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Brennan EF, Markopoulos A, Rodriguez J, Sheth NK, Shah N. Addressing a Gap in Medical School Training: Identifying and Caring for Human Trafficking Survivors Using Trauma-Informed Care. MedEdPORTAL 2023; 19:11304. [PMID: 36926052 PMCID: PMC10011204 DOI: 10.15766/mep_2374-8265.11304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/23/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Human trafficking (HT) is a substantial public health problem, and health care workers are uniquely positioned to help identify and care for survivors. Despite this fact, few medical schools incorporate HT training using trauma-informed care (TIC) principles into their curricula. We developed a training session to educate medical students on recognizing HT red flags and providing TIC to HT survivors. METHODS One hundred twenty-seven fourth-year medical students at Rush Medical College attended a 2-hour session consisting of didactic lectures by expert speakers and participated in a group discussion guided by a clinical vignette. Students completed anonymous pre- and postsession surveys that assessed comfort levels in detecting HT red flags and providing TIC. We used a paired t test to compare pre- and postsession survey responses. RESULTS Ninety-five pre- and postsession surveys were matched with unique identifiers and used for analysis. The results demonstrated significant improvement in all the metrics assessed. DISCUSSION This training significantly improved medical students' comfort in identifying and caring for HT survivors, addressing an especially important gap in medical school education. This training can be implemented at other institutions to further improve awareness and efforts in identifying and caring for HT survivors while avoiding retraumatization.
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Affiliation(s)
| | | | - Jaclyn Rodriguez
- Sexual Assault Nurse Examiner (SANE) Coordinator, Office of the Illinois Attorney General
| | - Neeral K. Sheth
- Director, Medical Education in Psychiatry, and Assistant Professor, Department of Psychiatry and Behavioral Sciences, Rush Medical College
| | - Nupur Shah
- Faculty Physician, Department of Emergency Medicine, Rush University Medical Center
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Budtz CR, Rønn-Smidt H, Thomsen JNL, Hansen RP, Christiansen DH. Primary Care Physical Therapists' Experiences When Screening for Serious Pathologies Among Their Patients: A Qualitative Study. Phys Ther 2022; 102:6549490. [PMID: 35302642 PMCID: PMC9155951 DOI: 10.1093/ptj/pzac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/12/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A vital part of the initial examination performed by a physical therapist is to establish whether the patient would benefit from physical therapist intervention. This process includes knowledge about contraindications for treatment and screening for serious pathologies. However, little is known about the physical therapists' views and thoughts about their own practice when screening for serious pathologies. The purpose of this study was to explore the experience gained by physical therapists when screening for serious pathologies among their patients. METHODS This was a qualitative study based on individual semi-structured interviews with 9 primary care physical therapists. The interviews were analyzed using reflexive thematic analysis, and generated themes were explained and reported with relevant quotes. RESULTS Three overall themes were generated: (1) the role of physical therapists in the diagnostic process; (2) responsibility from the individual to the group; and (3) the difficult task of cooperation. The physical therapists described how they relied more on their clinical suspicion than on asking red-flag questions when screening for serious pathologies. They also questioned their differential diagnostic abilities. Finally, they saw a potential to further enhance their confidence in the area by reflecting on the matter with colleagues and by receiving more feedback about their clinical reasoning regarding serious pathologies from general practitioners. CONCLUSION These findings suggest that physical therapists primarily rely on their clinical suspicion when screening for serious pathologies but at the same time are uncertain about their differential diagnostic abilities. IMPACT These findings can inform future interventions targeting the physical therapists' abilities to detect serious pathology.
