OBJECTIVES:In this study, we aimed to characterize the landscape of the literature and describe lower urinary tract symptom (LUTS) care experiences using the Agency for Healthcare Research and Quality's (AHRQ's) patient experience framework, describe the characteristics of the studies, and identify critical knowledge gaps. METHODS:We performed a systematic search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus of peer-reviewed publications from 1995 to 2024. The search terms were related to LUTSs, drivers of healthcare inequities, and the domains of the AHRQ. We then performed a content analysis of the included studies. RESULTS:Of the 4597 articles reviewed, we included 11 studies in the analysis. The most studied LUTS was urinary incontinence (10/11, 91%). Of the included studies, six were comparative, and most (4/6, 66.7%) found worse care experience in patients with limited English proficiency and low socioeconomic status. When examining the studies using the care experience framework of the AHRQ, the most frequently evaluated domains of care experience were communication with clinicians (8/11, 73%) and access to care (8/11, 73%). For communication with clinicians, language barriers (3/11, 27%) and symptom minimization by clinicians (3/11, 27%) were common, especially among patients with limited English proficiency and of older age, respectively. In regard to access to care, concerns about healthcare costs (5/11, 45%) and patients' fear or embarrassment about accessing LUTS care (4/11, 36%) were commonly occurring themes, especially among racially minoritized groups. CONCLUSIONS:The findings of this systematic review demonstrated that patients with limited English proficiency, older age, low socioeconomic status, and racially minoritized backgrounds have poor LUTS care experiences.
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly, occurring in 0.3% to 0.5% of the general population and in 10% of patients with congenital heart disease. Historically considered benign, PLSVC is increasingly recognized for its clinical significance in the fields of interventional cardiology, electrophysiology, and surgery. The present narrative review combines the available evidence regarding PLSVC, focusing on its embryology, anatomical variants, diagnostic challenges, and tailored management strategies, to address clinical uncertainties and improve procedural outcomes for patients undergoing intervention. The clinician needs to understand the risk for right-to-left shunting of PLSVC, procedural risk during placement of the catheter or device, and its association with arrhythmias and stroke. Common in high-risk patients (eg, in congenital heart disorders, unexplained hypoxia), early detection by advanced imaging and forward procedural planning are key to reducing complications and optimizing patient outcomes.
OBJECTIVE:The objective of this study was to evaluate the impact of the stress intervention Docs for Dinner on factors related to physician disengagement and professional isolation. METHODS:A specifically designed survey was distributed to physicians who had participated in the program. RESULTS:The results indicate that physician participants found the experience to be positive and worthy of continuation and that it allowed a unique interaction with colleagues, increased engagement with colleagues, promoted a more positive view of the relationship with the healthcare system, enhanced a sense of well-being, and had a small but positive impact on motivation for patient care. CONCLUSIONS:Docs for Dinner appears to be a readily implemented and well-received approach to enhancing physician engagement and collegial interaction, increasing the sense of well-being, and fostering perception of a healthcare organization that may help to mitigate contemporary stressors facing physicians.
OBJECTIVES:This study aimed to assess the impact of delivering a fellow-led educational presentation on human immunodeficiency virus (HIV) health to medical trainees as a strategy of interprofessional education and recruitment in HIV medicine and infectious diseases. METHODS:Between July 2024 and April 2025, at the University of Texas Southwestern Medical Center, Infectious Diseases fellows designed and delivered in-person presentations on HIV health to medical trainees, including third-year medical students and second-year categorical Internal Medicine residents. Pre- and postpresentation, the trainees completed an eight-question survey, which was developed in accordance with recommendations from the Association for Medical Education in Europe. Using a 5-point Likert scale, seven survey questions measured self-reported knowledge of HIV care; one measured subspecialty interest in HIV medicine and/or infectious diseases. After converting participants' Likert scale responses to continuous variables on a 1-to-5 numeric scale, the pre- and postpresentation survey responses of trainees and trainee subgroups (medical students, residents) were compared using Wilcoxon signed rank tests. Survey responses also were stratified by trainee type using a two-way mixed effects analysis of variance. RESULTS:In total, 121 trainees (86 medical students, 35 residents) attended the presentation and completed the surveys. On each content-based survey question, the trainees' self-reported knowledge of HIV care increased postpresentation (P<0.001). Trainees' subspecialty interest also increased postpresentation (P<0.001). Within the trainee subgroups, knowledge and interest increased on each survey question postpresentation (P≤0.003), and the change in interest was similar between the medical students and residents. Compared with the residents, medical students reported greater knowledge of the population groups disproportionately affected by HIV (P<0.001), HIV acquisition (P=0.009), and the HIV care continuum (P=0.002). CONCLUSIONS:Among medical trainees at a single-site medical center in the southeastern United States, delivering a fellow-led educational presentation on HIV health was associated with increased self-reported knowledge of HIV care and subspecialty interest. This intervention may promote interprofessional education and recruitment.
