Medical respite programs provide short-term housing and clinical support for unhoused patients who are too ill to recover safely on the streets or in shelters but no longer require hospitalization. This perspective reviews the clinical, financial, and systems-level benefits of medical respite, including reduced readmissions, fewer emergency department visits, improved outpatient follow-up, and lower hospital costs. Despite these benefits, access remains limited by insufficient funding, variable eligibility criteria, administrative complexity, and low provider awareness. Using New York City and other state programs as examples, the authors argue that expanding medical respite requires increased investment, streamlined referral pathways, and stronger clinician advocacy. Medical respite represents a patient-centered and cost-effective approach to safe discharge planning, health care stewardship, and improved care for unhoused patients.
Background:Joint arthroplasty remains a cornerstone of orthopedic surgery, restoring mobility and alleviating pain for millions of patients worldwide. With advances in implant longevity and expanding use among younger, more active individuals, attention has turned toward the long-term systemic effects of implant wear and corrosion. While cobalt and chromium toxicity from metal-on-metal designs is well documented, emerging data suggest that non-cobalt metal ions—particularly titanium (Ti), niobium (Nb), zirconium (Zr), and vanadium (V)—may also accumulate in systemic circulation and cerebrospinal fluid (CSF), raising concern for potential neurologic sequelae. Purpose:This review synthesizes current mechanistic and clinical evidence linking non-cobalt metal ion exposure from joint implants to neurologic outcomes, with the goal of informing both orthopaedic and neurology practice. Methods:Recent mechanistic, cohort, and case-based literature was examined to characterize (1) pathways of ion release and systemic accumulation, (2) mechanisms of neural barrier penetration and neurotoxicity, (3) observed neurologic manifestations, and (4) clinical and surveillance implications. Key studies include cross-sectional analyses of blood and CSF metal levels, case reports of neurologic dysfunction, and translational work on metal-induced oxidative and inflammatory injury. Results:Non-cobalt metal ions are released through mechanical wear, fretting, and electrochemical corrosion, subsequently entering systemic circulation and crossing neural barriers. Elevated Ti, Nb, and Zr concentrations have been documented in CSF of arthroplasty patients compared with controls, confirming central nervous system exposure. Mechanistic data implicate oxidative stress, mitochondrial dysfunction, and glial activation in metal-related neurotoxicity. Clinical observations include cognitive decline, peripheral neuropathy, and movement disorders, although large-scale, longitudinal evidence remains limited. No randomized controlled trials have evaluated neurologic endpoints, and standardized surveillance protocols are lacking. Conclusions:While modern joint arthroplasty is highly effective, accumulating evidence supports the biologic plausibility and emerging reality of neurologic effects associated with systemic accumulation of non-cobalt metal ions. Patients with high activity levels, renal impairment, or pre-existing neurologic conditions may be particularly vulnerable. Future research should focus on prospective cohorts linking quantified metal exposure to validated neurologic outcomes, biomarker development, and implant innovations that minimize ion release. Integration of neurologic screening into long-term arthroplasty follow-up may be essential as implant lifespans continue to extend.
Seizure emergencies in low-resource settings present unique challenges due to limited access to diagnostics, antiepileptic medications, and emergency services. Global health literature emphasizes the importance of rapid, coordinated interventions when standard treatments are unavailable. During the 2025 Project World Health (PWH) service-learning trip in Jarabacoa, Dominican Republic, a male in his early-mid teens with a history of syncopal episodes presented to a temporary outreach clinic. While awaiting referral planning, he became emotionally distressed and developed a generalized tonic–clonic seizure, followed by recurrent seizures and apnea. A care team, including medical students, residents, nurses, pharmacists, and attending physicians, provided continuous monitoring and supportive management with airway protection, bag-valve-mask ventilation, intravenous access, and dextrose-containing fluids. No antiepileptic medications or diagnostic tools were available. The patient experienced prolonged seizure activity with recurrent respiratory arrest, suspected to represent ictal central apnea. Oxygen saturation dropped to 73% but stabilized above 92% with sustained ventilation. Emergency care continued for over 45 minutes until transfer by emergency medical services. He was later hospitalized and discharged without neurologic deficits. This case highlights the clinical and logistical challenges of managing seizure emergencies in resource-limited environments, underscoring the lifesaving potential of rapid, coordinated interdisciplinary action. Even without access to pharmacologic therapy or advanced diagnostics, effective teamwork and decisive supportive care proved critical. Furthermore, this experience illustrates the educational value of global health initiatives like PWH, which foster adaptability, critical thinking, and collaboration. Pre-trip training in emergency protocols, including seizure management, is essential for optimizing patient outcomes in similar contexts.