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Affiliation(s)
| | | | | | | | - David Høyrup Christiansen
- Goedstrup Hospital, Department of Occupational Medicine - University Research Clinic, Herning, Denmark,Aarhus University, Department of Clinical Medicine, Aarhus, Denmark,Regional Hospital Central Jutland, Research, Heibergs Allé 2K, Viborg, Denmark
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Burnett-Hartman AN, Lee JK, Demb J, Gupta S. An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer. Gastroenterology 2021; 160:1041-1049. [PMID: 33417940 PMCID: PMC8273929 DOI: 10.1053/j.gastro.2020.12.068] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022]
Abstract
Rising trends in the incidence and mortality of early-onset colorectal cancer (CRC) in those who are younger than 50 years have been well established. These trends have spurred intense investigation focused on elucidating the epidemiology and characteristics of early-onset CRC, as well as on identifying strategies for early detection and prevention. In this review, we provide a contemporary update on early-onset CRC with a particular focus on epidemiology, molecular characterization, red flag signs and symptoms, and screening for early-onset CRC.
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Affiliation(s)
| | - Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
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Fiorino G, Bonovas S, Gilardi D, Di Sabatino A, Allocca M, Furfaro F, Roda G, Lenti MV, Aronico N, Mengoli C, Angeli E, Gaffuri N, Peyrin-Biroulet L, Danese S. Validation of the Red Flags Index for Early Diagnosis of Crohn's Disease: A Prospective Observational IG-IBD Study Among General Practitioners. J Crohns Colitis 2020; 14:1777-1779. [PMID: 32990721 DOI: 10.1093/ecco-jcc/jjaa111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Diagnostic delay >12 months is frequent in Crohn's disease [CD]. Recently, the International Organization for Inflammatory Bowel Disease [IO-IBD] developed a tool to identify early CD and reduce diagnostic delay. Subjects with an index ≥8 are more likely to have suspected CD (odds ratio [OR] 205, p <0.0001). We aimed to validate this questionnaire at the community level in patients seen by the general practitioners [GPs] in two large areas of Lombardy, Italy. METHODS Consecutive adult patients referring to the GP were screened. The GPs administered the Red Flags [RF] questionnaire to the eligible patients. All patients were referred to the nearest participating centre to confirm or exclude the diagnosis of CD. Sensitivity, specificity, and positive and negative predictive values [PPV, NPV] of the RF index [RFI] were calculated. Patients lost to follow-up after the first gastroenterological visit were analysed using a non-responder imputation, assuming they were negative for CD diagnosis. RESULTS From November 2016 to November 2019, 112 patients were included. A total of 66 subjects [59%] completed the study after the first gastroenterological visit. The prevalence of CD was 3.6% in the study population [4/112]. The RF index had 50% sensitivity, 58% specificity, 4% PPV, and 97% NPV. A combined diagnostic strategy with faecal calprotectin [FC] [RFI ≥8 and/or FC >250 ng/g] resulted in significantly improved accuracy: sensitivity 100% [29-100%], specificity 72% [55-85%], PPV = 21% [5-51%], NPV = 100% [88-100%]. CONCLUSIONS The RF Index combined with FC is a valid tool to identify patients with high probability of having CD at early stage.
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Affiliation(s)
- Gionata Fiorino
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
| | - Stefanos Bonovas
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
| | - Daniela Gilardi
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Antonio Di Sabatino
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | | | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Giulia Roda
- Humanitas Clinical and Research Center - IRCCS, IBD Center, Department of Gastroenterology, Rozzano, Italy
| | - Marco V Lenti
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Nicola Aronico
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Caterina Mengoli
- IRCCS San Matteo Hospital Hospital Foundation University of Pavia, First Department of Internal Medicine, Pavia, Italy
| | - Enzo Angeli
- Humanitas Gavazzeni, Radiology, Bergamo, Italy
| | - Nicola Gaffuri
- Humanitas Gavazzeni, Gastroenterology and Endoscopy, Bergamo, Italy
| | | | - Silvio Danese
- Humanitas University, Biomedical Sciences, Pieve Emanuele, Italy
