Journal of the National Medical Association最新文献

{"title":"Hospitalists' Perspective on Goals of Care Discussions with Racially and Ethnically Diverse Patients","authors":"Amanda Dowden M.D.","doi":"10.1016/j.jnma.2025.08.082","DOIUrl":"10.1016/j.jnma.2025.08.082","url":null,"abstract":"<div><h3>Background</h3><div>Previous literature has shown that patients of racial and ethnic diverse backgrounds are less likely to be engaged in goals of care discussions during hospitalization. The objective of this study is to shed light on barriers to addressing goals of care in this vulnerable population.</div></div><div><h3>Methods</h3><div>All hospitalists at a major tertiary center were surveyed. Study data were collected using REDCap electronic data capture tools. This needs assessment will be performed via an anonymous and voluntary survey of hospitalists. Descriptive statistics and Chi test will be used for analysis.</div><div>Data records consist of Anonymous survey responses from hospitalists. Questions will include identifying barriers and facilitators to discussing Goals of Care with patients of diverse racial and ethnic backgrounds as well as hospitalist perspective on current recommendations to improve these discussions in this population. Part 1 of the study assesses hospitalist confidence in carrying Goals of Care conversations. Part 2 of the study assesses hospitalists barriers to goals of care discussions amongst patients of ethnic and racial backgrounds. Part 3 assessing how practical hospitalists feel GOC conversations are in their clinical practice.</div></div><div><h3>Results</h3><div>Qualitative analysis revealed two themes which characterized hospitalists’ difficulty approaching end of life care: preconceived views of patients’ preferences and lack of institutional resources. The data shows that the number of hospitalists who feel very and extremely confident having G.O.C discussions with patient’s drops significantly when talking to non- English speaking patients from 67% to 19%. There is a similar trend when discussing life support from 81% to 19%. Additionally, 52% state that language is a moderate to extreme barrier to GOC discussions with patients. Of interest, only 4% state that race and ethnicity is a moderate barrier to GOC discussions and 11% state that spirituality or religion is a barrier to GOC discussions. Additionally, when asking about integrating the recommended goals of care questioning to underserved/diverse populations 48% felt that it would not be realistic in clinical practice.</div></div><div><h3>Conclusion</h3><div>The data suggests that looking forward it is necessary for us to eliminate disparities in end of life care. This study provides evidence to support development of interventions at the clinician and institutional level to reduce disparities in Advanced Care Planning.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 44"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989951","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":"Analysis of Treatment Modalities and Demographic Characteristics in Hidradenitis Suppurativa","authors":"Vyshnavi Rallapalle BS,&nbsp;Mallory Von Lotten MS,&nbsp;Madeleine Obuya BS,&nbsp;Evan Liu BS,&nbsp;Tiffany Mayo MD","doi":"10.1016/j.jnma.2025.08.020","DOIUrl":"10.1016/j.jnma.2025.08.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Hidradenitis Suppurativa (HS) is a chronic inflammatory condition that affects 0.1% to 2% of the general population, with a higher prevalence in African Americans and females. HS can be a debilitating condition with burdensome costs. Numerous guidelines and treatment options have been developed for HS in which antibiotics have been a mainstay in reducing flares; However, there is limited quality evidence on which antibiotic regimens are most effective and maintain long-term efficacy. The purpose of this study is to analyze the use of various antibiotics in HS patients as well as the use of other topical and oral medications for the management of this disease to help optimize future treatment guidelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective chart review of patients diagnosed with HS from April 2023 to June 2024 was conducted at a single institution. Various patient demographics were analyzed including age, gender, race, and body mass index (BMI). Hurley Staging was used to stratify HS disease severity from stages I to III. Prescribing practices for topical therapies, oral antibiotics, isotretinoin, androgen receptor antagonists, zinc, intralesional kenalog, and immunologic treatments were also analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 90 patients with HS, 77 (86%) were female and 13 (14%) were male with a median age of 44.5 years (range 19-73 years) and a mean BMI of 37 kg/m2. In terms of race, 71 (79%) of patients were African American, 15 (17%) were White, and 4 (4%) were not reported. 