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    URiM Faculty Retention through Stay Interviews: Should I Stay or Should I Go?
    (2023) Sotto-Santiago, Sylk; Gist, Amanda
    Academic medical centers can improve the quality of care and address health inequities by recruiting and retaining faculty historically underrepresented in medicine and STEM (URiM). Extant literature has reported the experience and limited number of URiM faculty in academic medicine. Scholars and practitioners have identified retention of URiM faculty as a significant concern in part because URiM faculty are less likely to remain in academia and be promoted when compared with their white-majority peers. While exit interviews can be beneficial, they might not provide the most accurate feedback. For example, if an employee is leaving an organization, they might not want to burn bridges by offering negative feedback.10 In academia, where the networks are broad, but the specialties and research niches are small, burning bridges is not an option. Given the state of URiM faculty in academic medicine and the departmental commitment to its faculty, the department leadership decided to conduct stay interviews with URiM faculty as the first phase of a retention effort. What follows is not only a descriptive account of experiences of URiM in the department of medicine, but also an exploration if stay interviews should be implemented across all divisions for faculty and staff.
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    Clinical conundrum: managing iron overload after renal transplantation
    (BMJ, 2021-02-05) Upadhyay, Binayak; Green, Steven D.; Khanal, Nabin; Antony, Aśok C.; Medicine, School of Medicine
    Iatrogenic iron overload, which is not uncommon in patients undergoing long-term haemodialysis, arises from a combination of multiple red cell transfusions and parenteral iron infusions that are administered to maintain a haemoglobin concentration of approximately 10 g/dL. Although iron overload due to genetic haemochromatosis is conventionally managed by phlebotomy, patients with haemoglobinopathies and chronic transfusion-induced iron overload are treated with iron-chelation therapy. However, the management of iron overload in our patient who presented with hepatic dysfunction and immunosuppressive drug-induced mild anaemia in the post-renal transplant setting posed unique challenges. We report on the decision-making process used in such a case that led to a successful clinical resolution of hepatic iron overload through the combined use of phlebotomy and erythropoiesis stimulating agents, while avoiding use of iron-chelating agents that could potentially compromise both hepatic and renal function.
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    Using an ambulatory electrocardiogram monitor to record skin sympathetic nerve activity
    (Elsevier, 2022) Liu, Xiao; Rosenberg, Carine; Ricafrente, Joselyn; Leier, Mary E.; Dinh, Harrison; Everett, Thomas H., IV; Chen, Peng-Sheng; Medicine, School of Medicine
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    Clinical Characteristics and Transplant-Free Survival Across the Spectrum of Pulmonary Vascular Disease
    (Elsevier, 2022) Hemnes, Anna R.; Leopold, Jane A.; Radeva, Milena K.; Beck, Gerald J.; Abidov, Aiden; Aldred, Micheala A.; Barnard, John; Rosenzweig, Erika B.; Borlaug, Barry A.; Chung, Wendy K.; Comhair, Suzy A. A.; Desai, Ankit A.; Dubrock, Hilary M.; Erzurum, Serpil C.; Finet, J. Emanuel; Frantz, Robert P.; Garcia, Joe G. N.; Geraci, Mark W.; Gray, Michael P.; Grunig, Gabriele; Hassoun, Paul M.; Highland, Kristin B.; Hill, Nicholas S.; Hu, Bo; Kwon, Deborah H.; Jacob, Miriam S.; Jellis, Christine L.; Larive, A. Brett; Lempel, Jason K.; Maron, Bradley A.; Mathai, Stephen C.; McCarthy, Kevin; Mehra, Reena; Nawabit, Rawan; Newman, John H.; Olman, Mitchell A.; Park, Margaret M.; Ramos, Jose A.; Renapurkar, Rahul D.; Rischard, Franz P.; Sherer, Susan G.; Tang, W. H. Wilson; Thomas, James D.; Vanderpool, Rebecca R.; Waxman, Aaron B.; Wilcox, Jennifer D.; Yuan, Jason X-J; Horn, Evelyn M.; PVDOMICS Study Group; Medicine, School of Medicine
    Background: PVDOMICS (Pulmonary Vascular Disease Phenomics) is a precision medicine initiative to characterize pulmonary vascular disease (PVD) using deep phenotyping. PVDOMICS tests the hypothesis that integration of clinical metrics with omic measures will enhance understanding of PVD and facilitate an updated PVD classification. Objectives: The purpose of this study was to describe clinical characteristics and transplant-free survival in the PVDOMICS cohort. Methods: Subjects with World Symposium Pulmonary Hypertension (WSPH) group 1-5 PH, disease comparators with similar underlying diseases and mild or no PH and healthy control subjects enrolled in a cross-sectional study. PH groups, comparators were compared using standard statistical tests including log-rank tests for comparing time to transplant or death. Results: A total of 1,193 subjects were included. Multiple WSPH groups were identified in 38.9% of PH subjects. Nocturnal desaturation was more frequently observed in groups 1, 3, and 4 PH vs comparators. A total of 50.2% of group 1 PH subjects had ground glass opacities on chest computed tomography. Diffusing capacity for carbon monoxide was significantly lower in groups 1-3 PH than their respective comparators. Right atrial volume index was higher in WSPH groups 1-4 than comparators. A total of 110 participants had a mean pulmonary artery pressure of 21-24 mm Hg. Transplant-free survival was poorest in group 3 PH. Conclusions: PVDOMICS enrolled subjects across the spectrum of PVD, including mild and mixed etiology PH. Novel findings include low diffusing capacity for carbon monoxide and enlarged right atrial volume index as shared features of groups 1-3 and 1-4 PH, respectively; unexpected, frequent presence of ground glass opacities on computed tomography; and sleep alterations in group 1 PH, and poorest survival in group 3 PH. PVDOMICS will facilitate a new understanding of PVD and refine the current PVD classification.
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    Making Effective Educational Videos for Clinical Teaching
    (Elsevier, 2022) Krumm, Ilana Roberts; Miles, Matthew C.; Clay, Alison; Carlos, W. Graham, II; Adamson, Rosemary; Medicine, School of Medicine
    Prerecorded video content in medical education has become more common. Increasingly accessible technology coupled with the COVID-19 pandemic and subsequent need for distanced learning has greatly increased the interest in and need for high-quality video content. The use of short educational videos to augment other teaching methods has been shown to improve learners’ experiences, knowledge retention, and understanding of content. Multiple studies have demonstrated that video education can be a highly effective tool for learning, particularly for hard-to-visualize processes and for procedural education. Videos allow learners to view content at their own pace and revisit materials on demand. In addition, well-designed videos can be repurposed by educators, ultimately reducing time needed to create high-quality educational content. Currently available technology allows educators to create high-quality videos at minimal cost and with a modest investment of time. This article details practical tips for creating high-yield educational videos.
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    From Passive Gatekeeper to Quarterback: Evolving Perceptions of Primary Care Among Medical Students in Longitudinal Outpatient Clerkships
    (Springer, 2022) Henschen, Bruce L.; Shaunfield, Sara; Golden, Blair P.; Gard, Lauren A.; Bierman, Jennifer; Evans, Daniel B.; Wayne, Diane B.; Ryan, Elizabeth R.; Yang, Monica; Cameron, Kenzie A.; Medicine, School of Medicine
    Background: Longitudinal clerkships provide students with meaningful clinical care roles that promote learning and professional development. It remains unclear how longitudinal primary care clerkships inform students' perceptions of primary care. Objective: To explore perceptions of primary care among medical students enrolled in longitudinal primary care clerkships. Design: Qualitative, semi-structured interviews with medical students over 4 years. Participants: Thirty-eight medical students participated at baseline; 35 participated in a 2-year follow-up interview; 24 participated at 4 years. Each student was enrolled in one of two longitudinal primary care clerkships: a team-based Education-Centered Medical Home (ECMH) or a one-on-one individual preceptorship (IP). Approach: De-identified interview transcripts were analyzed using a process of open and axial coding, followed by elaborative coding for longitudinal analysis. Codes were compiled into a set of themes and compared across time periods and between clerkships. Key results: Students reported that primary care serves as a first point of contact, emphasizing longitudinal care with a wide scope of practice and approaching patient care with a biopsychosocial perspective. Student perceptions of primary care greatly expanded over the course of 4 years: for instance, initial perceptions of primary care physicians evolved from "passive gatekeeper" to a more nuanced "quarterback." Students in ECMH, whose clerkship provided more opportunity for patient continuity, further reflected on the relationships they themselves developed with patients. Conclusions: Regardless of their eventual specialty choice, longitudinal experiences may aid all students in fostering a sense of the broad scope and importance of primary care. However, without numerous opportunities to witness continuity of care, students may perceive primary care as having limited scope and importance. Longitudinal clerkships, emphasizing continuity with patients and preceptors, may foster in students a broad and nuanced perspective of the scope of primary care as a field.