Background: Diabetes mellitus elicits considerable concern regarding perioperative outcomes in cardiac surgery. This systematic review endeavors to elucidate the impact of diabetes on ICU and hospital length of stay (HLOS) following extracorporeal circulation (ECC) in cardiac surgery. Methods: A comprehensive search of PubMed, Scopus, Embase, and the Cochrane Library was conducted, targeting clinical trials published between 2004 and 2024. The primary outcome assessed was the correlation between the proportion of diabetic patients and ICU length of stay. Secondary outcomes included the correlation between the proportion of diabetic patients and HLOS, as well as the relationships between the proportion of diabetic patients and ICU length of stay with mean age, sex distribution, and BMI. Weighted correlation analyses were employed. Results: Thirteen studies (1,588 patients) were included. The weighted correlation between the proportion of diabetic patients and ICU length of stay was -0.176 (p=0.574, power=0.96), indicating a weak and non-significant correlation. Nine studies (925 patients) analyzed HLOS, revealing a weak but statistically significant negative correlation (-0.2545, p=0.002). The mean age of patients was 64.70 years, which did not significantly affect ICU length of stay (coefficient = 0.0652, p=0.506). Sex distribution showed 24.98% female and 75.02% male participants, with significant differences (chi-square = 38.764, p<0.01). BMI analysis showed a mean BMI of 27.21, which also did not significantly impact ICU length of stay (coefficient = -0.2049, p = 0.757). Conclusions: Diabetes does not significantly impact ICU length of stay but is associated with shorter hospital stays. This unexpected finding warrants further investigation, especially considering the low power of the HLOS analysis due to sample size reductions. Significant differences in sex distribution across studies highlight the need to consider sex as a variable in future research. Although age and BMI were not significant factors in ICU length of stay, they remain important for postoperative outcomes. Future research should address these limitations to enhance the reliability of findings and improve care for diabetic patients postoperatively.
We are pleased to present the newest issue of the Harvard Medical Student Review. The work collected here asks readers to pay closer attention: to the experiences that shape care, to the questions that emerge in clinical training, and to the evidence through which medicine examines and improves itself.
Medical futility, or treatment unlikely to produce meaningful benefit, generates some of healthcare’s most difficult ethical conflicts. Physicians assess benefit through evidence-based metrics, while families interpret these situations through frameworks shaped by culture, faith, and personal values. This disconnect fuels tension, especially around end-of-life care, where aggressive intervention may cause suffering even as families view withdrawal as abandonment. I examine how cultural attitudes influence these decisions and argue that current “cultural competency” training may inadvertently worsen conflicts by encouraging demographic stereotyping rather than genuine listening. Effective navigation requires early communication, institutional flexibility, and acknowledging medicine’s inability to answer questions about life’s meaning.
Emergency contraception (EC) is critical for preventing unintended pregnancies. Oral levonorgestrel (LNG) is the standard FDA-approved EC method, while the levonorgestrel intrauterine device (LNG-IUD) is an emerging alternative that provides immediate EC and long-term contraception, although not FDA approved for EC right now. This study evaluates the efficacy of LNG-IUD compared to oral LNG for EC through a systematic review and meta-analysis. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Medline, and ClinicalTrials.gov were searched through December 16, 2024. Five studies, including 920 participants, met population, intervention, comparison, outcome, and setting (PICOS) criteria, focusing on reproductive-age women using LNG-IUD or oral LNG as EC. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT), and a random-effects model was applied due to heterogeneity across studies. When indirectly compared with oral LNG, the LNG-IUD demonstrated a natural log of the odds risk ratio (ORR) of -0.51 (95% CI: -3.86 to 2.83, p=0.77), suggesting a slightly lower risk of pregnancy. However, the wide confidence interval and high p value likely reflect the small sample size and limited number of studies, reducing the ability to detect significant differences. This review found no statistically significant difference in efficacy between LNG-IUD and oral LNG for EC likely attributed to the limited data. Nonetheless, LNG-IUD may offer comparable or potentially greater efficacy, with the additional benefit of long-term contraception. Further large-scale, direct comparative studies are warranted to confirm efficacy and expand EC options for women.
