Characterization of applicants for residency training in pathology: Does diversity exist?

ContextA diverse workforce has been shown to improve productivity and innovation. The level of diversity among pathology residency applicants has not previously been reported.ObjectiveThis study aims to characterize the applicants at an academic pathology department to gain a better understanding of diversity among them.DesignBetween 2015 and 2017, data from a tertiary care center were analyzed for gender, US and international medical school, USMLE scores, and self-identified racial or ethnic group. For 2017, data was compared to that published by the Association of American Medical Colleges (AAMC).ResultsThere were 1293 pathology applicants with 48–49% being female. The overall underrepresented minority (URM) applicant pool in pathology represented 12.6%, 9.5%, and 11.1% of our applicants for 2015, 2016, and 2017, respectively. URMs from US medical schools alone represented 4.7%, 3.7%, and 4.5% of our applicants for 2015, 2016, and 2017, respectively. The percentage of 2017 US medical school graduates applying to any US pathology training program was 22.2% versus 38.7% applying to pathology at our center (p ≤0.001). URM applicants for pathology from US medical schools were significantly lower than URM applicants to all AAMC medical specialties (p = 0.035). Among our pathology applicants in 2017, USMLE I scores and number of applicants with any publications were higher for non-URMs compared to URMs (p = 0.048 and p = 0.046, respectively).ConclusionNo significant difference related to gender was identified among our applicants while racial/ethnic groups remain underrepresented with significantly fewer URM applicants from US medical schools compared to published AAMC data for all medical specialties.     

Evaluation of Racial Microaggressions Experienced During Medical School Training and the Effect on Medical Student Education and Burnout: A Validation Study

IntroductionMicroaggressions in the learning environment have been documented at various levels of medical training. However, there is lack of data detailing the prevalence and effects of racial microaggressions in medical school. This limits interventions that might improve the learning environment for underrepresented minority medical students (URMMS). This study describes the creation and validation of a survey instrument characterizing the experience of microaggressions in medical school and their impact on medical student education and burnout.MethodsAn anonymous survey instrument was adapted for medical students from the validated Racial and Ethnic Microaggressions Scale (REMS) and distributed to the national listservs of the Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), and the Asian Pacific American Medical Student Association. Responses were categorized into two cohorts: under-represented minority (URM) and non-URM based on self-reported race or ethnicity.ResultsA total of 217 responses were collected from medical students across the United States, with 148 (68.2%) students identifying as URM. URM respondents were significantly (p < 0.05) more likely to report experiencing race-related microaggressions during medical school (55% vs 31%), and to report that these microaggressions contributed to feelings of burnout (62% vs 29%) and compromised learning (64% vs 49%). URM students were significantly less likely to feel that adequate resources were available to address microaggressions (26% vs 39%, p < 0.05).ConclusionsOur results suggest that microaggressions experienced by URMMS can be evaluated using an adapted REMS. Additionally, the experience of microaggressions negatively impact the learning environment, and students feel the availability of sufficient resources to address microaggressions and their effects are lacking. Further research is needed to evaluate microaggressions and their impact on a larger scale. This should be followed by interventions to minimize the frequency and impact of these microaggressions.     

Introduction to the medical professions through an innovative medical student-run pipeline program

Underrepresented minorities (URMs) make up a disproportionately small percentage of medical school applicants, matriculants, and physicians relative to the general US population. Preprofessional pipeline programs may help introduce URMs to careers in the medical field. MiniMeds was developed as a paracurricular enrichment program that targeted URM students. The curriculum was designed and administered by medical students, and 2 trials of this program were conducted. Data were collected pre and post program through a survey that assessed knowledge of medical concepts and knowledge of and interest in careers in medicine. Attendance at program sessions correlated with baseline knowledge about medical professions. Knowledge about medical concepts increased significantly from baseline to follow-up for boys, a group significantly represented by URMs in our cohort. Median scores for knowledge of medical careers increased significantly from baseline to followup for URMs as well as for boys and girls. Preprofessional pipeline programs such as MiniMeds are able to engage and develop medical knowledge in URM students at a critical developmental age. Further evaluation and implementation of programs that incorporate medical students to actively develop and lead pipeline programs are warranted.     

