsened with exertion. On exam, patient had a BMI of 48.4. Acanthosis nigricans noted along the neck. Patient was diaphoretic, and required 2 L of nasal cannula, which was a new oxygen requirement. CTPE showed chronic thromboembolic pulmonary hypertension.</div><div>Echo showed an EF 60-65% with normal LV function. RV was moderate to severely dilated. The interatrial septum bowed toward left atrium consistent with elevated right atrial pressure. V/Q scan showed multiple bilateral segmental and subsegmental wedge-shaped perfusion defects, Large segmental perfusion defect in left upper lobe, right middle lobe and right lower lobe. Findings characteristic of pulmonary embolism, CTEPH. Cardiology was consulted with recommendations for a right heart cath. Cardiothoracic surgery was consulted which recommendation stat transfer to a pulmonary hypertension center and initiation of a guanylate cyclase stimulator outpatient. Due to cost, the patient was not able to be initiated on the guanylate cyclase stimulator. The patient was emergently transferred to a hospital that specializes in pulmonary hypertension and underwent open heart surgery via pulmonary endarterectomy.</div></div><div><h3>Methods</h3><div>How Is CTEPH Diagnosed? Workup includes V/Q Scan (imaging test of choice), Transthoracic echocardiogram (TTE), CT pulmonary angiography, Right heart catheterization, Pulmonary function tests, Cardiopulmonary exercise test</div></div><div><h3>Literature review and Results</h3><div>The true incidence of CTEPH is unknown because it commonly goes undiagnosed. Current reported cases after PE range from 0.5-0.9%. The landmark study by Pengo et al followed 223 patients prospectively after an acute PE for 10 years. There was a reported incidence of CTEPTH in 3.1% of patients. Still, the true incidence remains underdiagnosed and even fewer cases are being diagnosed in the United States. Management includes three options: Pulmonary Thromboendarterectomy, Balloon Pulmonary Angioplasty and medical therapy. Medical therapy includes lifelong anticoagulation to prevent new clots and remains an area of active research.</div></di","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 21"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989849","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":"Evaluating the Impact of Time-Restricted Eating on Metabolic and Cardiovascular Outcomes: A Systematic Review with Community-Based Insights","authors":"Elizabeth Artiles MS4","doi":"10.1016/j.jnma.2025.08.081","DOIUrl":"10.1016/j.jnma.2025.08.081","url":null,"abstract":"<div><h3>Introduction</h3><div>With the growing interest in non-pharmacologic approaches to cardiometabolic disease prevention, it is increasingly important to evaluate the role of lifestyle interventions such as intermittent fasting (IF). Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality globally, and emerging research suggests that dietary timing, specifically time-restricted eating (TRE) may play a role in mitigating risk factors such as insulin resistance, obesity, and systemic inflammation. However, inconsistencies in current literature regarding the efficacy of various TRE protocols have created ambiguity about its true clinical utility.</div><div>Fasting regimens such as 16:8, 18:6, 14:10, and 24-hour intervals have been proposed to improve glycemic control and reduce CVD risk through mechanisms including enhanced insulin sensitivity and modulation of inflammatory pathways. While preliminary data are promising, studies differ widely in protocol design, participant characteristics, and outcome measures, underscoring the need for standardized evaluation.</div></div><div><h3>Methods</h3><div>To address this gap, we conducted a systematic review of primary human studies published in the past 10 years that assessed the impact of TRE on metabolic and cardiovascular outcomes in adults. Inclusion criteria limited studies to participants over 18 years with a BMI &lt;45 kg/m². Analyses focused on glycemic markers, weight loss, insulin sensitivity and lipid profiles.</div><div>For example, Lowe et al (2020) found that 16:8 TRE protocols resulted in modest weight loss (∼0.94 kg over 12 weeks) and improvements in metabolic health. While evidence for 18:6 and 14:10 fasting remains limited, outcomes suggest potential parity in efficacy with longer fasts. Extended fasts, such as 24-hour intervals, demonstrated increased insulin sensitivity, though weight changes varied (Muñoz et al., 2020). Outcomes also appeared influenced by participant sex and baseline metabolic health, suggesting a need for individualized application.</div><div>Complementing the literature review, data from the MediRootz holistic diabetes prevention program, led by Dr. Maurice Hinson, revealed an average 5-pound weight loss over 7 weeks among participants practicing TRE. Greater benefit was observed in those who also incorporated complementary therapies. This supports the idea that a biopsychosocial model integrating culturally relevant, natural interventions such as fasting, plant-based nutrition, and community support may be especially effective in underrepresented populations such as African Americans disproportionately affected by cardiometabolic disease.