Category: Nevin Manimala

WMJ. 2025;124(3):249-257.

ABSTRACT

INTRODUCTION: Clinical faculty at academic health centers may benefit from specific mentorship and proficiencies that are distinct from those on research tracks. We describe the creation, activities, and 1-year impact of a faculty development program that included novel professional coaching training (the Clinical Faculty Mentoring Program), which was supplemented by skills- and knowledge-building activities (the Clinical Faculty Development Series).

METHODS: The goals and components of the Clinical Faculty Mentoring Program and Clinical Faculty Development Series are described in detail. A mixed methods evaluation plan guided collection of confidential survey and interview data before and after the first year of these activities. We used paired t tests to identify statistically significant changes.

RESULTS: The 43 clinical mentors reported significant gains in job satisfaction, teaching attitudes, knowledge of mentorship competencies, and confidence with coaching skills for mentorship (all P < 0.05). Of mentor respondents, 88% found the coach approach to mentoring program to be “very” or “somewhat” helpful. Coaching behavioral domains with the greatest evidence of improvement were supporting the mentee to integrate new awareness, insight, and learning into their worldview and behaviors (P = 0.0503) and managing time and focus of mentoring sessions (P = 0.022). All 37 mentees had at least 1 meeting with a mentor (100%). Over 9 months, 39 virtual Clinical Faculty Development Series sessions had an average participation of 38 participants (range 22-59). A majority of surveyed faculty (>55%) agreed or strongly agreed the sessions provided valuable opportunities for skills development with teaching, leadership, wellness, diversity, equity, inclusion, and promotion.

CONCLUSIONS: Among clinical mentors, our novel coach approach to clinical faculty mentoring and skill-building had favorable effects on job satisfaction, knowledge of mentorship competencies, and confidence in coaching skills. Outcomes from the Clinical Faculty Development series supported the mentoring program outcomes. Longitudinal follow-up is needed to determine how this program will impact mentees.

PMID:40953388

WMJ. 2025;124(3):236-242.

ABSTRACT

INTRODUCTION: The use of structured documentation via auto-populated discrete fields is important to facilitate medical decision-making, research, and quality improvement. If these fields are not filed properly, they will appear “empty,” leaving behind incomplete documentation. Examples include past medical history (PMH), past surgical history (PSH), family history (FH), and active hospital problems (AHP).

OBJECTIVES: Our SMART aim was to decrease the incidence of “no PMH/PSH/FH/AHP on file” in history and physical notes (H&Ps) at our single children’s hospital from 7.9%, 18.7%, 8.3%, and 17.0%, respectively, to less than 5% over 4 months.

METHODS: A multidisciplinary team utilized quality improvement methodology. The population included all encounters admitted to pediatric hospital medicine. The outcome measure was percentage of H&Ps with “no PMH/PSH/FH/AHP on file.” The process measure was percentage of H&Ps using the proper template. Interventions included a clinical decision support tool in H&P templates to display a hard stop if “no PMH/SH/FH/AHP on file” appears and documentation education. Statistical process control charts were used to analyze measures.

RESULTS: “No PMH/PSH/FH/AHP on file” decreased from baseline to 1.2%, 2.2%, 2.9%, and 4.2%, respectively, showing special cause variation. H&P template use remained high at 87.2%.

CONCLUSIONS: The creation of a simple clinical decision support tool was associated with a decreased incidence of “no PMH/PSH/FH/AHP on file,” achieving our goal. Utilizing automatic clinical decision support reduced the need to rely on education to cause a change, an important element of our tool. Future steps include implementation of a hard stop in other required areas of discrete documentation and ongoing evaluation of sustained change.

PMID:40953386

WMJ. 2025;124(3):230-235.

ABSTRACT

INTRODUCTION: Hypertension is a leading cause of morbidity and mortality worldwide. Although it is often asymptomatic, adequate blood pressure control can help decrease the risk of cardiovascular, renal, and neurologic diseases. Clinical pharmacists can play a critical role in blood pressure management and have been shown to help patients meet their goals. Despite this, patients often disengage from pharmacy services, and reasons for this are not well understood. This study sought to evaluate characteristics of patients who are referred but not engaged in a primary care pharmacy antihypertensive service and explore potential reasons for disengagement.