Florida was the fastest growing state in the United States in 2024, and it has the third highest state population in 2026. We reviewed health challenges related to rapid population growth, insurance coverage gaps, underinvestment in public health, policy trends, and the high proportion of older adults to assess Florida's health and healthcare system in comparison with national benchmarks. We conducted a comparative analysis using data from the US Census Bureau, the FLHealth Community Health Assessment Resource Tool Set, America's Health Rankings, and the peer-reviewed literature. Key indicators included demographic trends, insurance coverage, public health funding, and health outcomes. Florida has an estimated 2025 population exceeding 23 million-22.3% adults 65 years of age and older versus 18.2% nationally. Despite favorable metrics in smoking and obesity, Florida ranks 39th in overall state health system performance according to the Commonwealth Fund 2025 Scorecard on State Health System Performance. The state has not expanded Medicaid, and an estimated 315,000 residents are in an insurance coverage gap. Florida's rapid growth and proportion of older people present healthcare challenges. Disparities among uninsured, undocumented, and minority populations are exacerbated by limited insurance access and underfunded public health infrastructures. Declining public health budgets may increase costs from preventable hospitalizations. Given the high dental caries rates and low vaccination rates for Florida in 2025, a law forbidding water fluoridation and efforts to end mandatory vaccinations may exacerbate healthcare disparities. Strategic planning, adequate funding, and policy reform can address these systemic vulnerabilities and ensure equitable access to care in Florida and other southern states.
OBJECTIVES:Internal Medicine (IM) clerkships are a core clinical experience in medical school where third-year students (MS3s) learn and apply their medical knowledge to patient care. How students approach learning from direct patient care is shaped by their team environment, notably their attending physicians. Less, however, is known about how attending physicians conceptualize their instructional role in supporting student learning within resident-led inpatient teams. We examined how IM attendings understand how MS3s learn on the wards and how attendings conceptualize their role in supporting that learning within resident-led inpatient teams. METHODS:The authors conducted 20 semistructured interviews of IM attendings who supervised MS3s on inpatient teams in 2024. Participants were asked about how students learn from patient care and their role in supporting this learning. Data were analyzed iteratively through qualitative description using inductive thematic analysis. RESULTS:Twenty attendings participated in 30-minute semistructured interviews, resulting in thematic sufficiency. Three major themes emerged from the interviews: attendings must navigate their teaching role within resident-led teams, competing system and evaluative demands shape student engagement in clinical learning, and integration of clinical experience and structured autonomy enhance medical knowledge learning. Attendings held varying interpretations of their role in supporting student learning and described how students required guidance in navigating competing expectations. This ranged from providing direct student teaching to coaching residents in their instructional skills. CONCLUSIONS:Attendings described differing instructional approaches within resident-led inpatient teams. Understanding these conceptualizations may help identify opportunities to align instructional expectations and support student learning from direct patient care.