</div></div><div><h3>Conclusion</h3><div>Together, these findings suggest that IF, particularly when personalized and embedded in holistic care models like MediRootz, holds promise as a scalable, culturally adaptable tool for CVD prevention.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 43-44"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989950","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":"Improving Colon Cancer Screening by Incorporating a Diversity Equity and Inclusion Curriculum in an Internal Medicine Residency","authors":"Zeina Bani Hani MBBS ,&nbsp;Omar Yaghi MD MPH ,&nbsp;Tebianne Abubaker MD ,&nbsp;Ivan Berezowski MD ,&nbsp;Bobga Gang BS ,&nbsp;Ana Pabalan MD ,&nbsp;Mrudula Bandaru MD ,&nbsp;Chavon Onumah MD MPH MEd ,&nbsp;Marie L. Borum MD EdD MPH","doi":"10.1016/j.jnma.2025.08.083","DOIUrl":"10.1016/j.jnma.2025.08.083","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Colon cancer causes significant morbidity and mortality in marginalized communities in the United States. Screening can improve outcomes by identifying pre-cancerous and early stage colon cancers allowing for timely intervention. Diversity Equity and Inclusion (DEI) curriculum can increase awareness of health disparities and be a component of a multifaceted strategy to improve health outcomes. We evaluated the impact of a DEI educational intervention upon colon cancer screening rates in an internal medicine residency at an urban university medical center that serves a majority (64%) African-American population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Community-based focus groups that included healthcare learners and African-American community members were conducted. Discussions were transcribed and thematic analysis was performed. An internal medicine residency DEI curriculum was developed based upon focus group learnings. Curriculum included education about colon cancer disparities, bias mitigation, social determinants of health, culturally responsive care along with experiential learning through a visit to an African American history museum and community exploration workshop. Colon cancer screening rates during a 2 year period were assessed prior to and following the educational intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Focus groups discussion, involving African-American community members and internal medicine residents, provided the foundation for curriculum development. Barriers impacting colon cancer screening included awareness, insurance status, colonoscopy logistics, fear of cancer or procedures, physician trust and communication. In addition, African Americans, compared to health care learners, more frequently identified racial disparity in health care (p=0.0278), physician respect toward patients (p=0.0278) and inadequate physician communication (p=0.0013). All internal medicine residents during a 1 year period participated in the DEI curriculum. Patient navigation, an identified community need, was incorporated into the colon cancer screening recommendations offered by resident physicians. Colon cancer rates were among 2426 patients seen by physicians increased from 57.8% to 72.3% following the educational intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;There are a variety of DEI educational strategies that have been designed for resident physicians. However, most of the programs are one-time sessions, although some have spanned over 3 years. The most common assessment of DEI educational strategies has been pre- and post-intervention knowledge testing. There has been limited information about the impact of resident physicians’ patient care. This study was unique because it developed a multifaceted DEI curriculum which resulted in an improvement in colon cancer screening at an urban university medical center. While it can be difficult to directly measure the impact of DEI educational programs o","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 44-45"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989952","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":"How Perceived Hairstyle Prejudice Influences the Hairstyling of Medical Students and Residents","authors":"Chiemelie O. Onyekonwu BA,&nbsp;Temitayo Ogunleye M.D.","doi":"10.1016/j.jnma.2025.08.023","DOIUrl":"10.1016/j.jnma.2025.08.023","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Race-based hair discrimination has historically influenced professional advancement, pressuring individuals with natural hairstyles, braids, dreadlocks, hijabs, and dastars to conform to Eurocentric grooming standards. While the CROWN Act was introduced to protect against hairstyle-based discrimination, only 27 states have enacted it, leaving many without legal protections. This study examines how medical students and residents perceive hairstyle and head covering-related bias in clinical settings, ERAS photos, and residency interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This qualitative, cross-sectional study explored perceptions of hairstyle-based discrimination among medical students and residents of color. A 22-question survey was developed and administered via Qualtrics, incorporating multiple-choice, dichotomous, Likert scale, and open-ended questions. Four key themes were assessed:&lt;ul&gt;&lt;li&gt;&lt;span&gt;1.