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Background: Parents seek support on behalf of their transgender and gender nonconforming (TGNC) children. Previous qualitative studies explore the types of support parents seek inside and outside of healthcare settings. Healthcare providers often remain unprepared to effectively provide gender-affirming services to TGNC children and their accompanying parents and may benefit from learning about the support seeking experiences of parents with TGNC children. Aims: This paper summarized qualitative research studies that address the topic of parents seeking support on behalf of their TGNC children. We produced this report for healthcare providers to review to enhance gender-affirming services for parents and TGNC children. Methods: This paper outlines a qualitative metasummary of studies from the United States or Canada with data collected from parents of TGNC children. Data collection included the steps of journal runs, database searches, reference checks, and area scans. Data analysis involved the steps of extracting, editing, grouping, abstracting, and calculating the intensity and frequency effect sizes for finding statements from qualitative research study articles. Results: The results of this metasummary yielded two primary themes, six subthemes, and 24 total findings. The first primary theme of seeking guidance had three subthemes: educational resources, community networks, and advocacy efforts. The second primary theme of seeking healthcare had three subthemes: healthcare providers, mental healthcare, and general healthcare. Discussion: These findings provide information healthcare providers can use to inform their practice. These findings also highlight the importance of providers working collaboratively with parents when serving TGNC children. This article concludes with practical tips for providers. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco 21 (T21), which sets the minimum legal sales age for tobacco to age 21, is now a national law in the United States. Although T21 is expected to help curb youth tobacco use, its impact may be dampened due to poor retailer compliance. Even within environments where enforcement is strong (ie, compliance checks are conducted with tough sanctions for violations), compliance might vary due to other factors.Aims and Methods: Three studies were conducted in Columbus, OH, where T21 became strongly enforced in 2018. These studies examined how retailer compliance related to features of the neighborhood in which a retailer was located (Study 1), features of the retailer (Study 2), and features of the retail cashier (Study 3).Results: Study 1 found that, after controlling for race- and age-based factors, retailers located in high (vs. low)-poverty neighborhoods had a lower likelihood of conducting identification (ID) checks. Study 2 found that ID checks were related to whether retailers displayed signage about T21, as required by the city law. Study 3 found that, among cashiers, T21 awareness (which was high) and perceptions about T21 (which were moderate) were not generally related to their retailer's compliance; having (vs. not having) scanners for ID checks was related to a higher likelihood of compliance.Conclusions: These studies emphasize the many, multilevel factors influencing T21 outcomes. Findings also indicate the potential for T21 to widen disparities in tobacco use, indicating the need for strategies to equitably improve T21 compliance.Implications: T21, which sets the minimum legal sales age for all tobacco products to age 21, is now a national law in the United States. Despite optimistic projections about what T21 could achieve, the ultimate impact may be dampened when it is applied in real-world settings. Our project revealed the many, multilevel factors influencing T21 compliance. Findings also indicate the potential for T21 to widen disparities in tobacco use if gaps in compliance persist. Strategies for equitably improving T21 compliance are discussed. This article is of relevance to areas interested in implementing or improving their local T21 enforcement. [ABSTRACT FROM AUTHOR]

Background: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. Hypothesis/Purpose: The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. Study Design: Cohort study (prognosis); Level of evidence, 1. Methods: Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. Results: A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral (P <.01) and medial (P <.05) compartments and previous medial meniscal surgery (7% of knees; P <.04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. Conclusion: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes. [ABSTRACT FROM AUTHOR]

Background: Knee arthroscopy is one of the most common orthopaedic procedures performed in the United States. The publication of a randomized controlled trial of arthroscopy versus sham surgery by Moseley et al in 2002 showed no efficacy and challenged the role of arthroscopy for the treatment of osteoarthritis.Hypothesis: (1) Knee arthroscopy for osteoarthritis has decreased after the publication of the study by Moseley et al, (2) arthroscopy as a percentage of orthopaedic cases has decreased, and (3) the average age of patients undergoing arthroscopy has decreased.Study Design: Descriptive epidemiology study.Methods: The authors examined the American Board of Orthopaedic Surgery (ABOS) database that includes 6-month case logs for each examinee sitting for the Part II board examination for 1999 to 2009. Knee arthroscopy cases were identified by CPT (Current Procedural Terminology) code and knee osteoarthritis diagnosis was defined by ICD-9 (International Classification of Diseases, 9th Revision) code. Piecewise linear regression was used to evaluate knee arthroscopy before and after the publication of the Moseley et al article in 2002.Results: The number of knee arthroscopy cases for patients with osteoarthritis had greatly decreased by 2009 after peaking in 2001 (1621 vs 966 total cases, 2.36 vs 1.40 cases per surgeon). Cases classified as chondroplasty also decreased from 10.0% to 5.8% of knee arthroscopies (P < .0001). In addition, the total number of knee arthroscopy cases per surgeon decreased from a high of 11.9 in 2003 to a low of 8.6 in 2009. As expected, knee arthroscopy as a percentage of total orthopaedic cases decreased from a high of 9.9% in 2003 to 6.6% in 2009 (P < .0001).Conclusion: Knee arthroscopy for patients with osteoarthritis among orthopaedic surgeons during their ABOS examination case collection period has decreased after the publication of a highly publicized article demonstrating a lack of efficacy of this procedure. Further study is needed to determine if this change occurred in the orthopaedic community at large or if practice patterns only changed for surgeons during their board collection periods.Clinical Relevance: Randomized controlled trials can be effective in changing orthopaedic surgeon practice. [ABSTRACT FROM PUBLISHER]

