Journal of the National Medical Association最新文献

{"title":"Health Inequities within Radiation Treatment after Neurosurgery","authors":"Opeyemi E. Adelugba BS,&nbsp;LaCreis Kidd PhD, MPH,&nbsp;Brian Williams MD,&nbsp;Akshitkumar Mistry MD,&nbsp;Donald Miller MD, PhD,&nbsp;Joseph Chen PhD,&nbsp;Kavitha Yaddanapudi PhD,&nbsp;Shesh Rai PhD,&nbsp;Shearwood McClelland III MD,&nbsp;Adrianna Masters MD, PhD","doi":"10.1016/j.jnma.2025.08.073","DOIUrl":"10.1016/j.jnma.2025.08.073","url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>Brain metastases are the most frequent intracranial tumor type. Following surgical treatment of patients with brain metastases, about half of them will experience disease recurrence without adjuvant therapy. This relapse can be lowered with either whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). Unfortunately, rural patients often underutilize adjuvant therapy, despite radiosurgery having fewer acute and long-term side effects compared to WBRT alone. There are no published reports to inform radiation oncologists on how to improve the use of adjuvant therapy among metastatic brain cancer patients from underserved communities in Kentucky. Thus, there is a critical need to understand factors related to this disparity to improve disease prognosis in this population. We hypothesize differences in the use of adjuvant therapy are related to limited access to specialized care, lack of nurse navigators, and socioeconomic challenges among underserved populations, leading to poor disease prognosis.</div></div><div><h3>Materials/Methods</h3><div>We retrospectively identified patients with brain metastases who underwent surgical resection of 1-3 brain metastases between July 2018 to July 2023 at the University of Louisville Health Brown Cancer Center. We collected demographic, treatment type, and outcome data related to their follow-up and post-operative care (IRB 22.0796). To assess differences between categorical and quantitative data, we used the Fisher’s exact test and the Wilcoxon sum rank test with a significance level of 0.05.</div></div><div><h3>Results</h3><div>A majority of the patients were middle-aged [mean = 61; range = 39-81], white (80% white, 20% black), 55% male, 65% urban residents, 55% overweight/obese, and 22.5% uninsured. Rural patients were more likely to lack health insurance than those from urban areas (27.3% vs 14.3%; p = 0.0307). Among patients who were scheduled for a radiation oncology appointment post-surgery, only 13.3% kept their appointment. Notably, Black patients received higher radiation fractions (p = 0.0139) and were more likely to reside near the Brown Cancer Center compared to White patients. Disparities in death from 1-year post surgery and brain failure were more prevalent among both rural patients (p = 0.0044) and those who lacked insurance (p =0.008) than patients who lived in urban areas or who had insurance, respectively. Lastly, none of the patients were assigned patient navigators.</div></div><div><h3>Conclusion</h3><div>Our findings suggest patients from rural areas could benefit from additional resources such as a nurse navigator to address patients’ questions regarding the treatment process, ensure the patient meets with a radiation oncologist, and receive reminders to complete all prescribed radiation treatment post neurosurgery. Lastly, a nurse navigator can help patients secure needed health insurance, which will reduce financial barriers to adj","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 38-39"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989418","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 Disparities in Debt Burden among Underrepresented Medical Students Matched into Orthopaedic Surgery Residency","authors":"Lancelot Benn MD,&nbsp;Bianca Audrey Duah BA,&nbsp;Gonzalo F. Del Rio Montesinos MS,&nbsp;Addisu Mesfin MD","doi":"10.1016/j.jnma.2025.08.064","DOIUrl":"10.1016/j.jnma.2025.08.064","url":null,"abstract":"<div><h3>Introduction</h3><div>The rising cost of medical education in the United States has outpaced inflation over the past two decades, leading to significant financial burdens on students, particularly those from underrepresented in medicine (URiM) backgrounds. Recent data shows that the average educational debt for medical graduates has surged, with Black students anticipating more debt than their peers. This financial strain influences career choices, potentially deterring URiM students from pursuing specialties like orthopedic surgery. This study examines the racial disparities in anticipated debt and financial stress among URiM students who matched into orthopedic surgery during a single match cycle.