This reflective narrative explores experiences in pediatric wards in Ghana, highlighting the power of observation, empathy, and cultural humility in global health. Using a pencil and journaling as a lens, the essay examines the challenges of witnessing human suffering, ethical dilemmas faced by caregivers, and the role of careful observation in understanding patient care and resilience. It reflects on how these experiences shaped the author’s perspective on medical practice, emphasizing the importance of attentive observation, ethical reflection, and culturally informed empathy in global health and patient care.
Since Congress passed the National Institute of Health Revitalization Act of 1993, a document that mandates the inclusion of women and minority groups into medical research, sex differences in the clinical presentations of diseases and responses to medication have emerged.1 It has been found that women and men can present differently when experiencing a stroke, with women more often experiencing ‘atypical’ or ‘nontraditional’ signs and symptoms.2-8 Prehospital curriculum standards have not yet included this information for emergency medical technicians (EMTs) or paramedics. Further, prehospital provider education standards do not require competency in sex differences in epidemiology, physiology, pathophysiology, or pharmacology.9,10 Patients of EMS providers would likely benefit if their providers were aware of these sex differences, as previous research has found that women experiencing a stroke receive a lower quality of EMS care compared to men.11 Early identification of stroke and timely notification to the nearest appropriate hospital can impact treatment decisions, and time to treatment can heavily influence functional outcomes.12 Since there is robust evidence that the clinical presentation, quality of care, and health outcomes of stroke differ between men and women, EMS education should include and emphasize these topics.
Oral health conditions are common yet highly preventable, and they disproportionately affect socioeconomically disadvantaged communities. This cross-sectional survey of 144 homeless and housing-insecure adults in central Massachusetts assessed oral health status, access to dental and primary care, and resource needs. Participants were far more likely to have a primary care provider than a regular dentist, and poor oral health was strongly associated with poor overall health. Respondents most frequently reported needing dentists who accept public insurance, basic dental supplies, and transportation to appointments. The findings highlight opportunities to improve oral health for people experiencing homelessness through better supply access, case management, and integration of oral health into primary care.
This artwork presents the Hippocratic Oath written in ancient Greek as a calligram forming the Rod of Asclepius. By visually entwining text and symbol, the piece reflects on the intertwined nature of language, ethics, and healing in the medical profession, inviting viewers to contemplate the responsibilities that accompany the physician’s role.
This study evaluates a peer-led Medical Spanish program at Loyola University Chicago Stritch School of Medicine that enrolls more than half of first-year students and is tightly integrated with the English medical history curriculum. Using pre- and post-course assessments of comfort, cultural competency, and listening/reading comprehension, as well as an Objective Structured Clinical Examination (OSCE) for intermediate and above students, the authors found significant gains in language comfort and comprehension across most levels. OSCE results showed high rates of complete history-taking and strong ratings for pronunciation, vocabulary, conversational fluidity, and cultural awareness. The program illustrates how student-led, longitudinal language training can enhance clinical communication with Spanish-speaking patients, while highlighting the need to further strengthen cultural content and assessment tools.
Familial hypertrophic cardiomyopathy (FHC) is the most common inherited cardiac disease and is largely driven by mutations in sarcomeric proteins, especially β-myosin heavy chain (MYH7) and myosin-binding protein C (MYBPC3). This review synthesizes emerging data on how these mutations alter cardiomyocyte mechanics and gene expression. MYH7 mutations reduce force generation and myofibrillar density, while MYBPC3 haploinsufficiency produces hypercontractile, energetically inefficient myocytes. Transcriptomic and microRNA profiling reveal early changes in stress-response, fibrosis, and electrical remodeling pathways. The article also highlights evolving therapies, including cardiac myosin inhibitors like mavacamten and experimental gene-editing approaches, that target upstream molecular drivers rather than downstream structural consequences.
Weight bias is pervasive in clinical encounters yet remains underaddressed in medical education. Drawing on vignettes from their clerkship year, the authors illustrate how stigmatizing assumptions about patients with higher body mass index (BMI) can violate core ethical principles of justice, autonomy, and non-maleficence. They describe how biased narratives about an IVF patient, a transgender man on gender-affirming hormone therapy, and a child labeled “obese” both harm patients and normalize discriminatory practices among trainees. The essay argues for a weight-neutral, evidence-based approach that centers patient values, promotes respectful communication, and explicitly teaches students to recognize and resist weight stigma in clinical training and practice.