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Demographics (e.g., year of training, natural hair texture, routine hairstyle practices).&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;2.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Perceptions of hairstyle-based discrimination during clinical rotations, in ERAS photos, and residency interviews.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;3.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Medical specialties influence hairstyle choices to conform to professional expectations.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;4.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Definitions of professional hairstyles in medical settings.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;The survey was distributed electronically via Student National Medical Association (SNMA) social media platforms, with an estimated completion time of 15–20 minutes. Participation was voluntary, with informed consent obtained prior to survey administration. Responses were anonymous, and no compensation was provided. Thematic analysis was used to analyze qualitative responses, while descriptive statistics summarized quantitative data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 204 medical students and residents completed the survey. The majority (55% MS4s, 31% MS3s, 13% residents) identified as Black or African American (93%). Medical students and residents reported modifying their natural hairstyles to align with perceived professional norms, particularly during clinical rotations, ERAS photos, and residency interviews, due to concerns about implicit bias and negative evaluations. Surgical specialties, including General Surgery (80%) and Obstetrics &amp; Gynecology (45%), were identified as settings where students most frequently altered their hairstyles, often citing the need to maintain a sterile field. Additionally, Eurocentric beauty standards significantly influenced hairstyling decisions, with many participants straightening their hair for ERAS photos and interviews out of fear that natural styles would be perceived as unprofessional.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This study highlights the complex interplay between professional expectations, implicit bias, an","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 9-10"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989406","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":"Racial Differences in Metabolic Changes during Induction Therapy for Newly Diagnosed Myeloma","authors":"Roshana Brown ,&nbsp;Ross Firestone ,&nbsp;Ram Prakash Thirugnanasambandam ,&nbsp;Sandeep Raj ,&nbsp;Andriy Derkach ,&nbsp;Tala Shekarkhand ,&nbsp;Colin Rueda ,&nbsp;Kylee Maclachlan ,&nbsp;Malin L. Hultcrantz ,&nbsp;Sham Mailankody ,&nbsp;Heather Landau ,&nbsp;Gunjan Shah ,&nbsp;Michael Scordo ,&nbsp;Hani Hassoun ,&nbsp;Alexander M. Lesokhin ,&nbsp;Sergio Giralt ,&nbsp;Michael Pollak ,&nbsp;Neha Korde ,&nbsp;Saad Z. Usmani ,&nbsp;Carlyn R. Tan ,&nbsp;Urvi A. Shah","doi":"10.1016/j.jnma.2025.08.088","DOIUrl":"10.1016/j.jnma.2025.08.088","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Multiple myeloma (MM) disproportionately affects Black populations when compared to White populations. Additionally, metabolic disorders such as obesity and diabetes mellitus have been associated with worse survival in MM based on our prior research. These metabolic disorders also disproportionately affect Black individuals. The goal of this study is to evaluate baseline differences and changes during induction in body mass index (BMI), insulin resistance (adiponectin to leptin (AL) ratio), C reactive protein (CRP), body composition (visceral and subcutaneous adiposity), progression free (PFS) and overall (OS) survival in Blacks compared to White patients. A high AL ratio is associated with better insulin sensitivity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;A total of 389 newly diagnosed MM patients treated with either carfilzomib, lenalidomide and dexamethasone (KRd, N=191) or bortezomib, lenalidomide, and dexamethasone (VRd, N=198) were included. Clinical data on BMI, CRP, age, race, and gender were extracted from electronic health records. The cohort included 51 Black and 280 White patients. Body mass index (BMI) was classified into underweight (BMI &lt; 18.5), normal weight (BMI 18.5- 24.9), and overweight/obese (BMI ≥25). Changes in BMI were grouped as weight stable (BMI &lt; 5% change), weight loss (BMI decrease ≥5%), and weight gain (BMI increase ≥5%).