J Natl Med Assoc
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Case Reports
Mind the gap: A case of unexplained elevated anion gap without concomitant metabolic acidosis.
Hypertriglyceridemia causing unexplained hypobicarbotinemia and elevated anion gap is rare. We report the case of a 33-year-old woman who presented with an unexplained high anion gap after a subacute gastrointestinal illness. An arterial blood gas showed a normal bicarbonate level, and a lipid panel resulted in a triglyceride level too high to read, establishing the diagnosis. Treatment included using triglyceride-lowering agents with normalization in the patient's serum bicarbonate levels.
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Previous literature has explored patient perceptions of discrimination by race and insurance status, but little is known about whether the payer mix of the primary care clinic (i.e., that is majority public insurance vs. majority private insurance clinics) influences patient perceptions of race- or insurance-based discrimination. ⋯ Reports of race and insurance discrimination are higher in public clinics than private clinics. Sociodemographic variables, such as age, Black race, education level, and type of insurance also influence reports of race- and insurance-based discrimination in primary care.
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Despite recent attention to social justice, diversity, equity, and inclusion within medical education, little is currently known about whether and to what extent that attention has translated into the language of formal documents articulating organization purpose: medical school mission statements. Mission statements are the marquee declaration of a medical school's identity and purpose, and a recommended tool for applicants to determine "fit" when applying. This study examines whether and to what extent social justice, diversity, equity, and inclusion have made it into the formal public statements of organizational purpose and identity over the last several years. ⋯ Overall, mission statement change was quite common with most medical schools making changes across the 14 years covered in this study. And despite a doubling of the number of medical schools MSs mentioning diversity over a 10-year period, that increase seemed to slow in recent years even among schools who had a chance to change their MS. As of mid-2021, two in five US medical schools still have no mention of diversity related language in their most formal, said articulation of organizational purpose.
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The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements include training in caring for diverse populations and understanding social determinants of health. Our large pediatric residency program implemented a longitudinal equity, diversity and inclusion (EDI) curriculum. ⋯ A longitudinal EDI curriculum has the potential to influence individual trainees, their work, and perceptions of the broader institutions in which they operate. Residents recognized and valued the curriculum and felt driven to use this knowledge to ensure that institutional policies and practices led to equitable clinical care.
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Recognizing that the voice delivering the message is as important as the information being shared, we examined vaccine perceptions and willingness to encourage patients to obtain COVID-19 vaccinations among Black and Hispanic healthcare providers. ⋯ This is likely the first cross-sectional study in the United States demonstrating the substantial vaccine confidence among Black and Hispanic healthcare providers who serve minoritized communities that have borne the greatest risk of adverse COVID-related outcomes.