</div></div><div><h3>Methods</h3><div>Study Participants: This retrospective cohort study included 45 URiM medical students who matched into orthopedic surgery residency in March 2023. Data were collected via a 42-item Google survey distributed by the J. Robert Gladden Orthopaedic Society in June 2023, adapted from a previous study on racial disparities in medical student debt. The survey captured demographics, student debt, USMLE scores, and ERAS metrics. All 45 respondents met inclusion criteria, including one graduate from a Caribbean medical school.</div></div><div><h3>Results</h3><div>This study analyzed 45 URiM medical students who matched into orthopedic surgery residency in 2023. The cohort was evenly split between males and females (49% vs. 51%), with the majority identifying as Black (87%) and the remainder as Hispanic/Latino (9%). Most participants were allopathic graduates (87%) and attended public medical schools (53%), with 84% coming from institutions with an affiliated orthopedic residency program. The majority (89%) carried medical school debt, with an average burden of $203,315, while 60% also had undergraduate debt averaging $43,451. USMLE scores showed weak inverse correlations with debt: Step 1 (-0.20) and Step 2 (-0.15) scores tended to decrease slightly with higher debt levels. Specifically, students with higher medical school debt (&gt; $200,000) had lower mean Step 1 (220.3) and Step 2 (234.3) scores compared to those with lower debt burdens. Black students, who made up the majority of the cohort, also had higher debt burdens, with a mean medical school debt of $193,882.</div></div><div><h3>Conclusion</h3><div>Orthopedic surgery remains one of the least diverse specialties. Financial barriers contribute to the underrepresentation of URiM students in orthopedic surgery. High debt burdens and costly applications can discourage qualified URiM students. Findings align with national data: Black students consistently report higher debt burdens. Home programs or medical school locations did not mitigate debt levels. Application process costs add further financial strain. Diversity in orthopedic surgery is critical for improving patient care outcomes in underserved populations.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 33-34"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989500","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":"Does Enhanced Cognitive Processing Therapy with Lifesteps Reduce HIV Stigma and PTSD","authors":"Shibrika Pansy MS ,&nbsp;Carla Kmett Danielson PhD ,&nbsp;Erin Bisca MA ,&nbsp;Nathaniel Baker MS ,&nbsp;Stephaine Amaya PhD ,&nbsp;Tayler Wilson MA ,&nbsp;Cristina López PhD","doi":"10.1016/j.jnma.2025.08.087","DOIUrl":"10.1016/j.jnma.2025.08.087","url":null,"abstract":"<div><h3>Background</h3><div>People with HIV (PWH) report higher levels of trauma than the general population, with rates from 40 to 90%. Higher rates of traumatic exposure correspond with higher rates of Post-traumatic Stress Disorder (PTSD) in this population, with rates of PTSD in PWH estimated to be between 30 and 74%. Up to 64% of PLH endorse PTSD symptoms directly related to their HIV diagnosis. Our team recently enhanced Cognitive Processing Therapy (CPT), an evidence-based treatment for PTSD, with Lifesteps (L), an HIV medication adherence intervention, to create CPT-L to address PTSD and HIV outcomes.</div><div>The purpose of the current study is to report on preliminary HIV stigma and PTSD findings among a small sample participating in a pilot randomized controlled trial comparing CPT-L to Standard of Care (SOC).</div></div><div><h3>Methods</h3><div>PWH (N=41; Mean age=44.8; SD=12.3) who had experienced at least one traumatic event with current PTSD symptoms were recruited from local Ryan White HIV care clinics. Participants were randomized to receive CPT-L or SOC and completed validated assessments of PTSD and stigma at baseline and at 6-week post-baseline.</div></div><div><h3>Results</h3><div>Following 6-weeks of treatment, CPT-L participants showed significant decreases in PTSD (CAPS: CPT-L Δ=-17.7, SE=2.4 vs. SOC Δ=-6.2, SE=4.0; Cohen’s d=1.0). Males receiving CPT-L had a significantly greater decrease in PTSD as compared to females receiving CPT-L (Males-Δ=-25.3, SE=4.2 vs. Females-Δ=-8.6, SE=4.7; d=1.61) while the sex difference in the SOC group was null (d=0.06). Further, participants identifying as Black had significantly greater decreases in CAPS scores during treatment as compared to all other races (Black-Δ=-13.8, SE=2.8 vs. All Others-Δ=-6.0, SE=3.9; d=0.65). Changes in stigma total score from baseline to week 6 reached a Cohen’s d of .97 within the CPT-L group but the between group difference was not significant (Δ=6.22, SE=5.55, Cohen’s d=0.43, p=.273).