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2022 ◽  
Vol 54 (1) ◽  
pp. 24-29
Author(s):  
Byron K. Jasper ◽  
James N. Becker ◽  
Allison Myers ◽  
Peter F. Cronholm

Background and Objectives: Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America’s Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. Methods: We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. Results: Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. Conclusions: We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.


2021 ◽  
Vol 9 (11) ◽  
pp. 1184
Author(s):  
Mariana Paschoalini ◽  
Fernando Trujillo ◽  
Miriam Marmontel ◽  
Federico Mosquera-Guerra ◽  
Renan Lopes Paitach ◽  
...  

The dolphins Inia geoffrensis—boto and Sotalia fluviatilis—tucuxi are threatened cetaceans inhabiting river ecosystems in South America; population numbers are still lacking for many areas. This paper provides density and abundance estimations of boto and tucuxi in 15 rivers sampled during the past nine years as part of a multinational research alliance. Visual boat-survey data collection protocols and analyses have been developed since 2012 (based on Distance Sampling methods) and recently reviewed (2019) to improve robustness and comparability. Differences across the sampled rivers and the analyzed river basins (Amazon and Orinoco) pointed to a density/population size gradient with lower densities and abundances observed in the Orinoco basin (0.9–1.5 ind./km²), passing through the eastern Amazon basin (2–5 ind./km²), and the largest numbers found at the central Brazilian Amazon (lower Purus River—2012 (14.5 boto/km², N = 7672; 17.1 tucuxi/km², N = 9238)). However, in other parts of the central Amazon, the density of dolphins was smaller than expected for high productive whitewater rivers (1–1.7 ind./km² in the Japurá and Solimões rivers). We attributed these differences to specific features of the basin (e.g., hydro-geomorphology) as well as to the cumulative effects of anthropogenic activities.


2021 ◽  
Author(s):  
Jian-Nan Ye ◽  
Ke-Wa Ma ◽  
Yong-Qin Cao ◽  
Chao Sun ◽  
Xin Zhou

Abstract Recently, two prognostic evaluation systems based on different angles, UK Myeloma Research Alliance proposed UK Myeloma Research Alliance Risk Profile(MRP) and chinese inflammatory prognostic scoring index(IPSI), have shown prognostic differences in newly diagnosed multiple myeloma(MM) patients without transplantation. However, there is no relevant research on whether there is a difference in the evaluation of the two systems. Here, we used these two systems to evaluate the prognosis of 160 patients with MM based on bortezomib without transplantation from January 2007 to June 2018. It was found that the evaluation of patients at medium and low risk was similar, but in the high-risk group of MRP, IPSI could be further stratified, and in the high-risk group of IPSI, MRP could also be further stratified. It is suggested that myeloma patients with high risk factors of MRP and IPSI are ultra high risk patients with poor prognosis.


2021 ◽  
Vol 53 (9) ◽  
pp. 779-785
Author(s):  
Michael Donovan ◽  
Kristi VanDerKolk ◽  
Lisa Graves ◽  
Vicki R. McKinney ◽  
Kelly M. Everard

Background and Objectives: Family physicians are positioned to provide care for transgender patients, but few are trained in this care during residency. This study examines associations between program directors’ (PDs) perceptions/beliefs on transgender health care and inclusion of gender-affirming health care (GAH) in residency curriculum. Methods: Questions regarding current training in GAH, provision of GAH, competency in GAH delivery, barriers to GAH training, resident desire for GAH training, access to GAH curriculum, and feelings/perceptions about GAH were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey. Results: Challenges to including GAH in residency curriculum were inadequate numbers of transgender patients for residents to provide care (35.4%) and lack of faculty expertise in GAH for transgender patients (24.6%). PDs were more likely to include GAH into curriculum when they provided care for transgender patients in their own practice, completed continuing medical education in GAH since completing residency, had confidence in teaching GAH to residents, had residents who requested training on GAH, or had access to a GAH curriculum. PDs who believed that GAH should be a core competency in residency curriculum were more likely to have residents who requested increased education in GAH and wanted to provide GAH to transgender patients in their future practices. Conclusions: Barriers persist for training family medicine residents in GAH for transgender patients, but further training opportunities for faculty could help to decrease identified barriers. Further research should explore how best to increase family medicine faculty comfort/competence in educating residents in GAH.


2021 ◽  
Vol 53 (9) ◽  
pp. 773-778
Author(s):  
Winfred Frazier ◽  
Stephen A. Wilson ◽  
Frank D'Amico ◽  
George R. Bergus

Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. Conclusions: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.


PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Sarah E. Stumbar ◽  
Nana Aisha Garba ◽  
Marisyl de la Cruz ◽  
Prasad Bhoite ◽  
Matthew Holley ◽  
...  

Introduction: With growing efforts to provide comprehensive and inclusive sexual health care, family medicine clerkships are well positioned to educate learners about a spectrum of related topics. This study investigated the current state of sexual health instruction in family medicine clerkships, including specific factors impacting its delivery. Methods: Questions about sexual health curricula were created and included as part of the 2020 Council of Academic Family Medicine’s Educational Research Alliance survey of family medicine clerkship directors. The survey was distributed via email to 163 recipients between June 1, 2020 and June 25, 2020. Results: One hundred five (64.42%) of 163 clerkship directors responded to the survey. Our results revealed that during family medicine clerkships, family planning, contraception, and pregnancy options counseling are covered significantly more often than topics related to sexual dysfunction and satisfaction and LGBTQ+ health. Most clerkship directors (91.5%) reported less than 5 hours of sexual health training in their curriculum. Those with more dedicated sexual health curricular hours were more likely to include simulation. Lack of time (41.7%) was the most frequently reported barrier to incorporating sexual health content into the clerkship.  Conclusions: Coverage of sexual health topics during the family medicine clerkship is limited in scope and delivery. To support curricular development and integration, future studies should more thoroughly examine the factors influencing the inclusion of sexual health content in family medicine clerkships as well as the development of assessment methods to determine competency.


2021 ◽  
Vol 9 (3) ◽  
pp. e001144
Author(s):  
Julia Fashner ◽  
Anthony Espinoza ◽  
Arch G Mainous III

ObjectiveThis research project examined the effects of the COVID-19 pandemic on the required curriculum in graduate medical education for family medicine residencies.DesignOur questions were part of a larger omnibus survey conducted by the Council of Academic Family Medicine Educational Research Alliance. Data were collected from 23 September to 16 October 2020.SettingThis study was set in the USA.ParticipantsEmails were sent to 664 family medicine programme directors in the USA. Of the 312 surveys returned, 35 did not answer our questions and were excluded, a total of 277 responses (44%) were analysed.ResultsThe level of disruption varied by discipline and region. Geriatrics had the highest reported disruption (median=4 on a 5-point scale) and intensive care unit had the lowest (median=1 on a 5-point scale). There were no significant differences for disruption by type of programme or community size.ConclusionProgramme directors reported moderate disruption in family medicine resident education in geriatrics, gynaecology, surgery, musculoskeletal medicine, paediatrics and family medicine site during the pandemic. We are limited in generalisations about how region, type of programme, community size or number of residents influenced the level of disruption, as less than 50% of programme directors completed the survey.


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