26% of patients had Hurley Stage I disease, 22% had Hurley Stage 2 disease, and 29% had Hurley Stage 3 disease, with the other patients falling in between the stages. Treatment modalities included topical benzoyl peroxide (BPO) washes or other antiseptic washes in 88% of patients and topical clindamycin in 78% of patients, respectively. In terms of oral medications, antibiotics were widely prescribed to all patients at a rate of 76% overall. The most commonly prescribed oral antibiotic was doxycycline at 74%, followed by clindamycin at 20%, rifampin at 18%, bactrim at 4%, and metronidazole, augmentin, and moxifloxacin at 3% each, respectively. The mean duration of antibiotic therapy was 10 months (SD: 17 months). Other oral medication treatments, androgen receptor antagonists such as spironolactone and finasteride used in 40% of patients, and oral zinc prescribed to 32% of patients.&lt;/div&gt;&lt;div&gt;Intralesional kenalog injections were administered in 35% of cases and deroofing surgery was performed for 7% of patients. Ultimately, 44/90 (49%) of patients required treatment with immunomodulating or biologic therapies to reach their maintenance HS treatment goal.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The findings of this study indicate that along with topical antiseptic washes and clindamycin, antibiotics are a mainstay for treatment of HS. At this institution, doxycycline was the most commonly prescribed antibio","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 7-8"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989416","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":"Impact of Chemotherapy on Financial Toxicity in African-American Breast Cancer Patients","authors":"Maya J. Stephens MS, BS,&nbsp;Nimisha Kasliwal,&nbsp;Ursula J. Burnette MA,&nbsp;Louisa Onyewadume MD, MPH,&nbsp;Chesley W. Cheatham Med, MCHES,&nbsp;Tamika K. Smith AAB,&nbsp;Corey W. Speers MD, PhD,&nbsp;Janice A. Lyons MD,&nbsp;Shearwood McClelland III MD","doi":"10.1016/j.jnma.2025.08.075","DOIUrl":"10.1016/j.jnma.2025.08.075","url":null,"abstract":"<div><h3>Background</h3><div>With the rising cost of chemotherapy, the financial toxicity (FT) of systemic therapy can substantially impair patient quality of life. FT is also associated with various socioeconomic factors, one being race. Patients of African American race often bear the worst burden of cancer treatment-related FT, with a 40% increased mortality from breast cancer. The degree to which chemotherapy prior to radiation therapy (RT) impacts FT has yet to be formally quantified. We report early FT findings among African American breast cancer patients prior to receipt of adjuvant RT on the ongoing Navigator-Assisted Hypofractionation (NAVAH) Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232) to assess the impact of chemotherapy on FT.</div></div><div><h3>Methods</h3><div>African-American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following resection. As part of the trial, patients were assisted by a patient navigator during and after treatment. FT was measured using the validated 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey instrument. COST-FACIT scoring was used to find FT in patients before receipt of RT. Values from 26-44 represent Grade 0 FT (none), values from 14-25 represent mild Grade 1 FT (mild), values from 1-13 represent Grade 2 FT (moderate), and values of 0 represent Grade 3 FT (severe). The chi-square test was used to identify statistically significant differences (p &lt;0.05) between patients who received chemotherapy versus no chemotherapy prior to receipt of RT.</div></div><div><h3>Results</h3><div>The first 32 enrolled patients completing the pre-RT COST-FACIT survey were evaluated. 53% of patients underwent chemotherapy before RT. Mild to moderate FT was apparent in 56% of patients. The mean and median COST-FACIT score (range 4.4-39) was 25 (± 10.4). 78% of patients who experienced some level of FT underwent chemotherapy and 22% of patients experiencing FT did not receive chemotherapy (p = 0.0015). Of patients who did not experience FT, 21% received chemotherapy and 79% of patients did not. In total, 82% of patients who underwent chemotherapy before RT reported mild to moderate FT. Grade 3 FT was not observed.</div></div><div><h3>Conclusion</h3><div>The NAVAH study is the first to objectively compare FT among patients receiving chemotherapy before RT for early-stage breast cancer. Our findings indicate that more than 80% of patients who underwent chemotherapy experienced FT. Approximately 1 in 5 patients not experiencing FT received chemotherapy. The findings indicate that chemotherapy plays a significant role in patient quality of life, highlighting a subsection of patients who may benefit from proactive financial assistance to reduce the detrimental effect of FT on their livelihood.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 39-40"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989422","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":"Analysis of Vertebral Artery Injuries in Cervical Disc Arthroplasty","authors":"Gonzalo F. Del Rio Montesinos BS,&nbsp;Lancelot Benn MD,&nbsp;Christopher P. Bellaire MD,&nbsp;Addisu Mesfin MD","doi":"10.1016/j.jnma.2025.08.056","DOIUrl":"10.1016/j.jnma.2025.08.