&lt;/div&gt;&lt;div&gt;AL ratio was analyzed on banked biospecimens (n=128 at baseline and n=57 with post induction paired samples). Body composition (tissue compartment volumes for subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and muscle tissue (MT)) was analyzed (n=66 at baseline and n=32 post induction) Wilcoxon rank sum test assessed associations between race and baseline AL ratio and body composition, as well as change during induction. Fisher exact test assessed associations between race and CRP or BMI at baseline and change after induction. Multivariable Cox regression and landmark analyses assessed associations between race and PFS and OS adjusting for gender, age, RISS stage, cytogenetics, and cardiac history, as well as baseline BMI or BMI change.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In this cohort, Black patients were more likely to be female (p=0.02). Post induction, 24.5% Black patients and 17.9% of White patients gained weight, 12.2% Black patients and 16% White patients lost weight, and the rest remained weight stable (p=0.51).&lt;/div&gt;&lt;div&gt;Black patients were more likely to have a low AL ratio at baseline compared to White patients (p=0.006). However, the post induction AL ratio (p=0.30) and change in AL ratio (p=0.76) was not different between groups, possibly due to the smaller number of available samples. An elevated CRP (≥0.5) was seen in significantly more Black patients (43.5%) compared to White patients (25.2%) at baseline (p=0.02). Black patients had significantly higher SAT than white patients at baseline (p = 0.008) and significantly lowe","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 47-48"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989415","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":"FutureCare Directions: Empowering Patient Choices in a Free Clinic Setting","authors":"Alina Smoleva,&nbsp;Megan McDonald,&nbsp;Ethan Barkley","doi":"10.1016/j.jnma.2025.08.016","DOIUrl":"10.1016/j.jnma.2025.08.016","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Advanced Care Planning (ACP) is documentation that allows patients to provide their healthcare preferences in the event they become unable to make those decisions for themselves. This documentation includes the patient’s treatment goals, their preference for life sustaining measures, and designation of a healthcare proxy. ACP plays a crucial role to ensure patients receive the care that aligns with their values, while providing healthcare professionals with a guide on treatments. ACP also reduces the emotional burden and distress that can come with making unknown healthcare decisions for a family member. This allows them to focus on supporting their loved one rather than struggling with complex medical choices.&lt;/div&gt;&lt;div&gt;The primary goal of this quality improvement project was to assess the prevalence of existing ACP documentation among patients receiving primary care at a local free clinic in Anderson, SC. This patient population consists of uninsured patients, many who are experiencing homelessness and other marginalized groups. A second objective of this project was to implement initiatives and raise awareness among both the patients and the staff regarding importance of ACP, working to reduce the gap between underserved populations and those who are insured- who more frequently engage in ACP discussions during the annual wellness visits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;To assess the prevalence of ACP documentation, a retrospective chart review was conducted using Epic SlicerDicer. A total of 977 patients were identified as receiving primary care at the Anderson Free clinic. The initial step was to review patient records to determine how many already had existing ACP documentation.&lt;/div&gt;&lt;div&gt;The second step was to facilitate discussion surrounding advanced care planning. An Epic note template was created for providers to use during patient visits. This template was modeled after the Physician Orders for Scope of Treatment (POST) form. It included questions regarding patient preferences on cardiopulmonary resuscitation, medical intervention, nutritional administration, and a healthcare legal representative.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;To date, 313 charts have been reviewed out of the 977 identified patients. Of these, only four patients had some form of ACP documentation in place. The ongoing project has highlighted a clear disparity in ACP documentation among free clinic patients compared to insured populations. In addition to the continued data collection, the project has also implemented efforts aimed to increase awareness of ACP. Patients are provided with detailed information outlining the significance of ACP, what it is, and the options available for their preferences. These efforts are aimed to improve the discussion of ACP within the free clinic, ensuring patients can make informed decisions about the future of their healthcare regardless of their current insurance or socioeconomic status.