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    Reflection with ChatGPT about the excess death after the COVID-19 pandemic
    (Elsevier, 2023) Temsah, Mohamad-Hani; Jamal, Amr; Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
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    Quantification of murine myocardial infarct size using 2-D and 4-D high-frequency ultrasound
    (American Physiological Society, 2022) Dann, Melissa M.; Clark, Sydney Q.; Trzaskalski, Natasha A.; Earl, Conner C.; Schepers, Luke E.; Pulente, Selena M.; Lennord, Ebonee N.; Annamalai, Karthik; Gruber, Joseph M.; Cox, Abigail D.; Lorenzen-Schmidt, Ilka; Seymour, Richard; Kim, Kyoung-Han; Goergen, Craig J.; Mulvihill, Erin E.; Medicine, School of Medicine
    Ischemic heart disease is the leading cause of death in the United States, Canada, and worldwide. Severe disease is characterized by coronary artery occlusion, loss of blood flow to the myocardium, and necrosis of tissue, with subsequent remodeling of the heart wall, including fibrotic scarring. The current study aims to demonstrate the efficacy of quantitating infarct size via two-dimensional (2-D) echocardiographic akinetic length and four-dimensional (4-D) echocardiographic infarct volume and surface area as in vivo analysis techniques. We further describe and evaluate a new surface area strain analysis technique for estimating myocardial infarction (MI) size after ischemic injury. Experimental MI was induced in mice via left coronary artery ligation. Ejection fraction and infarct size were measured through 2-D and 4-D echocardiography. Infarct size established via histology was compared with ultrasound-based metrics via linear regression analysis. Two-dimensional echocardiographic akinetic length (r = 0.76, P = 0.03), 4-D echocardiographic infarct volume (r = 0.85, P = 0.008), and surface area (r = 0.90, P = 0.002) correlate well with histology. Although both 2-D and 4-D echocardiography were reliable measurement techniques to assess infarct, 4-D analysis is superior in assessing asymmetry of the left ventricle and the infarct. Strain analysis performed on 4-D data also provides additional infarct sizing techniques, which correlate with histology (surface strain: r = 0.94, P < 0.001, transmural thickness: r = 0.76, P = 0.001). Two-dimensional echocardiographic akinetic length, 4-D echocardiography ultrasound, and strain provide effective in vivo methods for measuring fibrotic scarring after MI. NEW & NOTEWORTHY: Our study supports that both 2-D and 4-D echocardiographic analysis techniques are reliable in quantifying infarct size though 4-D ultrasound provides a more holistic image of LV function and structure, especially after myocardial infarction. Furthermore, 4-D strain analysis correctly identifies infarct size and regional LV dysfunction after MI. Therefore, these techniques can improve functional insight into the impact of pharmacological interventions on the pathophysiology of cardiac disease.
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    What is the burden of asymptomatic coronavirus infections?
    (Elsevier, 2023) Al-Tawfiq, Jaffar A.; Memish, Ziad A.; Altawfi, Kauthar J.; Pan, Qiuwei; Schlagenhauf, Patricia; Medicine, School of Medicine
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    Pathological Complete Response of Metastatic Clear Cell Renal Carcinoma with Pembrolizumab and Axitinib: A Case Report and Review of Literature
    (Karger, 2023-02-02) Beirat, Amir F.; Menakuru, Sasmith R.; Khan, Ibrahim; Siddiqui, Salahuddin; Medicine, School of Medicine
    The role of cytoreductive nephrectomy has become unclear since the introduction of immunotherapy which is now the backbone of the treatment for metastatic renal cell carcinoma. Different combinations are used based on the prognosis. Achieving a complete response would be ideal and includes radiographic disappearance of lesions. However, there have been a few reported cases of pathological complete response with persistent radiographic evidence of cancer. The authors report a case of pathological complete response despite persistent radiographic evidence of residual disease in a patient with metastatic renal cell carcinoma treated with pembrolizumab and axitinib. The patient subsequently underwent cytoreductive nephrectomy after the 13th dose of pembrolizumab. The resected mass consisted of scar tissue with no viable tumor cells seen on pathology but only scar tissue. This case reveals that persistent radiographic evidence of the tumor may be explained by scar tissue, challenging the role of cytoreductive nephrectomy in the era of immunotherapy.