Why Competency Frameworks Are Insufficiently Nuanced for Health Equity Teaching and Assessment.

This article suggests how competency-based medical education should robustly integrate health equity by focusing on physicians' responsibilities to (1) know why and how underlying structural mechanisms contribute to health equity and then (2) take action to achieve health equity in their practice. This article first canvasses currently available frameworks for helping trainees cultivate these 2 specific skills of discernment and action. This article then offers strategies for teaching and assessing these skills in specific learning activities.

Should Uterus Transplantation for Transwomen and Transmen Be Subsidized?

Success in uterus transplantation (UTx) among ciswomen suggests that transwomen and some transmen will also likely have interest in this intervention. It does not seem likely, however, that all parties interested in UTx will have the same standing when it comes to federal subsidies or insurance coverage benefits. This analysis describes the comparative moral strength of claims for financial support for UTx that different parties might make.

Telemedicine in Anesthesiology: Using Simulation to Teach Remote Preoperative Assessment.

Background: The move toward telemedicine has markedly accelerated with the COVID-19 pandemic. Anesthesia residents must learn to provide preoperative assessments on a virtual platform. We created a pilot telemedicine curriculum for postgraduate year-2 (PGY2) anesthesiology.

Increased Rate of Fracture Injuries Associated With Alternative Modes of Transportation During COVID-19.

Objective: COVID-19 disrupted public transit and led to increased reliance on alternative modes of transportation (AMTs) internationally. This study hypothesizes that public interest and fracture injuries associated with AMTs increased during COVID-19 in the United States.

Methods: Monthly Google search probabilities and the number of fracture injuries associated with bicycles, scooters, skateboards/longboards, rollerblades, electric bicycles, and electric micromobility vehicles were collected from January 2017 to December 2021.

Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice.

: Evidence-based treatment is provided infrequently and inconsistently to patients with opioid use disorder (OUD). Treatment guidelines call for high-quality, patient-centered care that meets individual preferences and needs, but it is unclear whether current quality measures address individualized aspects of care and whether measures of patient-centered OUD care are supported by evidence. : We conducted an environmental scan of OUD care quality to (1) evaluate patient-centeredness in current OUD quality measures endorsed by national agencies and in national OUD treatment guidelines; and (2) review literature evidence for patient-centered care in OUD diagnosis and management, including gaps in current guidelines, performance data, and quality measures.

Jurors' Gender and Their Fear of False Child Sexual Abuse Accusations Are Related to Their Belief in Child Victims' Allegations.

We developed the first Fear of False Accusations scale, measuring the public's fear of personally being the target of untrue child sexual abuse allegations despite no actual wrongdoing as well as the fear of false allegations being a common problem in society. The scale was statistically reliable within a diverse sample of 964 participants. Several months later, in an ostensibly unrelated mock trial experiment, a subset of the participants assumed the role of mock juror and considered a criminal case involving an accusation of child sexual abuse.

Revisiting the WHO Analgesic Ladder for Surgical Management of Pain.

The opioid epidemic challenges current attitudes toward pain management and necessitates the reexamination of the World Health Organization (WHO) 3-step analgesic ladder, introduced in 1986 for cancer pain management. Surgical treatment of pain is a logical extension of the original guideline, which is often absent in conversations with patients about treatment options for their pain and consequentially underutilized. However, with concerns growing regarding opioid use, a shift in the stepwise approach of the WHO analgesic ladder in an age of developing technology and surgical offerings could have profound implications for patients and public health.

Graduate Medical Education Specialty Mix and Geographic Residency Program Maldistribution: Is There a Role for the ACGME?

As we've stated, GME is the final common pathway toward clinical medical practice in the US. It makes sense, then, that national physician workforce policy aimed at meeting future public health demands should be directed at this phase of medical education. It would also make sense that ACGME, as the single accreditor of all residency programs in the US, should be engaged in physician workforce policymaking on behalf of the public.

Ultrasound-assisted percutaneous trigger finger release: is it safe?

Trigger fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, the tendon, and the adjacent neurovascular bundles. The percutaneous trigger finger release (PTFR) lacks an incision and is thought to lead to a quicker recovery, but the safety and efficacy of this blind procedure are often questioned.

