Browsing by Author "Smith, Joseph"

Now showing 1 - 3 of 3
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    “I Didn't Know What to Say”: Responding to Racism, Discrimination, and Microaggressions With the OWTFD Approach
    (Association of American Medical Colleges, 2020-07-31) Sotto-Santiago, Sylk; Mac, Jacqueline; Duncan, Francesca; Smith, Joseph; Medicine, School of Medicine
    Introduction Academic medicine has long faced the challenge of addressing health inequities, reflecting on how these contribute to structural racism, and perpetuating negative social determinants of health. Most recently, we have constructed opportunities for dialogues about racism, discrimination, and microaggressions (RDM). As such, we created a professional development program that encouraged participants to (1) openly discuss RDM and the impact they have in academia, (2) learn about tools to address and respond to RDM, and (3) move towards the creation of inclusive environments. The target audience included institutional leaders, faculty, trainees, professional staff, and health care teams. Methods We sought to meet workshop goals by integrating anti-racist dramaturgical teaching, introducing concepts knowledge, and practicing communication tools. To assess learning and evaluate our workshops, participants completed a pre- and postsurvey. Results Results showed that 30 participants were more comfortable with discussing issues related to race/ethnicity, gender identity/expression, sexual orientation, and spirituality after participating in the workshops. Prior to the two workshops, the percentage of learners who felt confident initiating conversations ranged from 29% to 54%. After the workshops, the percentage of learners who felt confident ranged from 58% to 92%. The greatest increase, 100%, was observed in the levels of confidence in initiating conversations related to race/ethnicity. Discussion Despite medical education's commitment to cultural competence and institutional mission statements that value diversity, equity, inclusion, and justice, professional development opportunities are limited. Participants strongly agreed their participation in such a workshop was relevant and important to their professional work.
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    Multiple myeloma causing interstitial pulmonary infiltrates and soft-tissue plasmacytoma
    (Elsevier, 2018-05-19) Lok, Ryan; Golovyan, Dmitriy; Smith, Joseph; Medicine, School of Medicine
    Multiple Myeloma (MM) is a relatively rare disease and MM presenting outside the bone marrow, known as extramedullary myeloma (EMM), is rarer still. While the liver and CNS are most commonly affected in EMM, the lung parenchyma is an especially unusual site of involvement. We present the case of a 64-year-old male with known history of MM admitted with acute respiratory failure and a chest wall mass. Chest CT revealed patchy interstitial and alveolar opacities with no pulmonary masses or nodules. Bronchoalveolar lavage (BAL) was performed, with flow cytometry demonstrating monoclonal plasma cells expressing CD38, CD138 and CD56 with lambda light chain restriction. Fine Needle Aspiration of chest wall mass revealed CD138-positive cells as well. Review of the literature revealed only one other documented case of a patient presenting with both interstitial lung parenchymal involvement with MM as well as soft tissue plasmacytoma, with this occurring in a patient who had previously underwent stem cell transplant. To our knowledge, we report the first recorded case of this presentation in a patient without a history of stem cell transplantation. Furthermore, it demonstrates the utility of using BAL, rather than lung biopsy, to establish the diagnosis through less invasive means.
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    Teaching pursed-lip breathing through music: MELodica Orchestra for DYspnea (MELODY) trial rationale and protocol
    (Taylor & Francis, 2020-10-16) McGrath, Mackenzie; Smith, Joseph; Rattray, Nicholas A.; Lillie, Aimee; Crow, Shannon; Myers, Laura J.; Myers, Jennifer; Perkins, Anthony J.; Wasmuth, Sally; Burns, Debra S.; Cheatham, Ariel J.; Patel, Himalaya; Bravata, Dawn M.; Medicine, School of Medicine
    Background Patients with chronic obstructive pulmonary disease (COPD) commonly experience dyspnea, which may limit activities of daily living. Pursed-lip breathing improves dyspnea for COPD patients; however, access to pursed-lip breathing training is limited. Methods The proposed MELodica Orchestra for DYspnea (MELODY) study will be a single-site pilot study to assess the safety, feasibility, and efficacy of a music-based approach to teach pursed-lip breathing. Patients with COPD and moderate-severe dyspnea are randomized to intervention, education-control, or usual care control groups. Intervention patients meet twice weekly for eight weeks for melodica instruction, group music-making, and COPD education. Safety, feasibility, and efficacy is assessed qualitatively and quantitatively. Results This manuscript describes the rationale and methods of the MELODY pilot project. Conclusions If pilot data demonstrate efficacy, then a multi-site randomized control trial will be conducted to evaluate program effectiveness and implementation.