OBJECTIVES:The opioid epidemic has increasingly affected the U.S. population, posing significant public health challenges. We aimed to examine factors associated with opioid use disorder (OUD) among hospitalized adults in the United States using a multilevel modeling approach and to identify distinct patterns of co-occurring clinical conditions using latent class analysis (LCA). METHODS:We analyzed a random sample of 100,000 hospital discharge records from the 2000-2020 North Carolina State Inpatient Database, including equal numbers with and without OUD. Adult patients (18 years and older) with complete sociodemographic and clinical data were included. Diagnoses were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes, grouped via Clinical Classifications Software. Mixed-effects logistic regression models assessed associations with OUD, incorporating random effects for area-level income. LCA classified hospitalizations into two distinct clinical profiles based on cooccurring conditions related to OUD. RESULTS:Patients diagnosed as having OUD were younger, more frequently male, and predominantly White compared with those without OUD. Mental health diagnoses ranged from 2% for attention-deficit/hyperactivity disorder/adjustment/eating disorders to 22% for depression/bipolar disorder, whereas comorbidities such as hypertension was present in nearly half of hospitalizations. LCA identified two distinct clinical profiles: class 1, characterized by less obesity and psychiatric comorbidities (63.3% of records), and class 2, with higher obesity and psychiatric morbidities (36.7%). Mixed-effects logistic regression showed that male sex, White race, emergency department admission, and insurance type (Medicaid/self-pay) were independently linked to OUD, whereas hepatitis B or C was the strongest (odds ratio [OR] 5.62) and tobacco use was the weakest (OR 1.28) clinical correlate. In a mixed-effects logistic regression model, patients in class 2 versus class 1 had a nearly threefold higher odds of OUD (OR 2.83), after adjustment for sociodemographic factors. CONCLUSIONS:This study highlights important sociodemographic and clinical factors associated with OUD, including higher odds among male, White, and publicly insured patients. LCA identified distinct clinical profiles with varying psychiatric and obesity-related comorbidities linked to OUD risk. Key comorbidities such as hepatitis B/hepatitis C strongly predicted OUD, underscoring the need for integrated care. These findings inform targeted interventions for hospitalized populations facing complex medical and psychosocial challenges.
OBJECTIVE:The South Carolina Department of Public Health (SCDPH) Prescription Drug Monitoring Program (PDMP) is used to monitor the prescribing patterns of controlled substances, including opioids and stimulants. Data collected by the National Center for Health Statistics show that the number of drug overdose deaths involving opioids and stimulants has been increasing since 1999. Although databases such as the PDMP monitor healthcare professionals' prescribing habits regarding opioids and stimulants individually, there has been little research regarding opioid-stimulant coprescribing patterns. Considering increasing death rates and the lack of research, data from the SCDPH PDMP were used to identify factors that influence opioid-stimulant coprescribing. It was hypothesized that younger age, higher daily morphine milligram milliequivalents (MMEs), increased duration of prescription, and male gender would be associated with increased opioid-stimulant coprescriptions. METHODS:Data were gathered from the SCDPH PDMP from 2016 to 2021. The variables assessed included patient age, patient sex, filling date, supply length, daily MMEs, and Lexicomp Drug Classification. A linear regression statistical analysis was then performed to analyze the data. RESULTS:Between January 1, 2016 and December 31, 2021, a total of 9,785,146 opioid prescriptions were filled by 2,158,564 individuals, with 161,103 (1.65%) of them receiving a concurrent stimulant prescription. Patients who were 50 years of age and younger had a 2.74 greater odds of receiving a concurrent stimulant prescription (P<0.001), along with those who had an opioid prescription length of ≥ 30 days (odds ratio [OR] 4.38, P<0.001). Being female (OR 1.58) and a daily MME ≥ 50 mg but ≤100 mg (OR 1.24) were both significantly found to indicate an increased odds of having a concurrent prescription. CONCLUSIONS:This study indicates that those with longer opioid prescriptions, younger individuals, higher daily MMEs, and women are at an increased risk of opioid-stimulant coprescription. Future research should investigate other factors associated with opioid-stimulant coprescribing, such as education status, rurality, and whether specific opioid or stimulant agents are linked to coprescribing.
Hemoglobin A1c (HbA1c) remains a cornerstone of glycemic assessment in diabetes mellitus care, yet discordance between HbA1c and measured glucose values is common in clinical practice. Failure to recognize this discordance can lead to inappropriate treatment escalation, increased hypoglycemia risk, and patient distress. This article reviews the biological and clinical factors that contribute to HbA1c-glucose discordance and translates these findings into practical strategies for routine care. Common causes include iron deficiency, chronic kidney disease, altered red blood cell turnover, hemoglobin variants, and rapid changes in glycemia. A stepwise, practice-oriented framework is presented to guide clinicians in evaluating discordant glycemic data using targeted laboratory testing and continuous glucose monitoring metrics. Emphasis is placed on avoiding reflexive medication intensification and using glucose monitoring data to individualize treatment decisions. The role of interdisciplinary care and patient-centered communication is also highlighted.
