1 in 3 academic physicians report they are considering leaving their institution within 2 years. Burnout and lack of professional fulfillment were associated with intention to leave; a comprehensive approach will be needed to reduce physician turnover.
First-generation medical students experience disproportionate adversity and inadequate institutional support within medical education, forcing over-reliance on grit and resilience as survival strategies.
@catiehavemann
In this meta-analysis of
#COVID19
vaccine trials, adverse events in placebo arms ("nocebo responses") accounted for 76% of systemic adverse events after the first COVID-19 vaccine dose, and for 52% after the second dose.
A
@Wiki_Guidelines
Consensus Statement: For adults with infective endocarditis, oral transitional therapy was at least as effective as IV-only therapy.
@DrEmilyMcD
@DrToddLee
In this cross-sectional study, oncology drugs were 40-times more likely to be deemed cost effective when the study was funded by pharmaceutical companies compared with no funding.
Cross-sectional study comparing Medicaid &
#ACA
Marketplace finds fewer ED visits & more office visits in Marketplace, no clear quality advantage. Marketplace costs 80% more overall, with 10x higher out-of-pocket spending.
@Prof_HeidiAllen
@HarvardHPM
This study found that written exposure therapy (
#WET
) is non-inferior to cognitive processing therapy (
#CPT
) for
#PTSD
. WET was also associated with fewer treatment dropouts than CPT.
@VA_PTSD_Info
@strongstar_ptsd
RCT: Eating 10 min longer during family mealtimes increased fruit and vegetable intake but not dessert or bread consumption. Longer family meals are a simple tool that may improve children’s health.
In qualitative interviews, Black patients with serious illness reported experiencing racism in clinical settings, often through epistemic injustice, that was associated with medical mistrust and poor patient-clinician communication.
Case analysis of >3.9 mil COVID cases in California found that pediatric vaccination averted >375,000 cases of COVID-19 and 270 hospitalizations in children 6mo-15yrs in the 4 to 7 months following vaccine availability.
@JenniferR_Head
@Justin_Remais
This cohort study in New Delhi found 2.5% reinfection in health care workers (HCWs). The BBV152 (Covaxin) 2-dose effectiveness against reinfection was 86%. Findings suggest infected HCWs should receive complete vaccine doses to prevent future infections.
Only 8% of oncology clinical trials involve surgical interventions. Surgery can be critical to cancer care. There is a need for more surgeons in cooperative research groups and increased NCI funding to study surgical interventions.
Fathers of preterm infants reported less stress in Family Integrated Neonatal Care compared to standard care. Supporting fathers' participation in neonatal care is associated with improvements in fathers' mental health.
In a large nationwide cohort of 996,300 Danish-born females, there was no association between HPV vaccination and primary ovarian insufficiency.
@anders_hviid
Among vaccinated recipients of allogenic stem cell transplants, the incidence of
#COVID19
infection was higher during Omicron vs Delta waves; most infections were mild, with 3 hospitalizations and 1 death out of 211 patients at one center in France.
Eli Perencevich MD, MS, has been named Editor in Chief of
@JAMANetworkOpen
. Dr Perencevich is a professor of internal medicine and epidemiology at
@IowaMed
and is a founding Associate Editor of JAMA Network Open.
He will assume the position July 1.
This first of its kind study shines a light on a troubling problem - women physicians are underrepresented among perspective-type journal articles in top pediatrics journals. Read more from
@JulieSilverMD
:
#WomenInMedicine
Women and parents report greater burden from early AM/late PM multi-disciplinary tumor boards. Radiologists, pathologists, those with ≥2 kids, or attending ≥3 hrs/wk of tumor boards report greater overall burden.
@_katelynatkins
@CedarsSinai
Cohort study finds excess mortality during the early phase of the
#COVID19
outbreak in New York City was comparable to that observed during the peak of the 1918 H1N1 pandemic.
@jeremyfaust
@CarlosdelRio7
Every $1 invested in the New York City
#COVID19
vaccination campaign yielded an estimated $10.19 in cost savings from lower infection and mortality rates, fewer productivity losses, and averted health care use.
@suhas_gondi
@davechokshi
@Alison_Galvani
When physicians attend to emotions and then stop to allow a family to respond, families are able to express their emotions and provide valuable information. Learn more in this
#Pediatrics
Original Investigation:
Cohort study finds 33% of mildly ill individuals reported persistent
#COVID19
symptoms at an average of 6 months after their acute infection.
@HelenChuMD
@UWMedicine
Cross-sectional study finds few oncology clinical trials assess QoL until death which is important particularly when gains in OS are marginal.
@VPrasadMDMPH
Health care worker (HCW)-collected throat specimens may have higher sensitivity than HCW-collected nasal specimens for COVID-19 rapid antigen testing. Self-collected specimen sensitivity may improve by combining nasal & throat specimens.
40% of low income households with young children "churn" off SNAP benefits due to missed administrative deadlines at recertification, despite being eligible. Streamlining administrative processes needed.
