J Natl Med Assoc
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Atrial fibrillation (AF) is the most common heart rhythm disorder and is associated with a 5-fold increased risk of ischemic stroke. Racial/ethnic minorities and women with AF have higher rates of stroke compared to white individuals and men respectively. Oral anticoagulation reduces the risk of stroke, yet prior research has described racial/ethnic and sex-based variation in its use. We sought to examine the initiation of any oral anticoagulant (warfarin or direct-acting oral anticoagulants, DOACs) by race/ethnicity and sex in patients with incident, non-valvular AF. Further in those who initiated any anticoagulant, we examined DOAC vs. warfarin initiation by race/ethnicity and sex. ⋯ In a national cohort of Medicare beneficiaries with newly-diagnosed AF, overall oral anticoagulant initiation was lower in blacks and women, with no difference observed by Hispanic ethnicity. Among oral anticoagulant initiators, blacks were less likely to initiate novel DOACs, with no differences identified by Hispanic ethnicity or sex. Identifying modifiable causes of treatment disparities is needed to improve quality of care for all patients with AF.
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Historical Article
Discovering a Hidden Figure of Service and Leadership: The Reverend Charles Edgar Newsome, MD.
Collaborative research between the University School of Medicine Office of Diversity and Inclusion, Health Sciences Library and Department of African and African American Studies recently identified Dr. Charles Edgar Newsome as the institution's first African American physician graduate in 1893. Born May 25, 1856 in the town of Buffalo within Putnam County of Northwest Virginia, he served for 3 years and 6 months as a member of the Regimental Band of the United States Army 25th Infantry, also known as the Buffalo Soldiers, became Grand Master of the Grand United Order of Odd Fellows, and served communities of the state as a reverend, physician, and civic leader. Archival records and photographs uncover the remarkable life of Reverend Charles Edgar Newsome, MD, a hidden figure in history.
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Nigeria, Africa's most populous nation, is experiencing a dire challenge in meeting the specialty care access needs for its people, with extremely limited capacity to deliver subspecialty healthcare. Telemedicine/telehealth has been offered as a part of the solution to resolve health inequities, maldistribution and "brain drain" for health care services. In this preliminary communication, we assessed the impact of a telehealth innovation, subspecialty clinician-to-clinician electronic consultations (eConsult), on general practitioners (GPs) serving a diverse patient population in Nigeria. ⋯ The most commonly used specialties were Obstetrics/Gynecology, Pediatric specialties and subspecialties, and Dermatology. Nigerian GPs spent more time generating and submitting their eConsults than American counterparts, but high levels of physician satisfaction and education from the eConsults. GPs reported the reduction in unnecessary services and improved care plans in the majority of cases, suggesting the tremendous potential for eConsults to build capacity for clinicians in nations where subspecialty care services are scarce.
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Assessment of how medical residents learn and the impact on standardized test performance is important for effective training. Kolb's learning study inventory categorizes learning into accommodating, assimilating, converging and diverging based on the four stages of learning: active experimentation, abstract conceptualization, concrete experience and reflective observation. The American College of Physicians (ACP) Internal Medicine In-Training Examination (IM-ITE) has been shown to positively correlate with successful performance on clinical assessments and board certification. We sought to evaluate the association between the individual learning styles of IM residents and performance on the ACP IM-ITE. ⋯ 53 residents in the IM Residency Program of Morehouse School of Medicine completed the questionnaire. The predominant learning style was assimilating (49%), followed by converging (26%). There was no significant difference between the learning styles of residents when compared across gender, age, race, and PGY levels. Residents with a diverging learning style had the highest mean IM-ITE percentage score followed by assimilating and converging respectively (P = 0.14) CONCLUSIONS: The predominant learning styles among our IM residents are assimilating and converging, which is consistent with previous studies. Residents with a diverging style of learning appeared to perform better on the IM-ITE. We suggest that future studies should evaluate the feasibility of integrating brainstorming and group work sessions into the IM residency teaching curriculum and the impact on academic performance.