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical Disc Arthroplasty (CDA) treats cervical disc degeneration and spinal compression, offering a high success rate and improved neck disability index. During CDA, the vertebral artery (VA), a major blood vessel branching from the subclavian artery, is at risk. This courses the transverse foramen of C2-C6 vertebrae, exits at C2, and enters the skull via the foramen magnum. Injuries are often due to anatomical variations, though rare, can cause severe complications. The goal of this review is to analyze variables influence the incidence of vertebral artery injuries (VAI) such as Normal Anatomy, FDA-approved Devices, increase CDA, the prevalence of VAI in the anterior approach, case reports regarding the injury, preventative measures, and treatment were considered.</div></div><div><h3>Methods</h3><div>The articles chosen were from June 30th, 2000, to June 30th, 2024, and sourced from PubMed, Science Direct, and Web of Science. The articles inclusion and exclusion criteria were based on the qualitative and quantitative quality of the information sourced. We obtained the articles utilizing keywords such as cervical, cervical disc, vertebral artery, vertebral artery injury, disc arthroplasty, and degenerative disc. The risk of bias was obtained via the Robins-I V2 Tool for each individual article utilized. The synthesis of results was obtained via a meta-analysis of multiple articles.</div></div><div><h3>Results</h3><div>A total of 78 articles were analyzed, with 45 included in the systematic review. Anatomic variations of the vertebral artery occurred in 7.6% of 250 individuals, and the anterior approach of CDA had a 0.4% VAI occurrence. Surgeons with &lt;300 procedures had a 0.33% risk of VAI, while those with &gt;300 had 0.06%. FDA approved CDA in the U.S. in 2007, and among 11 approved devices, none reported VAI as a complication. Two case reports documented VAI post-CDA, highlighting limited literature. Stenting had a 97% success rate but required long-term monitoring. Between 2007-2013, CDA use increased 190%, replacing anterior cervical fusion. The risk of bias was low in intervention classification, outcome measurement, and result reporting but uncertain for confounding and missing data due to limited methodological details.</div></div><div><h3>Conclusion</h3><div>VAI risk in CDA necessitates careful consideration of anatomical variations, surgeon expertise, and robust preventive and treatment strategies. Increased usage underscores the need for more comprehensive research and reporting on potential complications.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 29"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989579","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":"Access to CAR T-Cell Therapies in Minority Communities: A Patient Survey Study of Disparities in Multiple Myeloma Care","authors":"Christie Okoye,&nbsp;Jonathan Tyes,&nbsp;Christy Houde,&nbsp;Jay Hydren,&nbsp;Mason Barnes,&nbsp;Rachel Jensen,&nbsp;Jenny Ahlstrom,&nbsp;Craig Cole,&nbsp;Jeffrey Zonder","doi":"10.1016/j.jnma.2025.08.093","DOIUrl":"10.1016/j.jnma.2025.08.093","url":null,"abstract":"<div><h3>Background</h3><div>Chimeric Antigen Receptor (CAR) T-cell therapy is a groundbreaking treatment for multiple myeloma, offering a potentially life-extending option for eligible patients. However, due to its high cost, intensive logistical requirements, and availability generally limited to specialized centers, access may not be equitably distributed. Black and Hispanic patient may experience disproportionately limited access to this therapy. While institutional and systemic disparities have been documented, less is known about how patient-level experiences, perceptions, and social determinants influence access and treatment outcomes.</div></div><div><h3>Objective</h3><div>This study aims to characterize disparities in access to CAR T-cell therapy among patients with multiple myeloma, with a particular focus on race, ethnicity, socioeconomic status, and social determinants of health. It further seeks to assess how these factors influence patient satisfaction and perceptions around treatment decision-making.</div></div><div><h3>Methods</h3><div>This is a prospective, cross-sectional survey study involving patients diagnosed with multiple myeloma, including those who are eligible for or have considered CAR T-cell therapy and who are enrolled in the HealthTree research registry. Participants will complete a 25–35-minute survey consisting of up to 46 questions on treatment experiences, access to care, perceived barriers, and patient-reported outcomes. An additional 11 questions will capture demographic and socioeconomic data, including race/ethnicity, education level, insurance type, and neighborhood-level metrics. The survey will be disseminated electronically via the HealthTree platform. Data will be analyzed using descriptive statistics and comparative analyses (e.g., chi-square tests, t-tests, ANOVA), with multivariable models used to assess factors associated with disparities in access and outcomes.</div></div><div><h3>Results (Trial in Progress)</h3><div>As of June 2025, data collection is ongoing. Preliminary survey responses have been received from a diverse group of participants enrolled in the HealthTree registry.