&lt;/d","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 5-6"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989729","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":"Assessing a Community Educational Program’s Effect on Vaccine Literacy and Acceptance in Black Communities","authors":"Jacinda C. Abdul-Mutakabbir PharmD, MPH,&nbsp;Raheem Abdul-Mutakabbir BS, MPH(c),&nbsp;Samuel J. Casey MA","doi":"10.1016/j.jnma.2025.08.013","DOIUrl":"10.1016/j.jnma.2025.08.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Immunization against influenza and herpes zoster significantly reduces mortality and disease-related morbidity. However, vaccination rates among the non-Hispanic Black populations in the United States remain suboptimal, despite evidence of increased infection rates and related complications. Factors such as systemic injustice and decades of medical mistreatment have contributed to reduced health literacy and access to healthcare. Community-based strategies that enhance vaccine knowledge and awareness have proven effective in increasing vaccine acceptance and uptake. This study explores the impact of a community-based educational intervention designed to improve influenza and herpes zoster vaccine literacy and acceptance among vulnerable Black individuals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The intervention comprised four interactive educational sessions, each lasting 45 minutes, that focused on preventable viruses, specifically influenza and herpes zoster. These sessions were held at a church in a vulnerable community in San Bernardino County, California. Participants aged 18 and older were invited to take part in a pre-and post-intervention study, which involved completing an anonymous survey to assess their attitudes, knowledge, and behaviors related to viruses and vaccines. To analyze the effect of the intervention on vaccine literacy, we applied the Mann-Whitney U test to compare responses to eight knowledge-based questions from the pre-and post-intervention surveys. Descriptive statistics were used to evaluate the impact of the intervention on vaccine acceptance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 138 participants completed the pre-intervention survey, while 116 (84%) completed the post-intervention survey. All participants identified as Black or African American, with 74% identifying as female and 65% aged 55 or older. Additionally, 99% of the participants lived in highly vulnerable areas, and 54% reported having at least one comorbid condition. Prior to the intervention, only 57% believed they were at risk for viral infections or related complications. However, following the intervention, 75% stated that it helped them reassess their risk. We observed significant improvements in vaccine literacy when comparing pre-and post-intervention survey responses, particularly concerning guideline-based recommendations for both vaccines (p&lt;0.05). Moreover, there was a notable increase in knowledge about the recommended co-administration of the herpes zoster and influenza vaccines (p&lt;0.05). Initially, 49% of participants expressed a high likelihood of receiving the influenza vaccine, while 65% indicated a high likelihood for the shingles vaccine. In contrast, after the intervention, 83% reported a high likelihood of getting vaccinated against influenza, and 85% indicated a high likelihood of receiving the herpes zoster vaccine. Furthermore, over 90% of post-intervention participants said they would r","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 3-4"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989872","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":"Key Traits for Patient Satisfaction among Black New Jersey Residents","authors":"Chelsea A. Koomson BA,&nbsp;Sydney Arende BA,&nbsp;Shanzeh Nasir BS,&nbsp;Pamela Brug MD,&nbsp;Gloria A. Bachmann MD, MMS,&nbsp;Juana Hutchinson-Colas MD, MBA","doi":"10.1016/j.jnma.2025.08.018","DOIUrl":"10.1016/j.jnma.2025.08.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The patient-physician relationship is key to adequate healthcare, influencing health outcomes and patient trust. Communication, empathy, and cultural competency are crucial in shaping these experiences (Wu et al., 2021). Understanding patient preferences is vital to reducing disparities in New Jersey, where Black residents comprise 13.1% of the population (U.S. Census Bureau, 2021). Many Black residents prefer Black physicians due to perceived cultural competency and trust (Hopkins, 2002). This study seeks to identify physician characteristics that contribute to satisfaction among Black New Jersey residents, aiming to enhance patient-centered care and reduce healthcare inequities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;A