Transitions from inpatient to post-acute care are complex and often confusing for trainees, clinicians, and patients. This perspective describes the development of a visual discharge decision aid created in collaboration with case management specialists to clarify rehabilitation and post-acute care options after hospitalization. The flowchart outlines criteria for long-term acute care hospitals, acute inpatient rehabilitation, skilled nursing facilities, assisted living, home health, and independent discharge. By improving awareness of functional status requirements, intensity of services, and typical patient trajectories, the tool aims to support more informed, patient-centered disposition planning and help trainees better understand the continuum of post-acute care.
Amidst the past year's assaults on science, medicine, and academia at large, we at the Harvard Medical Student Review recognize that our profession stands at a precipice. In times of crisis, we are called upon not just to endure, but to innovate. This special issue captures the aspirational visions of Harvard medical students for the next 25 years of medicine, emphasizing the urgent need to rebuild the social contract between medicine and the public, ensure sanctuary for all, and make scientific advances accessible to everyone.
This article examines the challenges facing Latine representation in medicine, from discriminatory attitudes to systemic barriers in medical education. The author shares personal experiences and argues for structural reforms in medical school admissions, longitudinal institutional investment, and meaningful mentorship to ensure Latine physicians are fully represented, supported, and empowered to provide culturally and language-concordant care.
Artificial intelligence (AI) tools are developing quickly and prominently within the U.S. healthcare system. It therefore seems essential to understand their weaknesses to practice medicine that is fully informed. The goal of this paper is to overview several key concerns surrounding healthcare AI, as well as some anticipated barriers to its implementation. AI’s generalizability is currently limited due to a widely fragmented Electronic Health Record (EHR) and inaccessibility to training data. AI tools are therefore at risk of acting on incomprehensive knowledge and generating inaccurate outputs. They are also extremely susceptible to several different forms of bias. Such bias can result in preferences towards diagnosing some diseases over others and recommending interventions that are only beneficial to certain populations. Privacy and transparency are also of great concern, especially when dealing with private medical data. While “black box” algorithms are criticized for their lack of transparency, innovators are working towards explainable AI (XAI) tools that can “show their work.” Developing guidelines make it difficult to predict how liability for AI malpractice may be distributed across parties but has interesting implications for how physicians will change their practice in response. Finally, the current U.S. payment structure does not easily accommodate healthcare AI tools. This challenge raises questions surrounding healthcare AI’s reimbursement mechanism as it becomes more widely utilized. While this paper does not provide solutions for the outlined concerns, it emphasizes the importance of understanding and anticipating the shortcomings of new healthcare technologies.
This paper explores the ethical implications and societal impacts of gerotherapeutics, which aim to delay aging and age-related diseases. As medical advancements target aging as a condition to be treated, the medicalization of aging raises concerns about reinforcing ageist stereotypes and marginalizing older adults. The growing anti-aging industry, fueled by societal pressures, particularly for women, may lead to economic and healthcare disparities. Misclassifying aging as a disease risks diverting resources away from essential public health needs. This paper argues for a shift in perspective, emphasizing aging as a natural process deserving of respect, rather than a condition to be "cured."
Throughout the last few decades, private equity (PE) has expanded into the field of ophthalmology at an incredible rate. Acquisitions of private practices by firms have increased with the intention of maximizing profits and patient volume to target the growing demand for medical services and address a fragmented healthcare system. PE investment has proven to greatly benefit PE firms and senior ophthalmologists of well-established practices. However, this trend of PE acquisition has received much criticism despite its seemingly positive short-term outlook. In this commentary, we discuss the potential setbacks of PE advancement in ophthalmology, including the loss of physician autonomy, reduced income for junior ophthalmologists, and decline in quality of patient care – all resulting from the increased focus on maximizing profitability. Furthermore, we consider the ramifications of PE investment on incoming ophthalmologists who are entering an uncertain job marketplace and may struggle to locate stable practice opportunities. This commentary concludes with the evaluation of private equity advancement through the lens of a medical student and an ophthalmologist, as well as a call for medical students and trainees to educate themselves on the matter and promote further research on the long-term consequences of this trend of PE investment.