METHODS: Data from the 2023 fiscal year (July 1, 2022 – June 30, 2023) were collected from UW Health’s electronic health record. Inclusion criteria were prespecified to include adults referred by their primary care provider to pharmacy services but who did not engage in care. Retrospective chart reviews were performed to gather demographic information on this population, and descriptive statistics were used for data analysis.

RESULTS: Of the 168 individuals who met the inclusion criteria, 66.1% of participants were not currently at their blood pressure goal. The majority of patients did not engage in pharmacist services due to lack of patient interest (n = 114, 67.9%) or being managed by another health care member team (n = 36, 21.4%).

CONCLUSIONS: The majority of patients who did not engage with a pharmacist for hypertension medication management despite referral from their primary care provider are not achieving their blood pressure goal.

PMID:40953385

WMJ. 2025;124(3):216-222.

ABSTRACT

INTRODUCTION: Chlamydia trachomatis and Neisseria gonorrhoeae are the two most reported bacterial infections in the United States, with over 1.5 million and 500 000 cases reported in 2019, respectively. The number of infections continues to rise, with significant disparities at the national level in the rate of infection between age, race, and sex demographic classifications. Although the disparities in chlamydia and gonorrhea infections have been well described in the US, little research has been done on a smaller community scale, such as La Crosse County, Wisconsin.

METHODS: We accessed data from La Crosse County, Wisconsin; the State of Wisconsin; and the United States for gonorrhea and chlamydia cases from 2001 through 2020 and completed both descriptive analysis and inferential statistical analysis.

RESULTS: Gonorrhea and chlamydia rates have risen at the local, state, and national levels. Demographic analysis of the cases in La Crosse County conveyed that females and Black populations having higher rates of infection. Additionally, the 25- to 39-year age group had a marked increase in gonorrhea rates at the county and state levels.

CONCLUSIONS: We were able to show demographic differences in chlamydia and gonorrhea incidence rates. The authors recommend that the 25- to 39-year-old group should undergo more regular comprehensive screening for all sexually transmitted infections.

PMID:40953383

Acad Med. 2025 Sep 15. doi: 10.1097/ACM.0000000000006268. Online ahead of print.

ABSTRACT

PURPOSE: Blinding in pediatric residency recruitment and the influence of implicit biases have not been formally studied. This study examined whether blinding to race and/or gender influences the selection of candidates for pediatric residency interviews and assessed the role of respondent implicit bias.

METHOD: An electronic survey was sent to all U.S. pediatric residency program directors in spring 2023. Nonresponders were sent weekly reminders for 5 weeks (survey remained open for 6 weeks). Respondents rated 5 fictitious applicants, each randomly assigned a gender (male, female, or blinded) and race (Black, White, or blinded), and completed an Implicit Association Test (IAT) to assess unconscious attitudes about race. The survey then asked about current strategies to mitigate unconscious bias in residency recruitment.

RESULTS: Responses were received from 85 of 202 programs (42%). All 85 program leaders reported using implicit bias training, with 64 of 83 (77%) using blinding and 74 of 84 (88%) using standardized rubrics to score applications as strategies to mitigate bias. The IAT revealed no statistically significant difference in the proportion of respondents with a positive implicit attitude toward Black versus White people (W = 840, P = .20). Statistically significant main effects were found for applicant race and interaction between applicant race and respondent IAT score, with respondents rating applicants with unknown race lower by a mean (95% CI) of 0.61 (0.07-1.16) points on the 5-point scale than the same applicants presenting as White or Black (t222 = 2.2, P = .03) and respondents rating White or unknown race applicants lower when their implicit attitudes toward Black people were more positive (t207 = -4.0, P < .001 and t208 = -2.9, P = .004, respectively).

CONCLUSIONS: Blinding applicant race may adversely impact some applicants’ interview prospects, suggesting that caution be applied when considering blinding to address implicit bias.

PMID:40953379 | DOI:10.1097/ACM.0000000000006268

J Am Acad Orthop Surg. 2025 Sep 11. doi: 10.5435/JAAOS-D-25-00590. Online ahead of print.

