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A Celebration of Two Anniversaries: The Merrill-Palmer Quarterly and the Merrill Palmer Skillman Institute
No full textIn this essay, we present highlights of the centennial celebration of the Merrill Palmer Skillman Institute for Child and Family Development and relate them to the 70th anniversary of the Merrill-Palmer Quarterly. In 2020, an exhibit was organized to explore the history of the institute in text, images, and artifacts. The history of the Merrill-Palmer Quarterly is inextricably linked with this past but also diverges from it. We argue that both the institute and the journal have influenced one another in ways that are reflected in their modern versions. The article shows how a longer and broader historical perspective adds not only to the Merrill Palmer Skillman Institute’s story but also to that of the Merrill-Palmer Quarterly
On Life-Destroying Diagrams
Get PDFLife-Destroying Diagrams by Eugenie Brinkema. Durham, NC: Duke University Press, 2022. Pp. 470. 32.95 paperback
Is There a Difference in Effectiveness Between Nonoperative Treatments for Modified Garcia-Elias Scapholunate Ligament Injuries Stages 1 and 2?
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Scapholunate interosseous ligament (SLIL) injuries result from falling on an outstretched hand. Studies have assessed the effectiveness of non-operative treatments, but none has compared different non-operative treatments. We analyze the effectiveness of casting and bracing/splinting based on patient reported outcomes (PRO).
Methods
Chart review was conducted on 1150 possible SLIL injury patients from 5 orthopaedic hand surgeons from a Midwestern, tertiary-care academic hospital system between 2021 and 2024. Two patient cohorts were divided based on treatment. PROs obtained were PROMIS Upper Extremity (UE) and Pain Interference (PI) pre-treatment and 2-3 months after. Patient improvement was calculated as difference between post- and pre-treatment PROMIS scores, with positive change in UE and negative change in PI indicating improvement. Statistical analysis was performed using paired t-tests comparing patient improvement between the two cohorts.
Results
17 bracing/splinting and 15 casting patients met our inclusion criteria. Bracing/splinting PROMIS UE pre- and post-treatment differences is a mean of 3.47 (SD = 6.84) while casting average difference is 7 (SD = 13.01). Bracing/splinting PROMIS PI pre- and post-treatment differences is a mean of -4.82 (SD = 6.98) while casting average difference is -3.53 (SD = 10.03). PROMIS UE and PI comparisons yielded no significant differences (p = 0.34, p = 0.67, respectively).
Conclusion Preliminary PROMIS results yielded no significant differences in the two treatments methods, suggesting nonoperative casting and bracing/splinting are all equally effective. Further analysis with a larger population is needed to confirm these findings and whether similar trends can be found with long-term SLIL outcomes
Skin of Color Representation in Biologic Advertisements for Psoriasis and Psoriatic Arthritis
Get PDFSkin of color (SoC) patients with psoriasis experience more severe disease, lower quality of life, and increased psoriasis-related hospitalizations compared to non-SoC counterparts (1-2). SoC patients with psoriasis demonstrate decreased familiarity with biologic medications (3-4) , which could lead to undertreatment and greater disease burden. In light of previous findings indicating inadequate SoC representation in dermatologic direct-to-consumer (DTC) advertising, we compared skin tone representation in patient-facing materials for 13 biologics FDA-approved for psoriasis and psoriatic arthritis (PsA) on pharmaceutical DTC advertising websites from July 20, 2023 to August 20, 2023. Images of 331 people, excluding videos, were analyzed via Fitzpatrick skin scale (I-IV) by five separate investigators. A greater frequency of non-SoC skin tones across all biologic websites was noted, with an average of 85.4% (SD: 1.9) within the I-III Fitzpatrick scale. Of the 13 websites, five had over 90% representation of skin types I-III, with one website solely containing images of individuals with skin types I-III. This lack of representation may be a barrier for SoC patients when starting therapy, delaying treatment and prolonging disease burden for patients
Factors affecting Length of Stay in Pediatric Orthopedic Surgical Patients
Get PDFBackground: Length of stay is calculated by the Center for Medicaid and Medicare services based on different patient variables. This study aims to identify and understand which factors affect hospital stays in pediatric orthopedic surgery patients to create strategies to reduce length of stay and refine length of stay predictions for these patients.