</div></div><div><h3>Conclusions</h3><div>The results suggest CPT-L can be used as a tool to reduce HIV stigma and PTSD in PWH, particularly among males and Black people. Clinical implications and future research directions should explore ways in which physicians who work with PWH can best intergrate CPT-L into their practices to promote a larger scale impact in the reduction of PTSD and HIV stigma, and ultimately improve HIV health outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 47"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989414","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":"Post-Radiation Survey Data from Navigator-Assisted Hypofractionation (NAVAH) Phase I Trial","authors":"Dante A. Sanders MS,&nbsp;Tamika K. Smith AAB,&nbsp;Ursula J. Burnette MA,&nbsp;Erica Fleming-Hall BS,&nbsp;Abizairie Sanchez-Feliciano BS,&nbsp;Maya J. Stephens MS,&nbsp;Louisa Onyewadume MD, MPH,&nbsp;Chesley W. Cheatham Med, MCHES,&nbsp;Daniel E. Spratt MD,&nbsp;Angela Y. Jia MD, PhD,&nbsp;Shearwood McClelland III MD","doi":"10.1016/j.jnma.2025.08.076","DOIUrl":"10.1016/j.jnma.2025.08.076","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer (PC) is the leading cause of malignancy-related death in men. Per the 2024 Ohio annual cancer report, stratification of PC patients by race reveals a greater than 80% increase in mortality of African-American versus White patients. An assessment of how social determinants of health (SDOH) impact disparities in cancer-related mortality contributed to the founding of the Navigator- Assisted Hypofractionation (NAVAH) program. The NAVAH program for PC takes an innovative patient navigation approach and culturally sensitive survey aiming to better identify SDOH faced by African-American patients receiving radiation therapy (RT) treatment. This is an early report of the post-RT data during piloting of the NAVAH PC program’s innovative survey as part of a Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232).</div></div><div><h3>Methods</h3><div>Patients who met criteria of having histologically diagnosed PC, African-American race, and having consented to RT with their Radiation Oncologist, were recruited for trial enrollment. Surveys were administered prior to receipt of RT and at one-month following RT completion. Post-RT survey questions were divided into sections representative of the following categories: availability (coordinating care; overall quality of care), accessibility (transportation; distance to care), affordability (financial considerations; employment; level of education), accommodation (access to internet; navigating transportation; healthcare literacy), and acceptability (comfort and prejudice among interactions with the system). Responses to each question were systematically scored and tabulated into representative scores: outstanding, excellent, good, average, below average.</div></div><div><h3>Results</h3><div>Scores thus far reveal: good availability (37 responses), excellent accessibility (3 responses), below average affordability (6 responses), below average accommodation (18 responses), and average acceptability (9 responses). The presence of patient navigation was noted to be helpful and positively contribute to cancer care, and participation in a clinical trial was viewed positively, with comfort in clinical trial participation at the cancer center where RT was received.</div></div><div><h3>Conclusions</h3><div>These findings support the viability of the NAVAH program survey for use in African-American PC patient population after RT completion. Scoring indicates that PC patients having completed RT positively embrace the quality and accessibility of services with neutral attitude about hospital facilities and providers, but have concerns about service cost and assistance. Continuance of this Phase I study will better elucidate SDOH faced by this patient population and the potential impact of RT receipt on these outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 40"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989423","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":"Rhabdomyolysis Associated with Salmonella infection: A Case Report","authors":"Jeffrey G. Palmer BS,&nbsp;Armando Ugarte,&nbsp;Cameau Charleus,&nbsp;Smita Mathur MD,&nbsp;Samrawit Zinabu,&nbsp;Kevin Boluyt,&nbsp;Miriam Michael MD","doi":"10.1016/j.jnma.2025.08.069","DOIUrl":"10.1016/j.jnma.2025.08.069","url":null,"abstract":"<div><h3>Introduction</h3><div>Rhabdomyolysis is a rare outcome of a Salmonella infection.