Benjamin R. Doolittle

Pediatric lipid screening remains underutilized, despite recommendations from many professional societies. In particular, certain lipid disorders such as familial hypercholesterolemia and elevated lipoprotein (a) are highly heritable and detectable in childhood. This low uptake represents not only a missed opportunity to identify high-risk youth for atherosclerotic cardiovascular disease (ASCVD), but also a lost occasion to identify high-risk adult relatives through reverse cascade screening. Expanding universal pediatric lipid screening to include lipoprotein (a) can serve as an effective strategy to uncover undiagnosed ASCVD in their relatives. Early identification of affected, asymptomatic individuals could prevent ASCVD morbidity and mortality.

Background and Objectives: Primary care utilization for young adults in the United States is lower than those for younger and older age groups. Many young adults are exposed to the medical system when they accompany their children to appointments. This study screened caregivers for utilization of adult primary care during pediatric visits in an internal medicine-pediatrics practice. Methods: Surveys were administered to caregivers attending visits with pediatric patients at an internal medicine-pediatrics clinic over a six-month period. Caregivers indicated whether they had a primary care provider (PCP) and if so, whether they had received care from this PCP within the past year. Results: Thirty-seven surveys were completed. The median age of respondents was 33.5 years, and 32 (91%) respondents identified as mothers. No PCP was reported by 14 (38%) respondents, with 12 (86%) expressing a desire to enroll in the internal-medicine pediatrics clinic. Conclusions: This study demonstrates that there are barriers to utilization of preventive healthcare even for adults who accompany their children to medical appointments, suggesting that pediatric medical encounters represent a missed opportunity to assess healthcare utilization among adults.

In this essay, we discuss the results of scientific dogmatism and the backlash it has created in society. We cite various examples from the pandemic to highlight our case. We argue that dogmatism will ultimately put the scientific paradigm in crisis and a different approach is needed to address populism. We further argue science is more digestible when emotional faculties of individuals are considered first. We use a philosophical approach to also describe the dangers of dogmatism and the interplay between technocracy and populism.

Objective: This study explored health professionals' experiences of using Artificial Intelligence (AI) in healthcare with a particular focus on the potential benefits and challenges of using AI in clinical practice. Method: Using a qualitative research design, data were collected through in-depth interviews with a convenience sample of twenty-two health professionals from various medical specialties in northern Punjab, Pakistan. Thematic analysis identified recurring themes on AI adoption. Results: Health professionals recognized AI as a psychosocial modifier which increased efficiency and overall professional well-being. Participants expressed that AI should function as a supportive tool rather than a replacement for human judgment, empathy, and patient interaction. They also acknowledged a hesitation to incorporate AI due to a distrust of its accuracy, and also indicated that institutions have been slow to adopt AI due to ethical, technical, and institutional challenges. Conclusion: AI adoption is increasingly reshaping clinical practice, but sustainable integration in Pakistan requires balancing innovation with ethical safeguards, trust, and empathy.

Ongoing interest in the intersection of spirituality and health has prompted a need for integrated research. This report proposes a distinct approach in a model that allows for successful and harmonious cross-fertilization within these latter two areas of interest. Our work is especially pertinent to inquiries around the role of spirituality in mental health, with special attention to chronic pain conditions. The latter have become an open channel for novel avenues to explore the field of spirituality-based interventions within the arena of psychological inquiry. To address this, the authors developed and implemented the Church and Academia Model, a prototype for an innovative collaborative research project, with the aim of exploring the role of devotional practices, and their potential to be used as therapeutic co-adjuvants or tools to enhance the coping skills of patients with chronic pain. Keeping in mind that the church presents a rich landscape for clinical inquiry with broad relevance for clinicians and society at large, we created a unique hybrid research model. This is a new paradigm that focuses on distinct and well-defined studies where the funding, protocol writing, study design, and implementation are shared by experts from both the pastoral and clinical spaces. A team of theologians, researchers, and healthcare providers, including clinical pain psychologists, built a coalition leveraging their respective skill sets. Each expert is housed in their own environs, creating a functional network that has proven academically productive and pastorally effective. Key outputs include the creation and validation of a new psychometric measure, the Pain-related PRAYER Scale (PPRAYERS), an associated bedside prayer tool and a full-scale dissemination strategy through journal publications and specialty society conferences. This collaborative prototype is also an ideal fit for integrated knowledge translation platforms, and it is a promising paradigm for future collaborative projects focused on spirituality and mental health.