Temporal trends of primary hinge knee arthroplasty and risk factors associated with revision: National Joint Registry data from 2003 to 2018 for 4921 patients

BackgroundThe aim was to describe temporal changes and associated changes in patient demographics and surgical variables, revision rate and factors associated with revision of primary hinge knee arthroplasty (HKA) in the UK.MethodsNational Joint Registry data for England, Wales, Northern Ireland and Isle of Mann was used to examine the temporal trends in patient demographics, surgical factors and indications for primary HKA usage over a 16-year (2003 to 2018) period and associated risk factors for revision.ResultsThere were 4921 patient episodes with a median follow up of 5.5 (range 0 to 16.3) years. The median age was 75years and the majority were female (72.9%). There was a tenfold increase in the use of HKA (p < 0.001), with an increased relative usage in female patients (p = 0.010), but no significant changes in age (p = 0.484) or BMI (p = 0.781). There were 227 revisions performed at a median of 695days. The overall unadjusted probabilities of revision at 1, 5 and 10 years were 1.5% (95% confidence intervals (CI) 1.1to1.8), 4.4% (95%CI 3.7 to 5.0) and 6.4% (95%CI 5.5 to 7.3), respectively. Cox proportional hazard analysis demonstrated younger age (p < 0.01), male sex (hazard ratio (HR) 1.43, p < 0.01), morbid obesity (HR 2.31, p = 0.022) or previous trauma as the indication (HR 1.48, p = 0.025) were associated with an increased risk of revision.ConclusionThere was an increase in the use of HKA with increased uptake among female patients. The revision rate was a 6.4% at 10 years, however, younger age, male sex, morbid obesity or previous trauma were associated with an increased risk of revision.Level of EvidenceIII Retrospective study.     

Specialty selection and success in obtaining choice of residency training among 1987 U.S. medical graduates by race-ethnicity and gender.

The authors developed baseline data on specialty selection and success in obtaining residency positions for the medical school graduates of 1987 who participated in the National Resident Matching Program (NRMP), compared by gender and race-ethnicity. They focused on primary care specialties and obstetrics-gynecology versus all other specialties, and sought to identify group differences in (1) patterns of specialty preference, (2) evolution of specialty choice from before to after medical school, (3) success in attaining the first choice of specialty through the NRMP, and (4) patterns in switching from an alternate specialty (ranked second or lower) to the first-choice specialty between the first and second years of residency training. The results showed substantial intergroup and intragroup variations, both before and after medical school, for family practice, internal medicine, and obstetrics-gynecology. Examination of NRMP outcomes revealed that the underrepresented-minority (URM) graduates, particularly men, were less successful both in achieving any match and in matching to their first-choice specialties. Analyses of patterns in switching specialties revealed several important facts about those who were matched to alternate specialties: (1) over half entered their first-choice specialties in the second year; (2) women had more success in switching to their first-choice specialties than did men, particularly among the URMs; (3) among those who received alternate specialties, the URM women were more likely than the URM men to leave graduate medical education by the second year (reversing the trend for the other groups); and (4) individuals whose alternate specialties were in primary care were much less likely to switch to their first-choice specialties.     

Emotional intelligence as a mediator between attachment security and empathy in pre-clinical medical students: A multi-center cross-sectional study

ObjectiveTo explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI.MethodsIn a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy.Results253 medical students (56.13% female), aged 19–29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = ?0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = ?0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score.ConclusionThis study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students.Practice implicationsEI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students.     