ABSTRACT

BACKGROUND: One of the main surgical treatments for ankle arthritis is arthrodesis. Mixed results are reported in the literature regarding which technique is superior: open arthrodesis or arthroscopic arthrodesis. This systematic review aims to report and summarize all available literature on this topic.

METHODS: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. The search criteria were for open and arthroscopic ankle arthrodesis. The MINORS score criteria were used to evaluate the strength and quality of the selected studies.

RESULTS: A total of 19 studies including 719 open and 835 arthroscopic arthrodesis were included. Average age and BMI for the open and arthroscopic groups were 56.6 and 56.8 years and 29.3 and 28.8 kg/m2, respectively. A statistically significant lower infection rate 8.5% vs. 1.1% and length of stay 5.4 vs. 3.3 days was found in the arthroscopic group (P = 0.05, 0.05). The union rate was 656 (91.2%) and 793 (94.9%) for the open and arthroscopic groups. Revision procedures were required in 40 open procedures (5.9%) and 28 arthroscopic procedures (3.5%); additional revision surgery (excluding revisions) was required after 89 open (13.2%) and 55 arthroscopic (6.9%) arthrodesis surgeries. A total complication rate of 41% and 20.4% was reported among the open and arthroscopic groups, respectively.

CONCLUSION: Both open and arthroscopic ankle arthrodesis surgeries are safe and effective treatments for ankle arthritis. This systematic review found with significance a lower infection rate and length of stay for the arthroscopic group. We hope the current review will help surgeons’ when planning surgical management for patients with severe ankle arthritis.

PMID:40953378 | DOI:10.5435/JAAOS-D-25-00590

J Gerontol Nurs. 2025 Sep 15:1-7. doi: 10.3928/00989134-20250908-03. Online ahead of print.

ABSTRACT

PURPOSE: Dementia, including Alzheimer’s disease, poses complex challenges requiring health care providers to respond with empathy and skill. The current study examined whether a simulation-based dementia education intervention could enhance empathy in health care students.

METHODS: Using embedded mixed methods, one-group quasi-experimental design, empathy levels in 125 prelicensure nursing and graduate occupational therapy students were measured via the Kiersma-Chen Empathy Scale-Revised (KCES-R) before, immediately after, and 6 weeks post-simulation. In addition, 36 post-debriefing focus groups explored student experiences qualitatively.

RESULTS: Findings showed significant empathy score increases across all time points (F[2,124] = 17.02, p < 0.001). Thematic analysis revealed five themes: The Illusion of Empathy, Developing Empathetic Skills, Confronting Uncomfortable Truths, The Eureka Moment: Transformative Realizations, and Empathy and Power Dynamics.

CONCLUSION: Findings suggest that simulation-based dementia experience improves empathy and motivates students to provide better care. Experiential learning is critical to preparing future health care professionals to meet the growing demands of dementia care.

PMID:40953372 | DOI:10.3928/00989134-20250908-03

J Gerontol Nurs. 2025 Sep 15:1-7. doi: 10.3928/02793695-20250908-01. Online ahead of print.

ABSTRACT

PURPOSE: The current study examined differences in senior nursing students’ knowledge, attitudes, and perceived competency about older adults, based on enrollment in Bachelor of Science in Nursing (BSN), Associate Degree in Nursing (ADN), and Practical Nursing (PN) programs offering gerontological nursing curricula content.

METHOD: A nonexperimental, descriptive survey design was used. A total of 145 senior nursing students from five prelicensure programs in Florida completed a 92-item survey incorporating the Palmore Facts on Aging Quiz 2, Kogan’s Attitudes Toward Old People Scale, and the Hartford Geriatric Nurse Competency Tool. Data were analyzed using analysis of variance (ANOVA), multivariate ANOVA, and Pearson correlation.

RESULTS: Students demonstrated limited knowledge about older adults but reported high perceived competency. A statistically significant difference in knowledge was found between program types, with PN students scoring highest. A moderate positive correlation existed between knowledge and attitudes. No significant differences were found for attitudes or perceived competency by program.