OBJECTIVES:Hurricane Helene was one of the most devastating natural disasters in US history, with 249 known fatalities and damages exceeding US$75 billion. This study evaluates the impact of Hurricane Helene on orthopedic injury epidemiology and patterns at a level I trauma center. METHODS:A retrospective review was conducted of consultations fielded by the orthopedic surgery department at a level I trauma center in Augusta, Georgia, during the 30 days pre- (August 28-September 26, 2024) and post-Hurricane Helene (September 27-October 26, 2024). Demographics, injury characteristics (mechanism, location, and type), and surgical intervention rates were collected. Pearson χ² and Fisher exact statistical analyses were performed to evaluate alterations in rates and injury patterns between the groups. RESULTS:In total, 466 patient consultations were evaluated; 535 orthopedic injuries were identified: 268 pre- and 267 post-Helene. Seventeen percent (47/267) of post-Helene injuries were directly related to the hurricane. There was a significant increase in high-energy trauma (37.7% vs 51.3%, P=0.005), supported by more frequent open fractures (4.9% vs 11.6%, P=0.007), an increase in chainsaw-related injuries (0% vs 5.6%, P=0.001), and an increase in injuries related to tree removal (0% vs 4.9%, P=0.001). There was a decrease in blunt/crush injuries (7.5% vs 3%, P=0.020), as well as surgical site infections (4.5% vs 1.5%, P=0.43) and postoperative/treatment complications (5.2% vs 1.9%, P=0.036). Surgical intervention rates remained unchanged (34.7% vs 36.5%, P=0.236), as did injury locations-upper extremity, lower extremity, and axial skeleton (P=0.497). CONCLUSIONS:Hurricane Helene significantly altered orthopedic injury patterns in Augusta, Georgia, with increased incidence of high-energy trauma, open fractures, and tree- and chainsaw-related injuries treated at a level I trauma center. There also was a decrease in surgical site infections and postoperative complications.
OBJECTIVES:This study examined the use of inhaled nitrous oxide as a pain management option during labor. Nitrous oxide offers a noninvasive, self-administered pain relief option that allows patients greater autonomy compared with other methods such as epidural analgesia or intravenous opioids. Its effectiveness and patient satisfaction remain a debated topic, however, with mixed results from previous studies. The primary aim of this cohort study was to analyze nitrous oxide utilization by focusing on identifying factors influencing its continued use during labor. METHODS:This was a retrospective cohort study of information collected from patient charts of those who used nitrous oxide between January 1, 2020 and July 1, 2023. Demographic and clinical characteristics were reviewed to assess patterns in continued nitrous oxide usage. RESULTS:There were 267 women who selected nitrous oxide for pain relief during labor. The study showed that the type of healthcare provider (certified nurse midwives vs doctors of medicine) (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.89, P=0.0115), and race relative to Hispanic patients, that non-Hispanic White women had a lower odds of remaining on nitrous oxide (aOR 0.27, 95% CI 0.11-0.68), as did non-Hispanic Black women (aOR 0.39, 95% CI 0.16-0.93) were significantly associated with continued nitrous oxide use during labor. The factors of maternal age, gestational age (term vs preterm), marital status, type of insurance, and parity were not significantly associated. CONCLUSIONS:Women who selected and continued using nitrous oxide until delivery were more likely to have a certified nurse midwife managing their labor/delivery and were more likely to be Hispanic. The study underscores the potential use of nitrous oxide to enhance patient autonomy during labor. Further research is needed to clarify the use of nitrous oxide for pain management during labor.
OBJECTIVES:Using the most recent US population projections data, we sought to update the estimated number of women who will undergo surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in the United States from 2025 through 2060. We hypothesize that the number of pelvic floor surgeries will increase in the upcoming decades. METHODS:We used the 2017 National Population Projections from the US Census Bureau, which provides age-specific estimates on the number of women in the US from 2025 to 2060. We used previously published age-specific rates of surgery for women undergoing SUI-only surgery, POP-only surgery, and either SUI or POP surgery. These rates were applied to the population estimates of women aged 18 to 89 years to determine the projected surgeries from 2025 to 2060 in 5-year increments. RESULTS:From 2025 to 2060, the population of women in the United Sates ages 18 to 89 years is projected to increase 17%, from 136.0 million to 158.5 million. Correspondingly, the total number of either SUI or POP surgeries will increase from 469,460 in 2025 to 553,858 in 2060. CONCLUSIONS:From 2025 to 2060, there will be an 18% increase in the projected number of surgeries for SUI or POP, from 469,460 to 553,858. Our field should be proactive in ensuring that enough specialists and fellowship-trained subspecialists are available to meet the future surgical demands of women with pelvic floor disorders.
