Background--Despite public awareness that tobacco secondhand smoke (SHS) is harmful, many people still assume that marijuana SHS is benign. Debates about whether smoke-free laws should include marijuana are becoming increasingly widespread as marijuana is legalized and the cannabis industry grows. Lack of evidence for marijuana SHS causing acute cardiovascular harm is frequently mistaken for evidence that it is harmless, despite chemical and physical similarity between marijuana and tobacco smoke. We investigated whether brief exposure to marijuana SHS causes acute vascular endothelial dysfunction.
Background: Participation in case-based diagnostic reasoning (DR) conferences has previously been limited to those who can attend in-person. Technological advances have enabled these conferences to migrate to virtual platforms, creating an opportunity to improve access and learner participation. We describe the design and evaluation of virtual morning report (VMR), a novel case-based DR conference.Methods: VMR took place on a videoconferencing platform. Participants included health professions students, post-graduate trainees, and practitioners. In designing VMR, we adapted concepts from experience-based learning theory to design opportunities for learner participation. Teaching strategies were informed by information-processing and situativity theories. We evaluated learner experiences in VMR using a survey with open and closed-ended questions. Survey items focused on accessing case-based teaching conferences outside of VMR, participant perceptions of the educational value of VMR, and VMR’s impact on participants’ confidence in performing DR. We used qualitative content analysis to manually code open-ended responses and identify themes. Results: 203 participants (30.2%) completed the survey. 141 respondents (69.5%) did not otherwise have access to a DR conference. The majority of participants reported increased confidence performing DR. Respondents highlighted that VMR supplemented their education, created a supportive learning environment, and offered a sense of community.Conclusions: VMR can expand access to DR education, create new opportunities for learner participation, and improve learner confidence in performing DR.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Background
Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs. non-PWUD. These are needed to inform optimal care for this marginalized population.
Methods
We identified adults hospitalized from 2013-2018 at 2 medical centers in San Francisco with S. aureus bacteremia or ICD-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible culture. In addition to demographic and clinical characteristic comparison, we constructed multivariate Cox proportional hazards models for one-year infection-related readmission and mortality, adjusted for age, race/ethnicity, housing, comorbidities, and MRSA.
Results
Of 963 hospitalizations for S. aureus infections in 946 patients, 372/963 (39%) occurred in PWUD. Among PWUD, heroin (198/372, 53%) and methamphetamine use (185/372, 50%) were common. Among 214 individuals using opioids, 98/214 (46%) did not receive methadone or buprenorphine. PWUD had lower antibiotic completion than non-PWUD (70% vs. 87%; p<0.001). While drug use was not associated with increased mortality, one-year readmission for ongoing or recurrent infection was double in PWUD vs. non-PWUD (28% vs. 14%; aHR 2.0 [95% CI:1.3-2.9). MRSA was independently associated with one-year readmission for infection (aHR 1.5 [95% CI 1.1-2.2]).
Conclusion
Compared to non-PWUD, PWUD with invasive S. aureus infections had lower rates of antibiotic completion and twice the risk of infection persistence/recurrence at one year. Among PWUD, both opioid and stimulant use were common. Models for combined treatment of substance use disorders and infections, particularly MRSA, are needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.