Background: Patients with type 2 diabetes (T2D) require continuous management to achieve optimal outcomes. Socioeconomic barriers can impede the delivery of optimal diabetes care. During the COVID-19 pandemic, telemedicine likely reduced common barriers to care compared with in-person visits. This study investigated the impact of telemedicine on no-show rates and diabetes outcomes in publicly insured patients and the potential link to reduced socioeconomic barriers. Methods: This retrospective study analyzed the records of 819 patients with T2D at the Yale Medicine Diabetes Center (YMDC). From June 2019 to March 2020, patients had in-person clinic visits, followed by telehealth visits from March to December 2020 due to system-wide COVID-19 isolation mandates. No-show rates, glycemic control metrics, and other biomarkers were compared in the same patients between their in-person and telehealth visit periods. Results: Patients utilizing telemedicine averaged no-show rates of 0.34 ± 0.69 compared with 1.19 ± 1.30 ( P < .001) for in-person visits. Average hemoglobin A1c (HbA1c) for telemedicine was 7.93 ± 1.95 compared with 7.91 ± 1.90 ( P = .65) for in-person visits. Percentages of patients achieving ≥70% glucose time in range (TIR) on an ambulatory glucose profile (AGP) was 43.90% for telehealth and 45.42% ( P = .76) for in-person visits. Conclusion: Publicly insured patients with T2D showed significantly reduced no-show rates and comparable glycemic control during telemedicine visits compared with in-person visits. Telemedicine visits may be associated with lower no-show rates due to a reduction of socioeconomic barriers. Future studies are warranted to further clarify potential associations of specific socioeconomic barriers to missed visits.

With advances in technology, medical decision‐making has become increasingly complex. Fractal geometry provides a framework to grapple with this daunting complexity. Fractals are defined as, ‘infinitely complex patterns that are self‐similar across different scales.’ These patterns have been used to understand the seeming randomness of recurring patterns in nature, financial markets, quantum physics, and even forest fires, war, and the respiratory system. Mandlebrot the mathematician who discovered his eponymous fractal pattern wrote, ‘Beautiful, damn hard, increasingly useful. That's fractals.’ The same could be said about medicine. To understand optimal medical decision making, we need to examine not only performance, but the complexity‐cost to obtain that performance. This complexity can be visualized through the fractal tree of potential branches produced by a plan of care. To confront the growing complexity of medical care, we must prune this fractal tree while ensuring favorable outcomes. To do this, we offer three propositions as pruning shears for the complexity of the fractal tree: wisdom, trust, and prevention.

Introduction: Individuals with higher social and economic needs are less likely to complete higher education, including medical and graduate nursing training. The purpose of this study was to explore the relationship between social determinants of health (SDOH) and perceptions of flourishing among medical (MD), physician assistant/associate (PA), and nurse practitioner (NP) students. Methods: This study consisted of a single online survey using a cross-sectional design. Current MD, PA, and NP students from 2 academic medical centers in the United States were recruited between August 6 and October 9, 2023. Survey questions included demographics and multiple validated instruments including the Secure Flourish Index (SFI; flourishing) and WellRx (SDOH). Students were categorized into 3 groups based on SDOH needs determined by the WellRx score. Descriptive statistics, chi-square, and ANOVA testing were performed (alpha = 0.05). Results: A total of 301 of 1820 (16.5%) eligible students participated. Students had an average of at least 1 unmet SDOH need (M 1.1, standard deviation [SD] 1.2). Over 35% of students (n = 111/301, 36.9%) needed to work, 14.0% (n = 42/301) reported difficulty paying for utilities, and 9.3% (n = 28/301) reported food insecurity. Some students (15.3%, n = 45/294) had seriously considered leaving training in the prior 6 months, citing personal mental health (66.7%, n = 30/45) and financial stress (55.6%, n = 25/45) as contributing factors. Total SFI scores were almost 16 points higher among low SDOH risk group students (M 88.2, SD 14.0) than high-risk group students (M 72.7, SD 13.5; P < .001). Discussion: Students’ social and economic needs are intertwined with their ability to flourish and their considerations for leaving training.