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Brindisino F, Passudetti V, Pennella D, Giovannico G, Heick JD. Recognition of pulmonary pathology in a patient presenting with shoulder pain. Physiother Theory Pract 2020; 38:597-607. [PMID: 32459135 DOI: 10.1080/09593985.2020.1768611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND . Shoulder pain is a common symptom of musculoskeletal disorder about the shoulder. However, shoulder pain can also be symptomatic of other non- musculoskeletal disease. Careful assessment of the clinical presentation is essential in differential diagnosis and decisions to treat or refer. CASE DESCRIPTION . A 56-year-old male preseted with shoulder pain and a previous diagnosis of subacromial impingement of the left shoulder. The shoulder pain increased with effort, was present at night making it difficult to sleep and became disabling for the patient in work and activities of daily living. In addition, the patient reported left thoracic pain and increasing episodes of dry coughing, shortness of breath, fever and unusual generalized fatigue. Physical examination did not reveal a musculoskeletal concern about the patient's shoulder. An increased body temperature was detected and when combined with auscultation and thorax percussion led the physiotherapist to hypothesize pulmonary involvement, later reinforced by the evocation of the patient's symptoms while measuring his peak expiratory flow. DISCUSSION . An underlyng serious pathology can be easily masked by shoulder pain. Physiotherapists need to consider that when a patient presents with a cluster of history and physical examination findings that are negative for mechanical shoulder pain, other systems must be considered as the source of presenting symptoms. Through the identification of risk factors and red flag findings, the physiotherapist can identify the need for referral.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy
| | - Valerio Passudetti
- "Pain Free" Manual Therapy Office, Physiotherapy Department, Treviso, Italy
| | - Denis Pennella
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Manual Therapy Lab Clinic, Physiotherapy Department, Bari, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy
| | - John D Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ, USA
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Danese S, Fiorino G, Mary JY, Lakatos PL, D'Haens G, Moja L, D'Hoore A, Panes J, Reinisch W, Sandborn WJ, Travis SP, Vermeire S, Peyrin-Biroulet L, Colombel JF. Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn's Disease: An IOIBD Initiative. J Crohns Colitis 2015; 9:601-6. [PMID: 25908718 DOI: 10.1093/ecco-jcc/jjv067] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diagnostic delay is frequent in patients with Crohn's disease (CD). We developed a tool to predict early diagnosis. METHODS A systematic literature review and 12 CD specialists identified 'Red Flags', i.e. symptoms or signs suggestive of CD. A 21-item questionnaire was administered to 36 healthy subjects, 80 patients with irritable bowel syndrome (non-CD group) and 85 patients with recently diagnosed (<18 months) CD. Patients with CD were asked to recall symptoms and signs they experienced during the 12 months before diagnosis. Multiple logistic regression analyses selected and weighted independent items to construct the Red Flags index. A receiver operating characteristic curve was used to assess the threshold that discriminated CD from non-CD. Association with the Red Flags index relative to this threshold was expressed as the odds ratios (OR). RESULTS Two hundred and one subjects, CD and non-CD, answered the questionnaire. The multivariate analysis identified eight items independently associated with a diagnosis of CD. A minimum Red Flags index value of 8 was highly predictive of CD diagnosis with sensitivity and specificity bootstrap estimates of 0.94 (95% confidence interval 0.88-0.99) and 0.94 (0.90-0.97), respectively. Positive and negative likelihood ratios were 15.1 (9.3-33.6) and 0.066 (0.013-0.125), respectively. The association between CD diagnosis and a Red Flags index value of ≥8 corresponds to an OR of 290 (p < 0.0001). CONCLUSIONS The Red Flags index using early symptoms and signs has high predictive value for the diagnosis of CD. These results need prospective validation prior to introduction into clinical practice.
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Affiliation(s)
- Silvio Danese
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Geert D'Haens
- IBD Unit, Gastroenterology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | - Julian Panes
- Gastroenterology Department, Hospital Clinic of Barcelona, IDIPABS, CIBERehd, Barcelona, Spain
| | - Walter Reinisch
- Medizinische Universität Wien, Klinische Abt. Gastroenterologie & Hepatologie, AKH Wien, Austria
| | - William J Sandborn
- Division of Gastroenterology, UC San Diego Health System, La Jolla, CA, USA
| | - Simon P Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre-lès-Nancy, France
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