The article focuses on the political career of William McKinley. McKinley was the 25th president of the U.S., and the last veteran of the American Civil War to be elected. By the 1880s, this Ohio native was a nationally known Republican leader. His signature issue was high tariffs on imports as a formula for prosperity, as typified by his McKinley Tariff of 1890.

The article discusses a 1988 update on the development of a credible theory related to the causation and prevention of suicide in the United States. Several clinicians are challenged by community doctors who seek proof by controlled trials, or social scientists who claim the role of social events in the causation of suicide. It is also important to keep in touch with epidemiological issues related to suicide across various age groups. A current concern is on the increasing suicide rates among young men.

New drugs and biologics have had a tremendous impact on the treatment of many diseases. However, available measures suggest that pharmaceutical innovation has remained relatively flat, despite substantial growth in research and development spending. We review recent literature on pharmaceutical innovation to identify limitations in measuring and assessing innovation, and we describe the framework and collaborative approach we are using to develop more comprehensive, publicly available metrics for innovation. Our research teams at the Brookings Institution and Deerfield Institute are collaborating with experts from multiple areas of drug development and regulatory review to identify and collect comprehensive data elements related to key development and regulatory characteristics for each new molecular entity approved over the past several decades in the United States and the European Union. Subsequent phases of our effort will add data on downstream product use and patient outcomes and will also include drugs that have failed or been abandoned in development. Such a database will enable researchers to better analyze the drivers of drug innovation, trends in the output of new medicines, and the effect of policy efforts designed to improve innovation. [ABSTRACT FROM AUTHOR]

Introduction: Language discordance is a known barrier to diabetes care in patients with type 2 diabetes. This study aimed to better understand the subjective experiences of a group of Spanish-speaking study participants with low English proficiency who were learning to manage their diabetes using a language-concordant health coaching intervention., Methodology: This qualitative exploratory study used structured interview data to understand subjective experiences among participants. Thematic content analysis was conducted from a subset of health coaching phone transcripts ( n = 17) performed during a language-concordant health coaching intervention study., Results: Among the 17 participants included in the study, even with language-concordant coaching, participants had challenges in managing their diabetes care. Participants described internal and external factors, such as socioeconomic instability, that complicated their behavior changes and self-management abilities., Discussion: A health coaching intervention in patients with low English proficiency can help to improve health outcomes. Findings from this study can guide the development of health care services and the management of chronic diseases in diverse populations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The June 2022 U.S. Supreme Court decision on Dobbs v Jackson Women's Health Organization resulted in state-specific differences in abortion care access across the country. The primary concern in the obstetrics and gynecology education community has been the impact on resident and fellowship training programs. However, the impact on undergraduate medical education and the broad implications for future generations of physicians are crucial to address. It is estimated that 48% of matriculants to MD-granting medical schools will receive their medical education in the 26 states with significant abortion restrictions or bans. Undergraduate medical educators need to continue to adequately teach the basic science, clinical care, and population health outcomes of reproductive medicine, including pregnancy and abortion. In addition, students in states with more restrictions on abortion will have less or no clinical exposure, and those in states with few restrictions may be excluded due to overcrowding of learners from restricted states. Students' own health care also needs to be considered, as access to abortion care for themselves or their partners may create applicant pool demographic shifts by state as applicants consider options for where to pursue their medical education. It is important to ensure that teaching of foundational science of pregnancy, abortion, and reproductive health continues throughout the United States. Undergraduate and graduate medical educators will need to closely monitor the downstream impact of decreased clinical exposure of abortion. Further study of the personal health impact of abortion care access for medical students and awareness of the changing applicant pool demographics by state is needed., (Copyright © 2022 by the Association of American Medical Colleges.)