</div></div><div><h3>Discussion</h3><div>This study will provide real-world patient-level insights into disparities in CAR T-cell therapy access, beyond clinical and institutional metrics. By highlighting patient experiences and perceptions, it aims to inform policy, provider education, and system-level interventions that can close the access gap and improve equity in advanced myeloma care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 51-52"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989865","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":"Educating Physicians about Respect and Medical Distrust: Focus Groups Outcome","authors":"Marie L. Borum MD, EdD, MPH","doi":"10.1016/j.jnma.2025.08.032","DOIUrl":"10.1016/j.jnma.2025.08.032","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Colorectal cancer causes significant morbidity and mortality in the United States. African-Americans have among the highest incidence and death rates in the nation. Screening for colorectal cancer improves outcomes. Multiple barriers, including perceived cost, inconvenience, transportation and fear, have been recognized to decrease adherence to screening recommendations. This study used a bi-directional learning focus group involving African-American adults and early career physicians to assess colorectal cancer screening barriers with attention to potential sociocultural concerns.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A bi-directional learning focus group of African American adults from a community church and early career physicians was conducted with a trained facilitator. An audio recording was transcribed verbatim with subsequent thematic analysis by two investigators using an iterative process. A post-focus group survey was conducted to confirm identified focus group themes with specific attention devoted to identifying potential sociocultural concerns. Analysis of pre- and post-focus group surveys was performed using Fisher Exact test with significance set a p&lt;0.05. A second bidirectional learning focus group was conducted to review the results and to assess understanding of themes identified during the initial focus group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The focus group consisted of 18 members (7 African-American adults, 11 non-African-American early career physicians). 100% of participants recognized that there are recommended guidelines for colorectal cancer screening. The focus group identified lack of awareness (81%), colonoscopy preparation (80%), physician trust (60%), lack of insurance coverage (56%), transportation (56%), extended colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of the procedure or cancer (35%) as screening barriers. However, community members more often than early career physicians identified historical racial disparity in health care (p=0.0474), physician respect toward patients (p=0.0128) and insufficient physician discussion (p=0.0006) as screening barriers.&lt;/div&gt;&lt;div&gt;Post-focus group surveys highlighted the desire for physicians to recognize the impact of historical racial disparities in health care delivery. While specific discussion about disparities was not desired, emphasis on communication, listening and shared decision- making was recommended. Factors which community members identified as demonstrating respect included providing adequate time for the appointment, listening with reciprocal communication, sitting and eye-contact during discussions, using titles or honorifics during initial meeting and performing physical examination as appropriate. While community and early career physicians appreciated that discussions about medical recommendations are necessary, there was a significant disparity in the perceived adequacy of physician-pati","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 15-16"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989937","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":"Spiritual Beliefs and Preferences among Patients with Multiple Myeloma","authors":"Danielle Cain ,&nbsp;Hannah Johnston ,&nbsp;Michelle Ware-Ivy ,&nbsp;Benjamin A Derman","doi":"10.1016/j.jnma.2025.08.089","DOIUrl":"10.1016/j.jnma.2025.08.089","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Multiple myeloma is the second most common hematologic malignancy in the United States, with over 36,000 new cases annually. Despite its prevalence, little is known about the role of spirituality and religion throughout the myeloma disease course. We surveyed patients with multiple myeloma to assess their spiritual beliefs and preferences for incorporating spirituality into care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We developed a comprehensive electronic survey incorporating validated instruments, including the Centrality of Religiosity Scale (CRS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12), and the European Organization for the Research and Treatment of Cancer Myeloma Module Quality of Life Questionnaire (QLQ-MY20). A patient advocate reviewed all questions for clarity and cultural appropriateness. The survey was distributed anonymously via X/Twitter and the electronic health record system. Survey scores were calculated using standard instrument-specific scoring algorithms. Group comparisons were made using the Mann-Whitney U-test. Correlations between spirituality scores and QLQ-MY20 subscales were assessed using Spearman’s rank correlation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 281 respondents, 176 (63%) completed all survey components and were included in the analysis. The median age was 65 years; 64% were female and 82% were married or in a committed partnership. The cohort was predominantly Non-Hispanic (NH) White (85%), with 8.5% identifying as NH Black. Most participants identified as Christian (70%), followed by atheist/agnostic (11%), spiritual but not religious (10%), Jewish (6%), and other (3%). Among Christian patients (n=123), both catholic (n=44) and protestant (n=63) denominations were represented.&lt;/div&gt;&lt;div&gt;Most respondents (140/176, 80%) believed that clinicians should consider religious factors when presenting treatment recommendations, and 75 (42%) expressed interest in receiving spiritual care services or inspirational resources as part of their care plan. However, only 19% of respondents had discussed their spiritual beliefs with their care team. This interest was especially high among Black respondents (12/15, 80%) compared to non-Black respondents (p&lt;0.001).&lt;/div&gt;&lt;div&gt;The median FACIT-Sp-12 score was 33 and the median CRS score was 3.73. Black respondents had significantly higher FACIT-Sp-12 (37 vs 33, p=0.0085) and CRS scores (4.4 vs 3.67, p=0.0092), indicating stronger spiritual identity. Atheist/agnostic patients had significantly lower FACIT-Sp-12 (median 22.5 vs 35, p&lt;0.001) and CRS scores (median 1.33 vs 3.87, p&lt;0.001) compared to all other respondents, reflecting lower spiritual well-being and religiosity. These patients also reported lower body image scores on the QLQ-MY20 (66.67 vs 83.34, p=0.01). Spearman correlation analysis showed a weak but significant positive correlation between CRS and the QLQ-MY20 disease symptoms subs","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 48-49"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989955","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":"A Practical Approach to Multimodal Management of Chronic Pain in Primary Care","authors":"Fildrin T. Ndimbo MD","doi":"10.1016/j.jnma.2025.08.024","DOIUrl":"10.1016/j.jnma.2025.08.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic pain affects approximately 20.9% of adults in the United States, surpassing the prevalence of diabetes and posing a substantial burden on healthcare systems. Patients with chronic pain often experience frequent healthcare visits, comorbid mental health disorders, and diminished quality of life. Primary care providers (PCPs) play a pivotal role in managing these patients, yet they encounter multiple challenges, including limited appointment times, inadequate training in pain management, and concerns about opioid prescribing. As the opioid crisis continues to shape pain management policies, an emphasis on multimodal, evidence-based strategies has emerged as a critical approach. Integrating pharmacologic, non-pharmacologic, and interventional techniques can improve patient outcomes while reducing the reliance on opioids.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using the latest guidelines, including the CDC’s 2022 opioid prescribing recommendations, the American Academy of Pain Medicine guidelines, and systematic reviews on interventional pain procedures. Case studies are presented to illustrate practical applications of multimodal pain management in primary care, emphasizing scenarios where early referral to interventional pain specialists may be beneficial.</div></div><div><h3>Results</h3><div>Non-Pharmacologic Approaches: Evidence supports the use of physical therapy, cognitive behavioral therapy (CBT), mindfulness- based stress reduction, acupuncture, and spinal manipulation in chronic pain management. Exercise therapy has shown sustained benefits in osteoarthritis and chronic low back pain. Multidisciplinary rehabilitation programs are associated with improved functional outcomes.</div><div>Pharmacologic Approaches: First-line medications include NSAIDs, serotonin-norepinephrine reuptake inhibitors (duloxetine), tricyclic antidepressants (amitriptyline), and anticonvulsants (gabapentin, pregabalin) for neuropathic pain. Acetaminophen has a limited role in osteoarthritis but may be useful as adjunct therapy. Opioids should be reserved for select cases, with clear treatment goals and an exit strategy.</div><div>Interventional Pain Management: Epidural steroid injections provide short-term relief for lumbar radiculopathy, while radiofrequency ablation is effective for facet joint and sacroiliac joint pain. Neuromodulation techniques, including spinal cord stimulation, show promise for neuropathic pain and complex regional pain syndrome (CRPS). Regenerative therapies such as platelet-rich plasma (PRP) injections are emerging as potential adjuncts.</div><div>Bridging Primary Care and Pain Medicine: Many primary care providers feel unequipped to manage chronic pain beyond pharmacologic interventions. Establishing referral pathways for interventional procedures can optimize patient outcomes. Collaborative care models, including co-management with pain specialists, enhan","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 10-11"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988782","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 Guillain-Barré Syndrome Outcomes: One-Year Analysis","authors":"Quinton D. Johnson BS,&nbsp;Emmanuel Y. Kerolle BS,&nbsp;Amara A. Chike BS,&nbsp;Jeff G. Palmer BS,&nbsp;Somtochi A. Edeh BS,&nbsp;Samrawit W. Zinabu MD,&nbsp;Miriam B. Michael MD","doi":"10.1016/j.jnma.2025.08.068","DOIUrl":"10.1016/j.jnma.2025.08.068","url":null,"abstract":"<div><h3>Introduction</h3><div>Guillain-Barré Syndrome (GBS) is an acute autoimmune neuropathy that can lead to paralysis, muscle weakness, sensory deficits, and mortality. Racial disparities in healthcare access and disease outcomes are well-documented, but their impact on GBS outcomes remains unclear. This study examines one-year outcomes (paralysis, numbness, muscle weakness, and mortality) in Black/African American and White/Caucasian patients matched for comorbidities.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using propensity-matched Black/African American and White/Caucasian patients diagnosed with GBS. Matching criteria included comorbid conditions such as diabetes, obesity, pregnancy-related conditions, respiratory diseases, and circulatory diseases. Risk analysis, Kaplan-Meier survival analysis, and t-tests were performed to assess differences in outcomes between racial groups.</div></div><div><h3>Results</h3><div>No statistically significant differences were found between Black and White patients for paralysis (p = 0.163), numbness (p = 0.849), muscle weakness (p = 0.333), or mortality (p = 0.694). Kaplan-Meier survival analysis also showed no significant difference in time-to- event for any outcome.</div></div><div><h3>Conclusion</h3><div>This study suggests that, after adjusting for key comorbidities, racial background does not significantly influence one-year outcomes in GBS. These findings highlight the importance of equitable medical care and early intervention. Future research should explore healthcare access, treatment differences, and long-term functional recovery to further understand potential disparities.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 36"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989413","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":"Barriers and Facilitators to Timely Distal Radius Fracture Care","authors":"Sciaska Ulysse BA,&nbsp;Jeffrey W. Kwong MD, MS,&nbsp;Kalpit Shah MD,&nbsp;Robin N. Kamal MD, MBA, MS,&nbsp;Lauren M. Shapiro MD, MS","doi":"10.1016/j.jnma.2025.08.058","DOIUrl":"10.1016/j.jnma.2025.08.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite mounting evidence that delays in the surgical treatment of displaced distal radius fractures can adversely affect outcomes, factors such as insurance type and language have been associated with disparities in time to surgery (TTS) in quantitative studies. We sought to better characterize the specific barriers and facilitators to timely surgical care of operative distal radius fractures using qualitative methods.</div></div><div><h3>Methods</h3><div>In this multi-institutional study, we recruited English, Spanish, Mandarin, and Cantonese-speaking patients aged ≥18 years old with isolated, closed distal radius fractures treated with surgical fixation. Patients were invited to participate if their surgery was delayed (defined as ≥10 days between injury and surgery). Malunions (surgery &gt;6 weeks after injury) were excluded. Interviews were conducted using a semi-structured interview guide and were audio recorded, de-identified, and transcribed verbatim. Thematic analysis was conducted using a deductive approach guided by the Models of Pathways to Treatment framework, which describes the events, processes, and intervals from the initial injury to the start of treatment. Representative quotes were selected to illustrate key barriers and facilitators following the four intervals defined by the framework: appraisal, help-seeking, diagnostic, and pre-treatment.</div></div><div><h3>Results</h3><div>Eighteen individuals (mean age 55.2 ±17.4 years) completed a semi-structured interview; 83% were female. The average TTS (SD) was 14.2 days (3.4), with a range of 10-22 days. Barriers (N=113) such as the minimization of symptoms (appraisal), language challenges (help-seeking), healthcare system inefficiency (diagnostic), and lack of insurance coverage (pre-treatment) were identified as key factors to delays in diagnosis and treatment. Facilitators (N=117) such as the presence of social support (appraisal), patients’ familiarity with the hospital system (help-seeking), early involvement of orthopaedic surgeons rather than other non-specialized providers (diagnostic), and thorough patient education (pre-treatment), were recognized as factors that may help minimize delays.</div></div><div><h3>Conclusion</h3><div>Qualitative interviews identified factors influencing timely surgical care for distal radius fractures. Distal radius fractures involve multiple care phases, each with compounding roadblocks. Findings highlight the need for targeted interventions such as streamlined referral pathways, expanded multilingual patient education, and policy changes addressing insurance-related delays.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 30"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989581","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}