Developing an integrated model of health care for refugees, asylees, immigrants, and special immigrant visa holders requires a multifaceted approach due to their unique and complex health care needs. Selleck LNG-451 This article provides an in-depth understanding of the components necessary to develop a model of care addressing the needs of immigrants and to share opportunities and challenges associated with these models. This includes highlighting population- and individual-level factors important to caring for immigrant populations, providing guidance on creating a model of care that addresses these factors, and describing established clinics that exemplify various models of care.Immigrants enrich the United States through economic contributions and unique perspectives. Immigrants find themselves navigating a new culture, a complicated health care system, unfamiliar social programs, and an ever-changing policy environment. They may be discouraged by unmet expectations of life in the United States, changing family dynamics, and discrimination. Screening for the social determinants of health is crucial, as not all patients will proactively seek the advice of their health care provider for these issues. Health care providers can assist and empower immigrants to navigate these challenges, as well as serve as advocates on a broader scale.Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. Primary care providers have strategies to promote mental well-being, including focusing on resilience and social determinants of health. Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.Women's health is largely influenced by cultural beliefs, local traditions, and access to care across the world. Immigrant and refugee women experience health in varied ways; prior experiences with health care and beliefs about health should be explored with women on their arrival to the United States. Topics that should be discussed include menstrual practices, contraception and beliefs about family planning, prior screening for preventable diseases, pregnancies and experiences with childbirth, sexual assault and trauma, and history of traditional practices, including female genital mutilation (dependent on area of origin).Immigration, and health issues surrounding the immigration status of patients, remains much in the media forefront and will likely remain so in the future due to ongoing political challenges. Although precise definitions of immigrants, refugees, and asylum seekers remain vitally important when framing discussions around immigration, all newcomers face health challenges. By educating themselves about these issues, health care professionals can better care for their patients, no matter their specialty.
The American College of Surgeons (ACS)/Association of Program Directors in Surgery (APDS) Resident Skills Curriculum includes validated task-specific checklists and global rating scales (GRS) for Objective Structured Assessment of Technical Skills (OSATS). However, it does not include instructions on use of these assessment tools. Since consistency of ratings is a key feature of assessment, we explored rater reliability for two skills.
Surgical faculty assessed hand-sewn bowel and vascular anastomoses in real-time using the OSATS GRS. OSATS were video-taped and independently evaluated by a research resident and surgical attending. Rating consistency was estimated using intraclass correlation coefficients (ICC) and generalizability analysis.
Three-rater ICC coefficients across 24 videos ranged from 0.12 to 0.75. Generalizability reliability coefficients ranged from 0.55 to 0.8. Percent variance attributable to raters ranged from 2.7% to 32.1%. Pairwise agreement showed considerable inconsistency for both tasks.
Variability of ratings for these two skills indicate the need for rater training to increase scoring agreement and decrease rater variability for technical skill assessments.
Variability of ratings for these two skills indicate the need for rater training to increase scoring agreement and decrease rater variability for technical skill assessments.Incidence and prevalence of atrial fibrillation (AF) and chronic kidney disease are increasing, and the two conditions commonly coexist. Renal impairment further increases the risk of ischemic stroke and systemic thromboembolism in patients with AF but also paradoxically predisposes to bleeding. Renal function should be monitored closely in patients with AF requiring oral anticoagulation therapy, particularly those receiving direct oral anticoagulants. Vitamin K antagonists can be used as part of a dose-adjusted anticoagulation regimen in patients with mild to moderate renal dysfunction. Dialysis-dependent patients taking vitamin K antagonists are at increased risk of sustaining major hemorrhage.Obstructive sleep apnea (OSA) creates a complex and dynamic substrate for atrial fibrillation (AF), which is characterized by structural remodeling as a result of long-term OSA as well as transient and acute apnea-associated transient atrial electrophysiological changes. OSA is present in 21% to 74% of patients with AF, and nonrandomized studies suggest that treatment of OSA by continuous positive airway pressure may help to maintain sinus rhythm after electrical cardioversion and improve catheter ablation success rates. Management of OSA in patients with AF requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and sleep specialists.Obesity and metabolic syndrome are both associated with atrial fibrillation (AF). Recent research has revealed new insights into the effects of cardiac and noncardiac adipose tissue in mediating these associations. Cardiac adipose tissue, such as epicardial fat, is a powerful predictor of AF and leads to myocardial fatty infiltration and adipokine-induced fibrosis. Increases in noncardiac adipose tissue cause deleterious metabolic, neurohormonal, hemodynamic, and structural changes. Weight loss leads to a regression of adiposity-related fibrosis, structural abnormalities, conduction abnormalities, and reduction in AF burden. As a result, weight loss and risk factor treatment is now an established pillar of AF management.Selleck LNG-451
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