OBJECTIVES:Transgender and gender-diverse (TGD) individuals represent a growing demographic in the United States. This population, however, faces many health inequities, in part attributable to a lack of education for physicians in training on transgender health care at both the graduate and undergraduate medical education levels. We developed a curriculum on gender-affirming care for Internal Medicine (IM) residents to fill this educational gap. METHODS:We created a virtual, asynchronous, case-based curriculum on gender-affirming care for IM residents at a large urban academic medical center. To address gaps in prior curricula, we included attitudinal, knowledge, and skills-based material and assessments. We used precurriculum, immediate postcurriculum, and delayed 1-month postcurriculum surveys to assess curriculum efficacy, learner satisfaction, and knowledge retention. RESULTS:We found that 77.8% of IM resident participants had cared for a TGD patient but had received little prior training in gender-affirming care, and residents reported low levels of confidence in caring for this patient population. After completing the curriculum, performance on knowledge-based questions improved significantly, and residents reported significantly higher confidence in providing gender-affirming care. These improvements were durable on the delayed posttest. CONCLUSIONS:A virtual, asynchronous, case-based curriculum on gender-affirming care in a primary care setting was effective at increasing residents' knowledge and confidence in transgender health, a topic that learners believed was important to their practice. These benefits persisted at 1 month, demonstrating knowledge retention. These findings support the importance of expanding education on gender-affirming care for TGD individuals, and interleaving material over time to promote retention.
Continuous glucose monitoring (CGM) offers real-time and longitudinal insights into glycemic patterns, time in range, and hypoglycemia. Adopting CGMs into practice can improve clinical outcomes while strengthening patient engagement and enabling data-driven care across routine visits and population health programs. Despite strong evidence of benefit, CGM remains underused in primary care, where most patients with diabetes mellitus are managed. Barriers include limited familiarity with CGM technology, interpretation, workflow, documentation and billing, and patient access and education. The purpose of this clinical review was to help equip primary care clinicians with a concise, family medicine-focused framework for adopting CGM, including technology overview, patient selection and education, practical interpretation of standardized reports, team-based workflow, documentation, and reimbursement.
OBJECTIVE:The purpose of this study was to evaluate the difference in patient-reported outcome measures (PROMs) after hip arthroscopy (HA) among patients with commercial insurance as compared with those with government-provided insurance, such as Medicare, Medicaid, and TRICARE or Veterans Affairs (VA). METHODS:This retrospective cohort study queried an institutional database for patients 18 years or older who underwent HA in the prior 10 years. Patients were excluded if they did not have at least 1-year postoperative PROMs, were self-pay, had Workers' Compensation insurance, were uninsured, or had a hip arthroplasty after their arthroscopy. Patients were divided into four groups: commercial insurance, Medicare, Medicaid, and VA or TRICARE. Demographic information and PROMs were collected at a minimum of 1-year follow-up, including the modified Harris Hip Score, Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports, and Non-Arthritic Hip Score. RESULTS:This study included 84 patients, 31 of whom had government-provided insurance, 53 had commercial insurance; 11 had Medicaid, six had Medicare, and 14 had VA or TRICARE coverage. Medicare patients were significantly older than those with commercial insurance (P=0.002). Patients with Medicaid (n=6) had significantly lower PROMs than those with commercial insurance (n=53). Significant differences were found in the modified Harris Hip Score (Medicare 50.8±15.1, commercial 69.1±15.8; P=0.015), HOS-Activities of Daily Living (Medicare 59.5±15.3, commercial 77.8±18.2; P=0.021), HOS-Sports (Medicare 31.9±16.1, commercial 69.7±28.0; P=0.005), and Non-Arthritic Hip Score (Medicare 55.8±18.0, commercial 77.6±19.5; P=0.020). No difference in PROMs were noted between those with commercial insurance and those with Medicaid or VA/TRICARE coverage. CONCLUSIONS:This study demonstrated that those with Medicare insurance had significantly lower PROMs than those with commercial insurance. It is unclear, however, to what extent this finding reflects underlying demographic differences such as age. Further research is needed to clarify this relationship.