Reducing Reliance on Test Scores Reduces Racial Bias in Neurology Residency Recruitment

PurposeWe sought to correct a low interview rate for racial groups underrepresented in medicine (URM) by analyzing our interview selection process, identifying sources of unintended bias, and developing a new process that would provide a more racially diverse interview pool.MethodsWe analyzed our review process to determine at which point we were eliminating URM candidates at a higher rate than those who are not from an underrepresented group. A point system was created incorporating clinical grades, extracurricular activities, research, letters of recommendation, board exam scores, and life experiences. We compared the rate at which interviews were offered to URM candidates and compared those rates to historical data. We then analyzed the new process by comparing groups who were offered interviews to those who were not.ResultsIn 2016, 56% of URM applicants were screened out by a mandatory minimum United States Medical Licensing Examination (USMLE) test score, whereas only 39% of all other groups were disqualified by test scores. This led to 20% of the URM applicants receiving interview offers. By comparison, 30.6% of other groups were offered interviews. After removing the required minimum test score for application review and modifying the screening process to a more holistic one the following application cycle, 24.5% of URMs were offered interviews in 2017 compared to 28.1% of others.ConclusionsA comprehensive review of applications that minimizes emphasis on USMLE step 1 scores substantially reduced the difference between the percentages of URMs and those of other racial backgrounds who were offered interviews for a Neurology residency.     

How good are medical students at communicating risk? An implementation study at three German medical schools

ObjectiveTo assess the objective and subjective risk communication skills of medical students in three universities in GermanyMethodsWe developed a risk communication skills Objective Structured Clinical Examination (OSCE) station and implemented it in three medical schools in Germany. 596 students contributed data to a risk communication checklist and a risk communication self-assessment. Multiple linear regression models were used to identify factors associated with the risk communication OSCE performance.ResultsParticipants in our study achieved on average 73.5% of the total risk communication skills score, which did not differ between locations (F(2-595) = 1.96; p = 0.142). The mean objective performance of students who assessed their skills as poor was significantly worse than the performance of students who assessed their skills as good (t(520) = ?5.01, p < 0.001). The risk communication skills score was associated with native language but not with gender nor General Point Average (p < 0.001).ConclusionsMedical students demonstrated acceptable risk communication skills scores and were able to self-assess their performance. However, selected communication techniques should be re-emphasised in the undergraduate medical curriculum.Practice implicationsOur research identified shortcomings in particular subgroups that can be addressed through tailored curriculum interventions.     

Do pre-admission programs make a difference in the enrollment of underrepresented-minority students at U.S. medical schools?

PURPOSE: To assess the association between the presence of pre-admission programs directed at underrepresented minority (URM) students at medical schools accredited by the Liaison Committee on Medical Education (LCME) and the first-year and total enrollments of URM students during the 1993-94 academic year. METHOD: The authors ranked 119 LCME-accredited medical schools by the percentages of their first-year classes and total enrollments made up of URM students. They then compared the schools in three ways: (1) schools ranking above versus below the median in terms of numbers of URM students; (2) the top 25% versus the lower 75%; and (3) the top 25% versus the lowest 25%. Logistic regression was used to determine the association between the presence of pre-admission programs and URM enrollment. RESULTS: Fifty-six percent of the medical schools had pre-admission programs. For both first-year and total enrollments, each comparison showed that schools ranked as having higher percentages of URM students (above the mean and in the top 25%) were more likely to have pre-admission programs than were the schools ranked lower (below the mean, lower 75%, and lowest 25%). CONCLUSION: This study suggests that the presence of pre-admission programs is positively associated with enrollment of URM students at U.S. medical schools.     