quantitative online survey analyzed Black residents’ perceptions of physician traits in New Jersey. The sample size was determined using a 90% confidence interval and a 10% margin of error for statistical reliability. Participants were recruited through community events, organizations, social media, and flyers. The survey, adapted from prior research (Grogan, 2000), measured patient satisfaction across ten physician traits: Trust, Respect, Individualized Care, Honesty, Empathy, Understandable Communication, listening, Relatability, Diversity, and Communication. Responses were rated on a 5-point Likert scale from 1 (\"strongly disagree\") to 5 (\"strongly agree\")&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The sample size consisted of n = 65 participants, all identified as Black residents of New Jersey. Among the ten physician trait categories measured, the highest-rated were Understandable (x̄ = 4.41), Individualized Care (x̄ = 4.32), and Honesty (x̄ = 4.28). In contrast, the lowest-rated categories were Respect (x̄ = 3.48) and Communication (x̄ = 3.43). The highest-rated individual statement was “I appreciate my doctor most when they take the time to address all of my questions and concerns thoroughly” (x̄ = 4.69). The lowest-rated individual statement was “I think there have been times when I would have gotten better medical care if I belonged to a different race or ethnic group” (x̄ = 3.28). The remaining traits were rated as follows: Empathy (x̄ = 4.19), Listening (x̄ = 4.23), Trust (x̄ = 3.92), Relatability (x̄ = 3.80), and Diversity (x̄ = 3.98).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The results of this study provide valuable insights into Black residents' preferences regarding physician characteristics in New Jersey. High ratings for Understandable, Individualized Care, and Honesty indicate that these traits are crucial to patient satisfaction. The emphasis on individualized care is especially evident in the highest-rated individual statement, “I appreciate my doctor most when they take the time to thoroughly address all of my questions and concerns” (x̄ = 4.69), highlighting the importance of patient-centered care. The lowest-rated statement (x̄ = 3.28) reflects the perception of potentially receiving b","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 6-7"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989935","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":"Mortality Review of Young Adults with Sickle Cell Disease","authors":"Christle K. Nwora MD,&nbsp;C. Patrick Carroll MD,&nbsp;Elizabeth J. Prince DO,&nbsp;Lydia Pecker MD, MHS","doi":"10.1016/j.jnma.2025.08.037","DOIUrl":"10.1016/j.jnma.2025.08.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Sickle cell disease (SCD), a common inherited blood disorder, is associated with increased mortality in young adulthood. The extent to which these deaths result from SCD complications or other causes is not well established.</div></div><div><h3>Methods</h3><div>This single center retrospective chart review conducted from January 1, 2013, and November, 7, 2023 included adults with SCD identified in our institution’s electronic medical record who died between age 18 and 30 years. Three study team members (CN, PC, EP) determined causes of death using autopsy reports, emergency medical services reports, and clinical documentation.</div><div>Discrepancies in data interpretation among the study team were resolved through iterative discussions.</div></div><div><h3>Results</h3><div>There were 27 deaths, 16 (59%) in men, median age of death of 26 years (range 22-28), and 21 (78%) had hemoglobin SS disease. The most common causes of death were respiratory failure (33%) and infection (26%). Three deaths (11%) were attributed to gun violence and four deaths (14%) to substance use (15%). Half of the study cohort (52%) died in a hospital, divided between the intensive care unit and the emergency department. SCD complications included history of acute chest syndrome (N=25, 93%), hepatopathy (N=13, 48%), central nervous events including stroke (N=13, 48%), nephropathy (N=11, 41%), and one failed bone marrow transplant. SCD therapies included use of hydroxyurea (N=25, 93%) and chronic transfusions (N=18, 67%). Eighteen individuals (67%) had established care at our institution’s SCD center.</div></div><div><h3>Conclusion</h3><div>Most young adults with SCD in this cohort died with end-organ disease complications, but 26% of deaths are attributable Baltimore’s dual public health crises, gun violence and the opioid epidemic. Individuals in this cohort had a high burden of chronic disease and end organ damage that contributed to a cascade of events leading death. Findings support the need for tailored comprehensive care for young adults with SCD.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 18"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989942","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}