Background: High quality self-care among individuals with chronic obstructive pulmonary disease (COPD) promotes better outcomes, however, there are few validated self-care measures that are psychometrically sound to be used in research., Objectives: The purpose of this study is to examine the psychometric properties of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) in an English-speaking population in the United States., Methods: Factorial validity, construct validity and reliability of the SCCOPDI were examined using components analysis via principal components analysis, hypothesis testing via multivariate linear regression, Cronbach's alpha, and split-half reliability., Results: The SCCOPDI demonstrated strong evidence of validity and reliability on par with the SCCOPDI's original construction. Component analysis produced item loadings consistent with the theoretical underpinnings of the instrument. Reliability metrics yielded good internal consistency across all subscales of the SCCOPDI., Conclusions: The SCCOPDI is a valid and reliable instrument to measure self-care in people with COPD., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Since its detection in the early 1980s, HIV and AIDS have claimed 32.7 million lives. The HIV epidemic continues to plague the world with its most devastating effects felt in Eastern and Southern Africa. The exposure, vulnerability, and impact of HIV have been prominent among military personnel due to environmental, demographic, and socioeconomic characteristics. Policies have been developed to mitigate its exposure, vulnerability, and impact on the military. However, there are disparities across these policies, especially on recruitment, enlistment, and deployment. These contentions inspired this evaluation, which was designed to provide vital information and insights for militaries developing new HIV policies, for example, the Ghana Armed Forces (GAF)., Materials and Methods: Content analyses of key documents and secondary resources from South Africa (SA), the USA, and the United Nations and International Labour Organizations were undertaken. The key documents evaluated included HIV and AIDS policies of the SA National Defence Force (SANDF), the U.S. DoD, UN Department of Peacekeeping Operations, and International Labour Organization (ILO); national HIV and AIDS policies; and legislations of SA and the USA., Results: The SANDF policy permits the recruitment of HIV-positive applicants while the U.S. DoD policy does not. Mandatory pre-employment health assessments including HIV testing is conducted for prospective applicants. Again, discrimination against persons living with HIV (PLHIV) is discouraged by national policies and legislations of both countries and the ILO policy. At the same time, the SA national policy permits discrimination based on requirement of the job.On deployment, the SANDF policy explicitly permits deployment of HIV-positive service members, while the U.S. DoD policy cautiously does so. Both policies support mandatory pre-deployment health assessments in line with the UN peacekeeping policy and medical standards even though voluntary confidential HIV counseling and testing is recommended by the UN. All HIV-positive service members are retained and offered treatment and care services; however, the U.S. DoD policy retires unfit service members after 12 months of consecutive non-deployment. Further, the UN policy repatriates service members with pre-existing medical conditions and pays no compensation for death, injury, or illness, which is due to pre-existing medical conditions or not mission-related., Conclusions: First, the contents of the military policies are not very diverse since most militaries do not enlist or deploy PLHIV except few countries including SA. Implementation and interpretation is however inconsistent. Some militaries continue to exclude PLHIV despite the existence of policies that permit their inclusion. Second, discrepancies exist among the military policies, national legislations, and international policies. The UN policy is not coherent and empowers the military to exclude PLHIV. Also, potential costs to be incurred, in the form of compensation and repatriation, seem to be a major factor in the decision to deploy HIV-positive service members. Harmonization of military HIV policies to ensure uniform standards, interpretation, and implementation and the coherence of the UN policy are essential to guide countries developing new policies, for example, GAF., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9-54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5-149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

While interprofessional collaboration is a critical aspect of optimal patient care, practicing physicians often have sub-optimal attitudes regarding the importance of collaboration with their nursing colleagues. The impact of clinical training on medical students' and residents' attitudes toward physician-nurse collaboration has not been investigated. The primary goal of our study was to examine if learners at different stages in their medical training had more or less favorable attitudes regarding interprofessional collaboration (IPC). A secondary goal was to compare residents in procedural versus non-procedural specialties to determine if attitudes toward IPC varied by specialty type. Third-year medical students and residents at a large public university completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Student (n = 129) and resident (n = 292) scores were compared using Student's t-tests. Resident responses were further analyzed by specialty type. Students' perceptions of the physician-nurse relationship were significantly more favorable than the views of residents, particularly in the "Authority" and "Responsibility" domains. Residents in procedural specialties had less favorable attitudes toward physician-nurse collaboration than those in non-procedural specialties. Our findings highlight the importance of developing effective interventions for improving interprofessional collaboration during medical training.

Purpose: With the growing recognition of the role of coaching in competency-based medical education, many medical education training programs are investing significant resources into developing coaching programs. However, there is a lack of rigorous research on academic coaching programs in medical education and recommended coaching practices are based on expert opinion without incorporating the student perspective. The aim of this study was to investigate factors that affect a students' perception of a successful coaching experience. Materials and method: This was a qualitative study performed in November 2018 at a medical school in the United States with a formal coaching program. Appreciative inquiry was the theoretical framework used to develop the question guide. The authors facilitated two focus groups and then used Colaizzi's phenomenological analysis approach to analyze the transcripts. Results: A total of 21 students participated in the focus groups. The analysis revealed four themes that describe students' perceptions of successful coaching experiences: coach attributes, relational skills, coaching skills, and utilization of coaching. Each of these themes had specific dimensions. Conclusions: The findings from this study illuminate the student stakeholder perspectives on successful coaching relationships, and should be considered when developing a coaching program and faculty development.