The role of race and ethnicity in the dermatology applicant match process

Objective: The field of dermatology is one of the least racially diverse specialties. We aimed to identify ways in which minorities become underrepresented within dermatology.Methods: We surveyed dermatology applicants who applied to Mayo Clinic in Scottsdale, AZ during the 2018–2019 application cycle and Mayo Clinic in Rochester, Scottsdale, and Jacksonville during the 2019–2020 application cycles. Underrepresented minorities (URM) were defined as Latino/Latina, African American, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander.Results: In total, 149 and 142 dermatology applicants completed the initial 2019 and 2020 surveys, 112 and 124 completed the follow-up surveys. The racial breakdown was 69.9% Caucasian, 23.7% Asian, 5.4% African American, 0.4% American Indian/Alaska Native, and 0.7% Native Hawaiian/Pacific Islander. Eight percent identified as Hispanic/Latino. Median Step 1 scores were lower for URM (p<0.01). URM had more publications (p=0.01). There were no observed differences in away rotations or interviews attended. URM were less likely to match (76.7%) vs. Whites (88.4%) and Asians (96.0%; p=0.03).Conclusion: URM are taking out more loans, pursuing research fellowships more often than their White counterparts, publishing more, completing the same number of away rotations and interviews, yet have lower match rates leading to underrepresentation in the field. It is important to realize how Step scores might reflect and reproduce disparities between different racial/ethnic backgrounds, in turn influencing the racial composition of dermatology residency programs.     

PROMIS is a Valid Patient-Reported Outcome Measure for Patients undergoing ACL Reconstruction with Multi-ligament Knee Reconstruction and Repair Procedures

BackgroundThis study aimed to (1) compare PROMIS with previously validated legacy instruments and (2) to assess between group differences of PROMIS PF-CAT [Physical Function Computer Adaptive Test] for patients undergoing isolated primary ACL reconstruction [ACLR] vs. primary ACL reconstruction with additional ligamentous intervention [MLIK].Level of Evidence: II; Prospective Cohort Study.MethodsAt a single preoperative timepoint, 42 [MLIK] and 73[ACLR] patients completed: Short Form 36 Health Survey (SF-36) Mental (MCS) and Physical Component Summary (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 dimensions (EQ-5D) and Marx Knee Scale. Spearman correlation coefficients (non-parametric data) assessed correlations between PROMIS PF-CAT and legacy PROs [Patient-Reported Outcome instruments]. Floor and ceiling effects were assessed using chi-square tests. Between group differences were assessed (Wilcoxon Rank sum test).ResultsPROMIS PF-CAT for the MLIK cohort [Table 2] demonstrated an excellent-good correlation with SF-36 Physical Function (PCS; r = 0.64, p < 0.01), EQ-5D (r = 0.68, p < 0.01), and KOOS Quality of Life (QOL) (r = 0.68, p < 0.01); good correlation with KOOS ADL (r = 0.52, p = 0.01), KOOS Sports (r = 0.44, p < 0.01), KOOS Pain (r = 0.44, p < 0.01) and WOMAC Function (r = 0.52,p = 0.01). PROMIS PF-CAT scores differed for ACL vs. MLIK cohorts (41.9 ± 6.6 vs. 37.6 ± 9.0, p < 0.01). PROMIS PF-CAT demonstrated the fewest floor and ceiling effects [Table 4] versus legacy PRO instruments.ConclusionPROMIS PF-CAT demonstrated strong correlations with previously validated PRO instruments and offers a favorable alternative for patients undergoing ACLR with MLIK repair/reconstruction procedures. Preoperative PROMIS PF-CAT scores were greater for patients undergoing primary ACLR versus MLIK intervention.     

The relationship between Vaspin,Nesfatin-1 plasma levels and presence of fragmented QRS with the severity of coronary atherosclerosis

PurposeDespite continuous efforts to address classical risk factors for atherosclerosis, the battle to control the disease is far from over and atherosclerosis is still a major factor in all-cause mortality. To investigate the relations between early diagnosis and severity of coronary atherosclerosis we examined vaspin and nesfatin-1 levels, and the presence of fragmented QRS (fQRS) in admission electrocardiograms.Materials and methodsWe divided 168 patients into asymptomatic control (18%), <50% coronary artery stenosis (28%), >50% stenosis (31%) and myocardial infarction (MI) (23%) groups. Patients were also evaluated in anatomically significant (>50%stenosis ?+ ?MI) and non-significant atherosclerosis (control+<50%stenosis) groups. Vaspin and nesfatin-1 levels were measured using ELISA methods.ResultsVaspin in MI and >50% stenosis groups was lower than in other groups (p ?< ?0.001). Nesfatin-1 in MI and >50% stenosis groups was lower only than in <50%stenosis group (p0.007). The presence of fQRS was higher in MI and >50% stenosis groups than other groups (p ?< ?0.001). In the anatomically significant atherosclerosis group, vaspin, nesfatin-1 and left ventricular ejection fraction (LVEF) values were lower while Gensini score and the presence of fQRS were higher (for all p ?< ?0.001). Lower vaspin levels and fQRS were related to in-hospital mortality (p ?< ?0.001 and p ?= ?0.02,respectively). Logistic regression analysis showed that male gender, diabetes mellitus, smoking, family history, lower LVEF, lower vaspin and fQRS were defined as independent risk factors for anatomically significant atherosclerosis (p ?= ?0.001).ConclusionsOur results indicate that low vaspin and fQRS were found to be novel independent risk factors for anatomically significant atherosclerosis and were predictors of mortality.     

Support programs for minority students at Ohio University College of Osteopathic Medicine.

The Ohio University College of Osteopathic Medicine ranks high among the nation's 19 osteopathic medical schools with respect to the percentage of underrepresented minorities (URMs) in the entering class. The college has strong recruitment and retention programs for URM and disadvantaged students. URM enrollment rose steadily from 11% in 1982-83 to 22% in 1997-98, despite the school's location in a rural, residential public university with few minorities as students or town residents. The college has six programs to support minority students through both undergraduate and medical school: the Summer Scholars Program (1983 to present), an intensive six-week summer program to prepare rising under-graduate seniors and recent graduates to apply to medical school; Academic Enrichment (1987 to present), to support first- and second-year medical students; the Prematriculation Program (1988 to present), an intensive six-week summer program for students who will matriculate in the college; Program ExCEL (1993 to present), a four-year program for undergraduates at Ohio University; the Summer Enrichment Program (1993 to present), an optional six-week program for students who will enter the premedical course at Ohio University; and the Post-baccalaureate Program (1993 to present), a year-long, individually tailored program for URM students who have applied to the medical college but have been rejected. The medical college first focused on supporting students already in the medical school curriculum, then expanded logically back through the undergraduate premedical programs, always targeting learning strategies and survival strategies, peer and faculty support, and mastery of the basic science content. The college plans to create an on-site MCAT preparation program and perhaps expand into secondary education.     

Severe lower limb cellulitis: defining the epidemiology and risk factors for primary episodes in a population-based case-control study

ObjectiveTo describe the epidemiology and risk factors for primary episodes of severe lower leg cellulitis (LLC).MethodsThis was a longitudinal cohort study using state-wide data linkage of adults presenting to Western Australian (WA) hospitals with a first ever LLC from January 2002 to December 2013. The study aimed at determining risk factors, medical records from the index patient, together with comparable data from controls matched by age, sex, postcode, and month of admission.ResultsDuring the period, 36 276 patients presented with their first episode of LLC. The incidence increased by 4.7% per annum, reaching 204.8 (95% CI 198.6–211.1) per 100 000 population by December 2013. Analysis of 29 062 case-control pairs showed several conditions with lower limb pathology were independently associated with LLC, including varicose veins (AOR 2.95, 95% CI 2.50–3.48, p < 0.001), lymphoedema (AOR 2.65, 95% CI 1.71–4.10, p < 0.001), tinea pedis (AOR 3.05, 95% CI 1.45–6.42, p 0.003), and saphenous vein harvest during coronary artery bypass grafting (AOR 1.74, 95% CI 1.32–2.30, p < 0.001). Also associated with LLC was obesity (AOR 2.05, 95% CI 1.82–2.31, p < 0.001), renal disease (AOR 1.28, 95% CI 1.14–1.44, p < 0.001), rheumatologic conditions (AOR 2.12, 95% CI 1.72–2.60, p < 0.001), hemiplegia/paraplegia (AOR 1.31, 95% CI 1.13–1.52, p < 0.001), and liver disease (AOR 1.77, 95% CI 1.51–2.06, p < 0.001).ConclusionsLLC presents a major burden to the health sector and is increasing with an ageing population. Given the high rates of recurrence, long-term morbidity, and economic impact, efforts to reduce primary episodes should be incorporated into the infectious diseases and healthy ageing research agenda.     

Attitudes toward prenatal genetic testing and therapeutic termination of pregnancy among parents of offspring with Prader-Willi syndrome

IntroductionPrenatal diagnosis (PND) raises ethical dilemmas such as the option of termination of pregnancy (TOP) in cases with severe outcome. Prader-Willi Syndrome (PWS), a complex neurogenetic syndrome with high morbidity and mortality throughout life. Recently, a unique prenatal phenotype was reported and TOP becomes a possibility.ObjectiveTo explore factors influencing the attitudes of parents of PWS children toward PND and TOP concerning a hypothetical pregnancy with a PWS fetus.MethodsAll 85 parents of individuals with PWS were interviewed regarding their attitudes towards PND and TOP using semi-structured questionnaire.ResultsFifty-seven parents were supportive of invasive PND and 28 of non-invasive tests only; none opposed PND. Thirty eight favored TOP, additional 31 supported TOP under certain conditions such as spiritual advice, 15 were categorically against TOP. Attitudes correlated with religiosity (p < 0.025), mother's education (p < 0.001), mother's work status (p < 0.001), current age of the child with PWS (p < 0.008). Couples had similar attitudes regarding PND and TOP. No correlation was found with gender, genetic subtype and parental age.ConclusionsMost parents of individuals with PWS support PND, however less than half support TOP. Religiosity was the most influential factor. Familial worldview should be taken into account during prenatal counseling.     

Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss

ObjectivesTo evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss.MethodsWe conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression.ResultsWe included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005).ConclusionsEstablishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping.Practice ImplicationsComprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.     

Antibody responses to BNT162b2 mRNA COVID-19 vaccine and their predictors among healthcare workers in a tertiary referral hospital in Japan

ObjectivesThis study aimed to determine antibody responses in healthcare workers who receive the BNT162b2 mRNA COVID-19 vaccine and identify factors that predict the response.MethodsWe recruited healthcare workers receiving the BNT162b2 mRNA COVID-19 vaccine at the Chiba University Hospital COVID-19 Vaccine Center. Blood samples were obtained before the 1st dose and after the 2nd dose vaccination, and serum antibody titers were determined using Elecsys® Anti-SARS-CoV-2S, an electrochemiluminescence immunoassay. We established a model to identify the baseline factors predicting post-vaccine antibody titers using univariate and multivariate linear regression analyses.ResultsTwo thousand fifteen individuals (median age 37-year-old, 64.3% female) were enrolled in this study, of which 10 had a history of COVID-19. Before vaccination, 21 participants (1.1%) had a detectable antibody titer (≥0.4 U/mL) with a median titer of 35.9 U/mL (interquartile range [IQR] 7.8 – 65.7). After vaccination, serum anti-SARS-CoV-2S antibodies (≥0.4 U/mL) were detected in all 1774 participants who received the 2nd dose with a median titer of 2060.0 U/mL (IQR 1250.0 – 2650.0). Immunosuppressive medication (p < 0.001), age (p < 0.001), time from 2nd dose to sample collection (p < 0.001), glucocorticoids (p = 0.020), and drinking alcohol (p = 0.037) were identified as factors predicting lower antibody titers after vaccination, whereas previous COVID-19 (p < 0.001), female (p < 0.001), time between 2 doses (p < 0.001), and medication for allergy (p = 0.024) were identified as factors predicting higher serum antibody titers.ConclusionsOur data demonstrate that healthcare workers universally have good antibody responses to the BNT162b2 mRNA COVID-19 vaccine. The predictive factors identified in our study may help optimize the vaccination strategy.     

Student perspectives on diversity and the cultural climate at a U.S. medical school.

PURPOSE: To obtain the perspectives of medical students at one school on racial/ethnic campus diversity and cultural competence and to gain their perceptions of the institutional climate around diversity at their university and of reasons for minority underrepresentation at their medical school. METHOD: A student-driven survey of all medical students (N = 398) at a single medical school in the spring of 2003, supplemented by four focus groups from all racial and ethnic groups on the campus. RESULTS: A large majority of the responding students (n = 216; 54%) endorsed the value of campus diversity and the importance of cultural competence to the process of becoming a clinician. Most students felt their university had achieved a positive cultural climate, characterized by openness to diverse perspectives and attention to equity. Most students also felt that the university's programs and policies reflected a commitment to diversity, but fewer students--those from underrepresented minorities (URMs) in particular--felt that the university truly valued having a diverse student body and faculty. Most students felt that the lack of diversity on campus was a barrier to recruiting and retaining minority candidates. Some minority students also blamed the medical school's limited social, academic, and financial support, as well as inadequate efforts to recruit minority students. CONCLUSIONS: Medical students generally place a high value on campus diversity and cultural competence. URM students in particular felt that their university could do more to implement its commitment to diversity, including making greater efforts to recruit and retain URM students. These views constitute a barometer for medical schools to gauge and track their efforts to enhance campus diversity, incorporate cultural competence education, and create an inclusive and welcoming climate for students of all backgrounds.     

Predictors of poor prognosis in healthy,young, individuals with SARS-CoV-2 infections

ObjectivesTo identify predictors of poor prognosis in previously healthy young individuals admitted to hospital with coronavirus disease 2019 (COVID-19).MethodsWe studied a cohort of patients hospitalized with COVID-19. All patients without co-morbidities, without usual treatments and ≤65 years old were selected from an international registry (HOPE-COVID-19, NCT04334291). We focused on baseline variables—symptoms and signs at admission—to analyse risk factors for poor prognosis. The primary end point was a composite of major adverse clinical events during hospitalization including mortality, mechanical ventilation, high-flow nasal oxygen therapy, prone, sepsis, systemic inflammatory response syndrome and embolic events.ResultsOverall, 773 healthy young patients were included. The primary composite end point was observed in 29% (225/773) and the overall mortality rate was 3.6% (28/773). In the combined event group, 75% (168/225) of patients were men and the mean age was 49 (±11) years, whereas in the non-combined event group, the prevalence of male gender was 43% (238/548) and the mean age was 42 (±13) years (p < 0.001 for both). On admission, respiratory insufficiency and cough were described in 51.4% (114/222) and 76% (170/223) of patients, respectively, in the combined event group, versus 7.9% (42/533) and 56% (302/543) of patients in the other group (p < 0.001 for both). The strongest independent predictor for the combined end point was desaturation (Spo₂ <92%) (OR 5.40; 95% CI 3.34–8.75; p < 0.001), followed by tachypnoea (OR 3.17; 95% CI 1.93–5.21; p < 0.001), male gender (OR 3.01; 95% CI 1.96–4.61; p < 0.001) and pulmonary infiltrates on chest X-ray at admission (OR 2.21; 95% CI 1.18–4.16; p 0.014).ConclusionsMajor adverse clinical events were unexpectedly high considering the baseline characteristics of the cohort. Signs of respiratory compromise at admission and male gender, were predictive for poor prognosis among young healthy patients hospitalized with COVID-19.