CONCLUSION: The current study underscores the need to systematically design an evidence-based curriculum inclusive of gerontological nursing content across BSN, ADN, and PN programs to prepare the future nursing workforce to care for older adults.

PMID:40953371 | DOI:10.3928/02793695-20250908-01

Retina. 2025 Sep 10. doi: 10.1097/IAE.0000000000004672. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the hyperreflective spots (HRS) across different stages of epiretinal membrane (ERM) using optical coherence tomography (OCT) and their relationship with anatomical and functional parameters.

METHODS: This observational study included 111 patients with ERM, categorized into early (stages 1-2, n=43) and late (stages 3-4, n=68). Total Hyperreflective Spots (HRST), Visual Acuity (VA), central retinal thickness (CRT), and outer nuclear layer (ONL) thickness were measured using OCT. Statistical analyses included Mann-Whitney U test for group comparisons and Spearman’s correlation to assess relationships between HRST and VA.

RESULTS: HRST increased significantly from early (27.67 ± 12.57) to late stages (35.15 ± 17.28, p=0.015). In early stages, HRST showed a moderate positive correlation with VA (ρ=0.48, p=0.001), while this correlation diminished in late stages (ρ=0.036, p=0.426). CRT also increased significantly from early to late stages (380.05 ± 94.51 μm vs. 523.54 ± 83.92 μm, p<0.001). ONL thickness showed no significant difference between stages (p=0.543). Linear regression model showed in early stages (1-2) that HRST and CRT were valuable VA predictors (Adjusted R2=0.284, p < 0.05).

CONCLUSION: HRST progressively increases with ERM severity, correlating with visual function in early stages but losing this association in advanced stages. These findings suggest that HRST could be a prognostic marker for early disease progression and highlight the need for timely intervention to preserve visual function.

PMID:40953359 | DOI:10.1097/IAE.0000000000004672

Neurology. 2025 Oct 7;105(7):e214113. doi: 10.1212/WNL.0000000000214113. Epub 2025 Sep 15.

ABSTRACT

BACKGROUND AND OBJECTIVES: Individual MRI markers of cerebral small vessel disease (CSVD) are associated with impaired cognition and dementia but may not reflect the overall burden of CSVD. In addition, it is unclear whether these markers provide additional value in dementia risk assessment beyond vascular risk factors alone. Thus, we studied the association between the additive burden of multiple CSVD markers and incident dementia and determined whether this relationship remains independent of the Framingham Stroke Risk Profile (FSRP), a tool used commonly used for stroke risk prediction.

METHODS: A total of 1,152 MRI scans from participants in the Original and Offspring cohorts of the Framingham Heart Study, a large observational cohort study, were included. Participants were older than 55 years and free of prevalent dementia, stroke, or other neurologic conditions at the time of MRI. A multimarker score capturing CSVD burden was defined as the sum of CSVD features detected in the MRI: cerebral microbleeds, covert brain infarcts, extensive white matter hyperintensities, high-burden perivascular spaces, and cortical superficial siderosis. Multivariate Cox regression models examined the association between the multimarker CSVD score and incident all-cause dementia, Alzheimer dementia (AD), and vascular dementia.

RESULTS: The mean age was 70.9 years (SD 8.7) (527 [46%] were male), and 211 (18%) had a CSVD score of ≥2. Over a median follow-up time of 7.4 years (interquartile range 4.6-11.3), participants with a score ≥2 had significantly elevated risk of all-cause dementia compared with those with no CSVD markers after adjustment for the FSRP (hazard ratio [HR] 1.67; 95% CI 1.05-2.66) and vascular risk factors (HR 1.76; 95% CI 1.10-2.81). The multimarker CSVD score demonstrated similar model performance metrics to the FSRP (Harrell c-statistics 0.82-0.83).

DISCUSSION: We found a significant association between all-cause dementia and multimarker CSVD scores, which was independent of the FSRP as well as its individual components. Our results support the use of a multimarker CSVD score as an indicator for incident all-cause dementia risk and suggest that it may be as robust as the FSRP. Further studies are necessary to validate the use of a multimarker CSVD score in dementia risk prediction.

PMID:40953349 | DOI:10.1212/WNL.0000000000214113