Methods: We conducted a retrospective chart review of 288 pediatric orthopedic patients admitted to the hospital from January 2018 to December 2021. All 288 patients met inclusion criteria. Data were collected and analyzed.
Results: Of the 288 patients included in the study, the average expected length of stay estimated by Medicare was 4.00 days leading to a significant average difference in LOS of 4.68 days (P \u3c 0.001). 82.63% (n = 238) of patients exceeded their predicted LOS. In comparing specific variables between patients, there was a significant difference in the age of patients (10.86 vs 13.46 years old [ P \u3c 0.001]), number of x-rays (3.18 vs 1.3 [ P = 0.003]), number of consults (2.47 vs 1.4 [ P = 0.003]), occupational therapy involvement (3.65 vs 1.67 days [ P = 0.005]), and use of a post-op Foley (P \u3c0.001) or post-op PCA medication (P = 0.002).
Conclusion: 82% of the patients in this study had a longer length of stay than predicted with an average difference of 4.68 days. Several factors were associated with a longer predicted LOS which can help guide patient care and treatment to reduce the length of stay
Evaluating the Current State of Quality Measure Reporting in the Merit-Based Incentive Payment System
Get PDFThe Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, we found that the number of quality measures available for reporting has declined annually since 2021, and that process measures accounted for a majority, 59% or more, of yearly measures. More than 33% of yearly measures failed to stratify physician performance effectively, and significant variability in the number of 2024 reporting options existed across specialties. Policymakers should ensure that future modifications to the MIPS program provide equal opportunity for physicians to achieve a positive Medicare Part B payment adjustment
Clinical Characteristics and Outcomes of Pediatric Staphylococcal Scalded Skin Syndrome (SSSS) at an Inner-City Tertiary Care Center
Get PDFIntroduction
Staphylococcal Scalded Skin Syndrome (SSSS) is a blistering skin condition caused by a toxin-producing staphylococcus species. Epidemiologic studies on pediatric SSSS in the United States are limited, with a reported incidence of 7.67 cases per million children and 45.1 per million infants. Immature renal function, lack of protective antibodies, and increased exotoxin target desmoglein-1 are hypothesized to increase incidence in younger children. We aimed to determine clinical and microbiological characteristics of pediatric SSSS and factors that could help predict disease severity.
Methods
A retrospective chart review was performed for admitted patients under 18 years old diagnosed with SSSS from 2010 to 2022 where surgery was consulted. Data was collected using the hospital’s medical records and International Classification of Diseases (ICD) codes.
Results
Our study included 23 children aged 0-6 years. PICU patients had statistically significant increases in hospital length of stay, feeding tube days, and highest total body surface area (TBSA) affected by SSSS. PICU patients were also significantly younger. Staphylococcus aureus was isolated in 17/23 patients, with two patients having multiple positive cultures; 15/16 were sensitive to methicillin and 12/16 were resistant to clindamycin. The majority received clindamycin and cefazolin treatment in-patient and oral cephalexin on discharge.
Conclusion
TBSA involvement on admission and age were the most significant predictors of PICU, hospital length of stay, and feeding tube days. The majority received clindamycin treatment likely due to its known anti-toxin effect despite resistance. This study sheds light on clinical characteristics of pediatric SSSS and factors impacting disease severity
Assessing Eye Care Needs and Service Accessibility in a Student-Run Free Clinic in an Underserved Urban Population
Get PDFIntroduction: Student-run free clinics offer valuable firsthand experience in providing care to uninsured and underserved communities. As efforts to enhance eye care expand over time, it is crucial to evaluate the accessibility and effectiveness of these services within the community. This study examines the demographics and needs of patients seeking eye care, as well as the availability of initial screenings at our clinic.
Methods: A retrospective review of patient charts was conducted for individuals who attended the Sight Saver’s free healthcare clinic to receive an eye exam. Data collected includes patient demographics, comorbidities, family history of eye-related diseases, visual acuity and IOP measurements, as well as whether the patient was referred to an ophthalmologist or optometrist. Visual acuity was categorized into mild or no visual impairment (20/20-20/70), moderate visual impairment (20/70- 20/200), severe visual impairment (20/400-20/400) and blindness (20/400-20/1200) using the International Classification of Diseases, Tenth Revision (ICD-10) system.