</div></div><div><h3>Case presentation</h3><div>This case presents a 21-year-old male with rhabdomyolysis likely caused by an ongoing Salmonella infection. He initially presented to the emergency department (ED) with severe hyperthermia following extraneous physical activity. His CPK levels and other labs demonstrated evidence of rhabdomyolysis and acute kidney injury. His stool PCR was also positive for Salmonella. His clinical condition worsened with findings concerning bilateral compartment syndrome, so he underwent bilateral gluteal fasciotomy.</div></div><div><h3>Discussion</h3><div>There are limited case reports of a Salmonella infection causing rhabdomyolysis and progressing to compartment syndrome. This case highlights the importance of expanding the causes of rhabdomyolysis beyond its typical causes, such as crush injury and strenuous exercise. A systemic approach leads to a more favorable outcome and prevents further progression or complications of rhabdomyolysis.</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":"144989507","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":"Comparative Epidemiological Study of Orthopedic Conditions in Michigan","authors":"Angel G.A. Prempeh BS,&nbsp;Olorunferanmi Oni BS,&nbsp;Allison Tenfelde MD","doi":"10.1016/j.jnma.2025.08.060","DOIUrl":"10.1016/j.jnma.2025.08.060","url":null,"abstract":"<div><h3>Introduction</h3><div>Variations in orthopedic care between urban and rural hospitals may influence length of stay (LOS), costs, and resource utilization. Yet the extent and nature of these differences remain poorly characterized. Understanding how hospital location, injury type, and insurance coverage influence length of stay and expenditures is essential. These factors play a crucial role in healthcare resource allocation and patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using 2018–2020 discharge records from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) database. Inclusion criteria was orthopedic-related diagnoses from Michigan hospitals. Hospitalizations were classified by location (urban vs rural), trauma status (trauma vs non-trauma), and insurance type (Medicare, Medicaid, private, other, uninsured). Length of stay, per-stay and aggregate hospital costs, and discharge rates were recorded. Multivariable t-tests, ANOVA, and a mixed-effects model analysis were conducted to compare differences across the variables.</div></div><div><h3>Results</h3><div>Among 334,756 orthopedic discharges, urban hospitals had a longer mean LOS than rural hospitals (4.57 vs 4.09 days; P&lt;.001). Non-trauma cases incurred higher per-stay costs than trauma cases ($19,645 vs $16,630; P&lt;.001). Uninsured patients had the longest mean Length of Stay (LOS) (4.70 days), followed by Medicare (4.35 days), Medicaid (3.89 days), private insurance (3.72 days), and other insurance (3.06 days). All differences were statistically significant (P &lt; .001). Aggregate expenditures were highest for Medicare ($3.3M; P&lt;.001), and urban hospitals showed greater overall spending across all insurance groups. Medicaid had higher per- stay costs than uninsured ($18,745 vs $15,892; P=.03) but lower total expenditures. Rural hospitals reported higher per-stay trauma costs ($16,659 vs $16,509; P=.88) but lower total expenditures ($1.08M vs $7.44M; P&lt;.001), whereas urban non-trauma cases had the highest total expenditures ($9.68M; P&lt;.001). In a mixed-effects analysis, urban location, non-trauma status, and Medicare coverage were independently associated with increased LOS and hospital costs (P&lt;.001).</div></div><div><h3>Conclusion</h3><div>Orthopedic care differences reflect variations in hospital infrastructure, case complexity, and reimbursement models. Urban hospitals often face higher costs, driven partly by Medicare-heavy admissions and resource-intensive non-trauma cases. Rural hospitals operate with tighter budgets, even though their per-stay trauma costs are similar to those in urban hospitals. Insurance- related cost fluctuations expose gaps in current reimbursement structures. Aligning payments with actual hospital burdens and investing in rural healthcare systems may help address these challenges.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 31-32"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989583","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":"Reporting Patterns: Racialized Inequities in Military Health Research","authors":"Kendra Outler,&nbsp;Shannon J. Alsobrooks MS,&nbsp;Adrianna S. Jeffress DO, MPH","doi":"10.1016/j.jnma.2025.08.044","DOIUrl":"10.1016/j.jnma.2025.08.044","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Numerous guidelines provide recommendations for reporting racialized inequities in health and healthcare research. However, dissemination and utilization of such guidelines may be stymied. This scoping review aims to understand how radicalized inequities among U.S. active duty service members are described in research and to what extent these descriptions align with recommended reporting practices.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This systematic scoping review was conducted using PubMed, CINAHL, PsycINFO, and Embase databases. Studies published between January 2022 and February 2023 that focused solely on U.S. active duty service members and health outcomes were included. Studies were excluded if racialized inequities were not described in both the Results and Discussion sections. Articles underwent abstract screening, full-text review, and data extraction by multiple co-authors. Data were analyzed using descriptive statistics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 1,083 screened studies, 21 met the inclusion criteria. Most studies (81%) included multiple military services and relied on administrative record extraction, where race and ethnicity were self-reported (86%). However, none of the studies explicitly provided a structurally responsive rationale for including race and ethnicity in analyses. Instead, racialized inequities were often attributed to race as a risk factor (57%) rather than to structural determinants. Additionally, 86% of studies aggregated service members into broad racial categories such as “other” or “other and unknown.” Language inconsistencies were common, with 52% using “race/ethnicity” or “Asian/Pacific Islander,” 29% using “non-White,” and 29% referring to race or ethnicity as nouns (e.g., “Blacks”). Only 14% explicitly referenced structural determinants of radicalized inequities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The findings indicate a limited use of structurally responsive language describing racialized inequities in the included publications focused on U.S. active duty service members. Race and ethnicity were frequently conceptualized as risk factors, and in one instance, as a biological construct, rather than as proxies for structural and institutional inequities. These results align with prior research indicating that racial and ethnic identities are often underreported or underrepresented in clinical trials and healthcare studies. To improve dissemination of reporting recommendations, journals and research institutions should implement structured guidelines and training programs emphasizing the use of health equity frameworks. Additionally, researchers could be encouraged to incorporate discussions of structural and institutional factors contributing to inequities, rather than solely presenting race as an explanatory variable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This scoping review highlights critical gaps in the reporting of racialized inequities in health resear","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 22-23"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989851","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 Disparities in Myeloma Care: Examining Access to Bispecific Therapies, Treatment Patterns and Outcomes among Minority Patients","authors":"Jonathan Tyes,&nbsp;Christie Okoye,&nbsp;Christy Houde,&nbsp;Jay Hydren,&nbsp;Mason Barnes,&nbsp;Rachel Jensen,&nbsp;Jenny Ahlstrom,&nbsp;Jeffrey Zonder,&nbsp;Craig Cole","doi":"10.1016/j.jnma.2025.08.096","DOIUrl":"10.1016/j.jnma.2025.08.096","url":null,"abstract":"<div><h3>Background</h3><div>Bi-specific antibody therapy represents a promising advancement in the treatment of multiple myeloma, offering targeted, off-the-shelf immunotherapy that may be more accessible than other cellular therapies. However, barriers such as treatment cost, complex care coordination, and the need for frequent clinical visits may still limit equitable access. Black patients—who experience higher incidence and earlier onset of multiple myeloma may face disproportionate challenges in receiving this therapy. While systemic inequities in cancer care are well documented, limited research has explored how patient-level perceptions, experiences, and social determinants influence access to bi-specific antibody treatment.</div></div><div><h3>Objective</h3><div>This study aims to characterize disparities in access to bi-specific antibody therapy among patients with multiple myeloma, with particular attention to race, ethnicity, socioeconomic status, and social determinants of health. It also seeks to explore how these factors shape patient satisfaction, treatment decision-making, and perceived barriers to care.