Endometriosis-induced acute small and large bowel obstruction: rare clinical entities.

The extragonadal manifestations of intestinal endometriosis necessitating immediate abdominal surgical exploration are, to date, sparsely represented within the literature. We present two cases of acute complete small and large bowel obstruction secondary to endometriosis, requiring emergent laparotomy; and review the pertinent literature.

Musculoskeletal manifestations of Russell-Silver syndrome.

The musculoskeletal manifestations of Russell-Silver syndrome were studied in 25 patients. The most common manifestations were short stature (25 patients), limb-length discrepancy (23 patients), clinodactyly (19 patients) metacarpal bone and phalangeal abnormalities (13 patients), scoliosis (9 patients), foot syndactylism (5 patients), and developmental dysplasia of the hips (3 patients). Five patients underwent lower extremity limb-lengthening procedures for discrepancies greater than 3 cm and three patients had successful pelvic and/or femoral osteotomies for hip dysplasia.

Genetics and gene manipulation therapy of premature coronary artery disease.

Despite the notable recent scientific advances, our ability to detect and prevent premature coronary artery disease (CAD) remains limited, and the identification of patients at risk is yet to be based on objective scientific testing. Eliciting a family history of CAD currently remains the only available screening tool to identify patients with a genetic predisposition. The risk of CAD attributable to genes appears to be most significant at younger ages, and this may explain the lack of definite markers for the disease.

Effects of tezosentan, a dual endothelin receptor antagonist, on the cardiovascular and renal systems of neonatal piglets during endotoxic shock.

Background/purpose: Endothelin is a potent mediator of the cardiovascular and renal systems. Studies have found that endothelin has an important role in regulating cardiac function and renal perfusion in neonates who are suffering from endotoxic shock. The authors believe that blockade of the endothelin response during endotoxemia will have a beneficial effect on neonatal cardiac and renal functions.

Paraneoplastic pemphigus and bronchiolitis obliterans associated with a mediastinal mass: A rare case of Castleman's disease with respiratory failure requiring lung transplantation.

Castleman's disease is an infrequent and usually benign lymphoproliferative disorder. Resection of the tumor usually is curative. The immunostimulatory nature of the tumor can, in rare instances, result in paraneoplastic manifestations.

Effects of tezosentan, a dual endothelin receptor antagonist, on the cardiovascular and renal systems of neonatal piglets.

Background/purpose: Endothelin is a potent biological vasoactive mediator in the cardiovascular and renal systems. Little is known of the effects of endothelin antagonism on the developing heart and kidney, and we hope to show that endothelin does have an important role in the cardiovascular and renal systems of the developing neonate. In this study the authors have examined the effects of tezosentan, a nonselective endothelin-A and endothelin-B receptor antagonist designed for parenteral use, on the cardiovascular and renal systems of healthy neonatal piglets.

Central versus peripheral mediation of naloxone's perfusion effects in endotoxic rats.

Opioid receptor antagonists can act centrally and peripherally. It is unclear if these 2 pathways differentially mediate the perfusion-associated effects of opioid antagonism during endotoxemia. Male, Sprague-Dawley rats (340-390 g) were surgically prepared with left ventricular, tail artery, and jugular vein catheters 24 h before experiments were begun.

Congenital cysts of the third and fourth pharyngeal pouches or pyriform sinus cysts.

Cysts arising from the III and IV pharyngeal pouches, although uncommon, are typical in their presentation. They occur in neonates, invariably in the left anterior neck and cause respiratory distress. Excision of the cyst with ligation of the tract at the level of the pyriform sinus is curative.

Splanchnic vascular control during sepsis and endotoxemia.

Endotoxemia and sepsis often result in circulatory derangements which manifest as perfusion maldistributions. It has been widely accepted that the splanchnic circulation decreases in perfusion during advanced septic or endotoxemic states. Impaired perfusion of splanchnic organs may result not only in organ dysfunction but also exacerbations of polymicrobial bacteremia due to intestinal mucosal leakage.