Results: The sample consisted of 241 patients with a mean age of 49.5 years (SD=19.6). The most common comorbidities were hypertension (35.7%), diabetes (18.3%), glaucoma (7.9%), cataracts (5.0%) and thyroid disease (3.3%). A family history of glaucoma was reported in 18.7% of patients, followed by diabetes (10.8%), cataracts (7.5%) and hypertension (5.0%). Visual acuity assessments revealed that the majority of patients had mild or no visual impairment (61% for right eye without correction (SCOD) and left eye without correction (SCOS)), while 16.2% (SCOD and SCOS) had moderate visual impairment, and 1.2% (SCOD) and 2.1% (SCOS) had severe visual impairment. The mean IOP was 18.7 mmHg (SD = 5.8) in the right eye (OD) and 18.2 mmHg (SD = 6.0) in the left eye (OS). In the patients that were assessed, 14.9% were referred to an ophthalmologist while 27% were referred to an optometrist.
Conclusion: This retrospective review highlights the prevalence of eye disease in the underserved population in Detroit, Michigan. The results emphasize the vital role of delivering early eye care and enabling detection and treatment of ocular conditions. There was a significant need for referrals to optometrists and ophthalmologists, highlighting the importance of increasing efforts to connect patients with appropriate eye care services. Expanding similar initiatives could further bridge gaps in access to proper eye care and assist in addressing disparities in ocular health in vulnerable communities
Race has no impact on prostate cancer-specific mortality, when comparing patients with similar risk of other-cause mortality: An analysis of a population-based cohort
Get PDFBackground: Other-cause mortality (OCM) can serve as a surrogate for access-to-care. The authors sought to compare prostate cancer-specific mortality (PCSM) in Black versus White men matched based on their calculated OCM risk.
Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for Black and White men diagnosed with prostate cancer between 2004 to 2009, to collect long-term follow-up. A Cox regression was used to calculate the OCM risk using all available covariates. This calculated OCM risk was used to construct a 1:1 propensity score matched (PSM) cohort. Then, a competing-risks multivariable tested the impact of race on PCSM.
Results: A total of 94,363 patients were identified, with 19,398 Black men and 74,965 White men. The median (IQR) follow-up was 11.3 years (9.8-12.8). In the unmatched-cohort at 10-years, PCSM and OCM were 5.5% versus 3.5% and 13.8% versus 8.4% in non-Hispanic Black (NHB) versus non-Hispanic White (NHW) patients (all p \u3c .0001). The standardized mean difference was
Conclusions: The results of this study showed similar PCSM in Black and White patients, when matched with their calculated OCM risk. This report is the first to indicate at a population-based level that race has no impact on PCSM
Understanding Challenges to Breast Cancer Screening for African American Women in Detroit: A Study of Social and Healthcare Inequities
Get PDFAfrican American (AA) women have lower adherence to breast cancer screening guidelines, which may contribute to delayed diagnoses and reduced survival rates. These disparities are often influenced by limited access to quality healthcare and persistent inequities faced within Michigan. With Detroit\u27s population being 77% AA, examining studies focused on the experiences of Black women within urban healthcare networks is essential to understanding the connections between demographic, socioeconomic factors, and breast cancer outcomes. To assess these studies, a literature search was conducted using Ovid Medline yielding 24 associated articles.
Mammogram rates among AA women in Detroit remain low, reflecting a complex web of socioeconomic, environmental, and healthcare barriers rooted in both historical and ongoing systemic issues. Low SES limits access to preventative care services, leading to delayed diagnosis and worse health outcomes even with Medicare/Medicaid coverage. The historical discrimination of AA in healthcare has also fostered greater apprehension towards these patients seeking preventative services. Differences in lived experiences contribute largely to lower quality care. Studies suggest that physicians with high implicit bias often conduct shorter visits and are less engaged with AA patients. This can extend to decisions regarding preventative care, as AA often receive less referrals for genetic and critical screenings than other races.
This initial review highlights research gaps in how health disparities impact breast cancer screening, treatment adherence, and survival rates among Black women. In the next research phase, is the exploration of attitudes toward mammogram screening in Southeastern Michigan