</div></div><div><h3>Methods</h3><div>This is a prospective, cross-sectional survey study involving patients with a diagnosis of multiple myeloma, including those who are eligible for or have received bi-specific antibody therapy. Participants will be drawn from the HealthTree research registry and invited to complete a 25–35-minute electronic survey containing up to 46 questions. Topics include treatment access, care navigation, perceived barriers, and patient-reported outcomes. An additional 11 items will capture demographic and socioeconomic data, including race/ethnicity, education, insurance coverage, and neighborhood-level indicators. Descriptive statistics and comparative analyses (e.g., chi-square tests, t-tests, ANOVA) will be used, along with multivariable modeling to examine associations between social determinants and disparities in access and outcomes.</div></div><div><h3>Results (Trial in Progress)</h3><div>As of June 2025, survey data collection is ongoing, with preliminary responses received from a diverse cohort of participants in the HealthTree registry.</div></div><div><h3>Discussion</h3><div>This study will generate real-world, patient-centered data on inequities in access to bi-specific antibody therapy for multiple myeloma. By incorporating lived experiences and perceptions, the findings aim to inform policy, improve provider awareness, and guide system-level changes to promote more equitable delivery of this emerging treatment modality</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 53"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989869","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":"Managing Severe Type B Aortic Dissection Complications","authors":"Kouomegne Simo MD, MHS,&nbsp;Salim Aziz MD","doi":"10.1016/j.jnma.2025.08.036","DOIUrl":"10.1016/j.jnma.2025.08.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Recurrent aortic dissection (AD) presents significant challenges in both medical and surgical management due to its high risk of severe complications and mortality. Type B AD, in particular, requires careful hemodynamic control and procedural interventions to prevent life-threatening sequelae. This case highlights the complexity of managing a patient with severe Type B AD, recurrent dissections, and multiple post-procedural complications.</div></div><div><h3>Methods</h3><div>A 49-year-old woman with uncontrolled hypertension, hyperlipidemia, and atrial fibrillation presented with sudden onset of chest pain radiating to the back and shoulders. Computed tomography angiography (CTA) revealed Stanford Type B AD with an intramural hematoma extending from the descending thoracic aorta to the aortic bifurcation. Initial management included thoracic endovascular aortic repair (TEVAR). However, she subsequently developed severe complications, including an aorto-esophageal fistula, mediastinitis, new pseudoaneurysms, and a second AD distal to the previous repair. A multidisciplinary approach was employed to manage her condition, incorporating anti-impulse therapy, multiple endovascular and open surgical interventions, and critical care support.</div></div><div><h3>Results</h3><div>Despite extensive medical and surgical efforts—including staged open repair, visceral debranching, and extracorporeal membrane oxygenation (ECMO) initiation—the patient experienced progressive deterioration. Persistent false lumen perfusion, refractory hemodynamic instability, and multi-organ failure ultimately led to cardiac arrest and death.</div></div><div><h3>Conclusion</h3><div>This case underscores the high-risk nature of recurrent Type B AD and the limitations of current treatment strategies. The need for multiple procedures highlights the challenges in achieving long-term stability. A multidisciplinary approach is essential, but further research into optimal management strategies and novel therapeutic options is needed to improve outcomes in such complex cases.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 17-18"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989941","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":"Parity in Health Care Requires Recognition of Disparities and Strategies to Improve Care Delivery","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-In-Chief, Journal of the National Medical Association)","doi":"10.1016/j.jnma.2025.08.001","DOIUrl":"10.1016/j.jnma.2025.08.001","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 5","pages":"Page 293"},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827418","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}