#OAResearch
Tax policy is an important, modifiable social determinant of health. Increased state-level tax revenue and increased tax progressivity (ie, higher taxes for wealthier individuals) were both associated with decreased infant mortality in the US, 1996-2019.
21% of medical journal articles cited by GPT-4 were found to be fake; GPT-3.5 cited an estimated 98% fake articles. Narrower topics had more fake articles than broader topics. Despite its promise, ChatGPT is currently not a reliable source of medical data.
Only 13-14% of
@usnews
-ranked medical schools give faculty 12-wks parental leave at full pay; lower rates for adoption/foster leave. Inadequate parental leave contributes to physician workforce attrition &
#BurnOut
.
@JessSlostadMD
@nedalai
@ShikhaJainMD
Case series observing 9 emergency medicine residents shows that 50% of ROS and PE content of physician documentation is inaccurate, likely to fulfill
@CMSGov
charting requirements.
@carlberdahl
(on
#JNOLive
Tuesday at 3 pm cst)
As
#COVID19
home testing increases and disease acuity decreases due to vaccination and treatment, wastewater surveillance provides accurate assessments of county
#SARSCoV
-2 incidence and may be the best metric for monitoring amount of circulating virus.
Decision analytical model finds more than half of
#COVID19
cases are spread from people without symptoms, highlighting the importance of mask wearing, staying 6ft away from others, hand hygiene, and testing select people without symptoms
@CDCgov
.
For infants born at 22-23 weeks, antenatal steroids at 21-22 weeks is associated with better survival in this
@NICHD_NIH
Neonatal Research Network study.
#neoEBM
#OAResearch
This cohort study found no association in positivity rates among health care workers who wore medical masks vs respirator masks in routine patient care suggesting that medical masks protected HCWs from acquiring
#COVID19
This model-based analysis estimated "on-ramps" and "off-ramps" for unmasking elementary students, using readily available data (case counts and vaccination rates). Appropriate metrics for unmasking will depend on community goals.
@SalomonJA
Prostate safety is a concern of men considering testosterone treatment. In the TRAVERSE Trial, a large testosterone RCT in men with hypogonadism, rates of prostate cancer and other prostate events were low and did not differ vs placebo.
Ultra-Restrictive Opioid Prescription Protocol (
#UROPP
): radical decrease in postoperative opioid use with no changes in pain scores & opioid refills.
Cohort study finds the
#ACA
was associated with 2 million fewer adults experiencing catastrophic health expenditures each year; 11 million, including 6 million privately insured, experience catastrophic spending annually.
@chasliu
@krchhabra
@DrJohnScott
Amid a changing landscape of public charge rules, nearly 1 in 6 low-income immigrant adults avoided public programs out of fear it would negatively impact immigration status, leading to delayed medical care.
@UCLACHPR
@NinezPonce
@UCLAFSPH
@CalEndow
RCT: Eating 10 min longer during family mealtimes increased fruit and vegetable intake but not dessert or bread consumption. Longer family meals are a simple tool that may improve children’s health.
Comparative effectiveness study with 41k insured people w OUD finds only buprenorphine/methadone associated with reduced
#overdose
at 3 & 12 mos; longer treatment assoc w lowest OD risk
#VisualAbstract
@DrSarahWakeman
@MDaware
Structural racism in the form of historical housing discrimination known as “redlining” is associated with higher stroke prevalence in NYC communities, even after controlling for classic stroke risk factors and other social determinants of health.
Commentary: Although many believe observational, real-world data will someday fill the gaps, for the time being, randomization remains the reference standard in cancer research.
@RahulBanerjeeMD
@VPrasadMDMPH
In this cohort study there was no evidence to support an association between a higher number of lumbar segments with radiographic changes and more severe back pain–related disability cross-sectionally or over time.
This cohort study found that after the
#MuslimBan
, missed primary care appointments and emergency department visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.
Meta-analysis: 94% of patients with atraumatic altered mental status received a noncontrast CT head, with an average yield of 11% which varied by setting: 18% in ED patients, 12% of ICU patients, and 3% of general inpatients had positive findings on CT.
Editorial: Current events surrounding racially motivated police brutality highlight that journals must focus on the effects of structural racism on the care of Black, Hispanic, indigenous, and other people of color, including interventions.
@GbengaOgedegbe
Gender-affirming surgery increased substantially among US adults from 2016 to 2019 and declined slightly in 2020. Breast and chest surgeries were the most common procedures performed and genital reconstruction was more common on older individuals.
This phase 3 randomized controlled trial demonstrated that a new macrophage-regulating drug significantly improved the incidence of complete wound closure in treating chronic diabetic foot ulcers.
High doses of oral CBD can exacerbate THC’s effects through inhibition of THC metabolism, leading to stronger drug effects. Cannabis users, clinicians, and regulators stakeholders must understand the potential risk of drug interactions.
For patients with limited English proficiency undergoing surgery, interpreter use is low and only 12% of patients received language-concordant discharge forms, which provide critical opportunities to tangibly enhance care plans’ quality & understanding.
Many firearm owners store firearms unlocked; those who lock their firearms most often use gun safes. Concerns about access speed often keep firearm owners from using locks, whereas concerns about child access may increase the odds they will use a lock.
In this cohort study of adult daily cigarette smokers with no plans to ever quit smoking, those who took up daily e-cigarette use experienced 8-fold greater odds of discontinuation versus those who did not use e-cigarettes.
IV sodium thiosulphate (STS) treatment is not associated with improvements in skin lesions and survival in patients with calciphylaxis with chronic kidney disease in this meta-analysis of observational studies.
This consensus statement & systematic review uses a WikiGuidelines methodology for clinical guideline development (precluding recommendations based on low-quality data/opinion), addressing 7 questions regarding osteomyelitis management.
@BradSpellberg
Half of people who disenrolled from Minnesota Medicaid in 2018 or early 2019 had no observable coverage 6 months later, and a large share returned to Medicaid within a year, suggesting many were still eligible or had very short-term changes in eligibility.
Older vs younger patients with cancer (≥70 vs <70) enroll in
#NCI
clinical trials at similar rates when screened and offered trial entry in the community setting, where 80% of older patients receive their
#GeriOnc
care.
@minasedrakmd
@WilliamDale_MD
#OAR
Quality improvement study from
@MSFTResearch
Project InnerEye team uses
#DeepLearning
to maintain clinical accuracy and reduce manual contouring time in radiotherapy treatment-CT scan mark up for radiotherapy in head & heck & prostate cancers.
@ozanoktay_
Only 0.2% of children 6-17-years-old with
#COVID19
in Sweden were diagnosed with
#LongCovid
, more often in girls, those hospitalized for COVID or with comorbidities, and those whose parents had post-COVID conditions, suggesting a possible genetic link.
This study finds that the first two overdose prevention centers to open in the US with government support were not associated with changes to neighborhood crime and disorder. Overdose prevention centers have a long track record of saving lives.
Liver metastases was associated with poorer survival (vs non-liver metastases) in patients with mismatch repair-deficient metastatic colorectal cancer treated with first-line pembrolizumab.
Systematic review & meta-analysis finds steroid injections & physical therapy are associated with the best outcomes for frozen shoulder.
@tendonglasgow
Cohort study finds racial/ethnic, gender, age, language & SES differences in accessing telemedicine for primary care and specialty ambulatory care during
#COVID19
; differences may compound existing inequities in care.
@eberly_lauren
@sri_adu
@PennMedicine
Women who benefited from the Brazilian Cash Transfer Program had an 18% lower risk of maternal death, reinforcing the great potential of these programs to improve maternal survival.
Intelligence, cognitive flexibility and academic performance improved following a 20-week RCT based on aerobic + resistance training among children with overweight or obesity.
@ortegaporcel
@profithugr
@canalUGR
and collaborators.
#OpenAccess
#Research
An insurer's cost-reduction policy may make 9 out of 10 ED patient weigh the chance of having an emergency against possible coverage denial.
#JNOVA50
cc:
@mdaware
Patient-level economic analysis found that icosapent ethyl to be cost-effective in the US healthcare sector at common willingness-to-pay thresholds for high-risk patients with hypertriglyceridemia.
Study found that among countries hosting
#COVID19
vaccine trials, high-income countries received proportionately more doses than their middle- and low-income counterparts, reflecting disparities in vaccine access.
@reshmagar
@jsross119
@millerbioethics
Living donor kidney transplants from donors biologically related to their recipients have a higher rate of allograft failure than those from unrelated donors after accounting for degree of HLA mismatching.
@SAHusainMD
@SumitMohanMD
@columbiakidney
Commentary: Despite the expansion in the number of patients eligible for expensive and potentially toxic immune checkpoint inhibitors, the ratio of patients benefitting is decreasing
@JAMAOnc
Cross-sectional study finds < 2% of OB-GYNs who treat Medicaid enrollees have X-waiver training to prescribe buprenorphine; those who are are more likely to work in suburban counties.
@MaxJordan_N
@Eugenia_South
@zacharymeisel
This case series describes ED patients w electric scooter-related injuries 🛴. 10.8% were < 18 y and 4.4% were wearing a helmet ⛑️. Most common were fractures (31.7%) and head (40.2%), and soft-tissue (27.7%) injuries. Learn more:
@MDaware
@JAMAPediatrics
This cross-sectional study of US physician compensation in academic medicine found women had lower early career earning potential than men in nearly every subspecialty analyzed, primarily due to lower starting salaries for women.
This systematic review and meta-analysis including 15,000 infants estimates rates of bacteremia and meningitis are low in febrile infants; nearly half as low in the second month of life
@JAMAPediatrics
#JNOVA50
cc:
@mdaware
Comparative effectiveness study uses
#COVID19
data from Wuhan and Guangzhou to estimate need for early & strict disease control strategies in US cities to mitigate the demand for inpatient and ICU beds.
@ruoranepi
@cmyeaton
@megan_b_murray
@mlipsitch