This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, is an overview of issues to consider regarding learner mistreatment and its effects on the undergraduate medical education learning environment in the United States. National data from the American Association of Medical Colleges Graduate Questionnaire and local data regarding learner mistreatment provide evidence that the learning environment at most medical schools needs to be improved. The American Association of Medical Colleges' definition of learner mistreatment focuses on active mistreatment, but data on passive mistreatment also contribute to a negative learning environment. The lack of tolerance for active mistreatment issues such as public humiliation and sexual and racial harassment need to be made transparent through institutional and departmental policies. Additionally, reporting mechanisms at both levels need to be created and acted upon. Passive mistreatment issues such as unclear expectations and neglect can also be addressed at institutional and departmental levels through training modules and appropriate communication loops to address these concerns. To fully confront and solve this challenging issue regarding learner mistreatment at the undergraduate medical education level, solutions to need to be implemented for faculty, residents, and students in the institutional, departmental, and clerkship settings., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Kocher, MH, Oba, Y, Kimura, IF, Stickley, CD, Morgan, CF, and Hetzler, RK. Allometric grip strength norms for American children. J Strength Cond Res 33(8): 2251-2261, 2019-To develop normative data from a large cohort of American school children (ages 6-18) for unscaled and allometrically scaled handgrip strength data that are uninfluenced by body size (body mass [BM] and stature [Ht]). Data (age, handgrip strength, BM, and Ht) were collected from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey databases, resulting in 4,665 cases (2,384 boys and 2,281 girls). Multiple log-linear regressions were used to determine allometric exponents for BM and Ht separately for each age and sex to satisfy the common exponent and group difference principles described by Vanderburgh. Appropriateness of the allometric model was assessed through regression diagnostics, including normality and homoscedasticity of residuals. Allometrically scaled, ratio-scaled, and unscaled grip strength were then correlated with BM and Ht to examine the effectiveness of the procedure in controlling for body size. The data did not allow for development of a common exponent across age and sex that did not violate the common exponent and group difference principles. Correlations between allometrically scaled handgrip strength with BM and Ht were not significant (p ≤ 0.479) and approached zero, unlike correlations of unscaled handgrip strength with BM and Ht (p < 0.001 for all), indicating that allometric scaling was successful in removing the influence of body size. Allometric scaling handgrip strength by age and sex effectively controls for body size (Ht and BM) and perhaps maturation (Ht). The allometric exponents and normative values developed can be used to compare handgrip strength within age and sex while controlling for body size.

This article, from the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics (APGO) Undergraduate Medical Education Committee (UMEC), provides educators with an overview of the use of simulation in undergraduate medical education in the field of obstetrics and gynecology. Simulation plays an important role in the education of medical students. Students are increasingly serving as clinical observers and providing less direct patient care. Simulation can help standardize education and ensure quality and comparability across an enlarging educational environment. This article summarizes the expanding role of simulation in undergraduate medical education in obstetrics and gynecology and its effect on important learner outcomes such as confidence, knowledge, skills, workplace behaviors, and translation to patient care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The implementation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the field of obstetrics and gynecology has arrived with Milestones Level One defined as the level expected of an incoming first-year resident., Purpose: We designed, implemented, and evaluated a 4-week elective for fourth-year medical school students, which utilized a multimodal approach to teaching and assessing the Milestones Level One competencies., Methods: The 78-hour curriculum utilized traditional didactic lectures, flipped classroom active learning sessions, a simulated paging curriculum, simulation training, embalmed cadaver anatomical dissections, and fresh-frozen cadaver operative procedures. We performed an assessment of student knowledge and surgical skills before and after completion of the course. Students also received feedback on their assessment and management of eight simulated paging scenarios. Students completed course content satisfaction surveys at the completion of each of the 4 weeks., Results: Students demonstrated improvement in knowledge and surgical skills at the completion of the course. Paging confidence trended toward improvement at the completion of the course. Student satisfaction was high for all of the course content, and the active learning components of the curriculum (flipped classroom, simulation, and anatomy sessions) had higher scores than the traditional didactics in all six categories of our student satisfaction survey., Conclusions: This pilot study demonstrates a practical approach for preparing fourth-year medical students for the expectations of Milestones Level One in obstetrics and gynecology. This curriculum can serve as a framework as medical schools and specific specialties work to meet the first steps of the ACGME's Next Accreditation System.

The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis.