Background US progress toward ending the HIV epidemic was disrupted during the COVID‐19 pandemic. Objectives To determine the impact of the pandemic on HIV‐related mortality and potential disparities. Methods Using data from the Centers for Disease Control and Prevention and the United States (US) Census Bureau, HIV‐related mortality data of decedents aged ≥25 years between 2012 and 2021 were analyzed. Excess HIV‐related mortality rates were estimated by determining the difference between observed and projected mortality rates during the pandemic. The trends of mortality were quantified with joinpoint regression analysis. Results Of the 79,725 deaths documented in adults aged 25 years and older between 2012 and 2021, a significant downward trend was noted in HIV‐related mortality rates before the pandemic, followed by a surge during the pandemic. The observed mortality rates were 18.8% (95% confidence interval [CI]: 13.1%–25.5%) and 25.4% (95%CI: 19.9%–30.4%) higher than the projected values in 2020 and 2021, respectively. Both of these percentages were higher than that in the general population in 2020 (16.4%, 95%CI: 14.9%–17.9%) and 2021 (19.8%, 95%CI: 18.0%–21.6%), respectively. Increased HIV‐related mortality was observed across all age subgroups, but those aged 25–44 years demonstrated the greatest relative increase and the lowest COVID‐19‐related deaths when compared to middle‐ and old‐aged decedents. Disparities were observed across racial/ethnic subgroups and geographic regions. Conclusions The pandemic led to a reversal in the attainments made to reduce the prevalence of HIV. Individuals living with HIV were disproportionately affected during the pandemic. Thoughtful policies are needed to address the disparity in excess HIV‐related mortality.
Thyroid ultrasonography (US) is readily available and its use has escalated particularly by non-specialists in patients with thyrotoxicosis. According to the American Thyroid Association (ATA), thyroid US should be used in patients with an inconclusive diagnosis after usual clinical and laboratory evaluation has been completed. However, the availability and lack of risk has led to its inclusion into the routine workup of a hyperthyroid patient. In evaluating our preliminary information, we discovered a lack of valid pre-test rationale or benefits. However we sought to determine in a larger population of thyrotoxic patients the reason for US, the benefits in making a diagnosis, or discovery of thyroid cancer. Our study is the first to date to evaluate the utility and benefits of US use in thyrotoxicosis in a largely Latino population drawn from a safety net medical center. Patients were identified retrospectively with a diagnosis of thyrotoxicosis from the RUHS Medical Center. Inclusion criteria included Grave’s disease, hyperthyroidism, or thyrotoxicosis that had an US for any reason. We determined the demographics and thyrotoxicosis laboratory findings. All patients that had an US were reviewed for rationale listed in the chart, US findings, and subsequent interventions. We also determined any role of the US findings in diagnosis or choice of therapy. We evaluated 163 patients meeting the criteria out of 600 thyrotoxic patients. The mean age was 46 years with 88% being women. Most patients were Latino (112/163 or 68.7%). 17 of the patients were Non-Hispanic whites (10.4%), 27 were African American (16.6%), and 7 were of Asian descent (4.3%). The majority (61%) had an US with no stated reason and the others were based on a neck exam finding. The findings from the US did not contribute to the diagnosis of thyrotoxicosis in any case. Use of US discovered 46 nodules with an average size of 1.44 cm. An FNA was conducted in 24 patients with nodules resulting in 12 thyroid surgical interventions. FNA discovered 4 papillary thyroid cancers confirmed at surgery and one micro papillary cancer. One FNA mischaracterized a papillary cancer found to be benign. Our findings in a largely Latino population demonstrated that US are not entirely useful as a preliminary work up as the US findings did not generally contribute to the diagnosis of thyrotoxicosis. US did discover four low or intermediate risk papillary cancers but also resulted in nine additional surgeries for benign lesions. Our results suggest that within this population the clinical effectiveness of routine US appears to be marginal. Providers are encouraged to follow ATA guidelines in the use of thyroid US in thyrotoxicosis.
BACKGROUND: One of the most significant barriers in providing care for transgender (TG) people is the lack of access to medical providers with knowledge and experience in TG health care. This care gap continues as transgender health remains the least-represented LGBT health topic in medical school education. To close this deficit, we developed an innovative IT-based education program to assess and improve residents’ knowledge, confidence and comfort with transgender health principles throughout their clinical training. METHODS: Our project targeted residents within our affiliated internal and family medicine programs and consisted of two phases. A pre-education phase, to determine current/perceived knowledge and comfort/attitudes towards caring for transgender patients using validated surveys, was enacted through our education platform using Google Forms. After assessing the gaps in comfort and knowledge, our student team developed an education program comprising the interventional phase in 2018. The program consists of three one-hour online modules and two one-hour live sessions featuring a lecture and interactions with transgender patients, covering topics such as: transgender health 101, medical therapies, and appropriate behavioral/medical evaluations. The residents will then complete the same assessment as a post-test both one month after program completion as well as at the end of each remaining year of residency to track longitudinal improvements in knowledge and comfort. RESULTS: On average, resident participants achieved a pre-test 74.4% accuracy in items assessing ‘knowledge,’ but only revealed self-assessed knowledgeability 40.0% of the time in items assessing ‘knowledge perception.’ Residents self-reported comfort counseling and treating transgender patients 81.9% of the time in response to items assessing ‘comfort with transgender care.’ Using chi-squared analysis, actual knowledge and comfort were similar (p = .064), but self-perceived knowledgeability significantly trailed behind both knowledge (-34.38%, p < .0001) and comfort (41.89%, p < .00001). CONCLUSION: Our initial results indicate that our novel approach was both feasible and aligned with residents’ self-education preferences. They demonstrate that a promising proportion of residents did imply comfort with transgender care, though perhaps culturally more generalizable to Southern California than residents nationwide. However, when comparing knowledge perception to actual knowledge and comfort, a discrepancy reveals that while these residents are generally comfortable and willing to treat transgender patients, they lack the knowledge base and confidence to do so. This finding clearly supports the need for the second-phase educational program and increases our optimism in its effectiveness in providing residents the tools to become thoughtful and effective providers.
Background: Patients with type 1 diabetes mellitus (DM1) are at risk for having autoimmune conditions such as Celiac Disease (CD). Although uncommon, the presence of CD in a patient with DM1 may result in poor glycemic control, gastrointestinal complaints, nutritional deficiencies, osteoporosis and lymphoma. Recognizing CD is problematic as it is often asymptomatic or presents in an atypical fashion. Despite recommendations from both the ADA and the American College of Gastroenterology our experience suggests there is a general lack of recognition of screening recommendations and presentation in CD particularly in patients with DM1. Methods: Our objectives were three-fold. We first developed a novel on-line assessment program to determine existing knowledge on CD in both medical and family practice residents and faculty. We then developed on-line and direct education to improve knowledge on screening, presentation and diagnosis of CD. Lastly, we have determined the screening rate of adults with a diagnosis of DM1. Results: Our screening rate of at-risk adults with DM1 is less than 20% indicating a poor recognition of CD as a recognized risk. In addition, we determined that CD is rarely considered in patients with DM1 with poorly controlled diabetes even in the context of GI complaints. Our preliminary survey of residents’ knowledge on screening, diagnosis and complications of CD was poor with less than 35% having adequate knowledge status. Conclusion: Screening for CD in our DM1 patients is poor due to lack of knowledge of criteria and screening strategy of providers. This may reflect a significant deficit in resident and faculty knowledge of CD. In addition, CD is rarely considered in symptomatic adults with DM1. We propose our education program aimed at both residents and our faculty will overcome our lack of an organized education program addressing CD and is predicted to improve screening, diagnosis and treatment of adults with DM1 suffering from CD within our population. Disclosure M. Epps: None. M. Fox: None. J. Jafari: None. A. Firek: None.
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