Faculty Bibliography

INTRODUCTION/BACKGROUND:Poor social connection is a risk factor for mortality comparable to smoking or obesity. Expert recommendations encourage clinicians to identify and address isolation, loneliness and absent social support; however, screening and documentation norms remain unstandardised in graduate medical education (GME) social determinants of health (SDOH) curricula. We assessed the knowledge, attitudes, and behaviours (KAB) of internal medicine resident physicians in a large, urban, academic medical centre regarding screening for and documenting social connection. METHODS:Between October 2022 and February 2023, a voluntary, anonymous mixed-methods survey was disseminated to assess resident physicians' KAB about social connection as a SDOH. Quantitative data were analysed descriptively. Qualitative responses underwent content analysis. An electronic medical record (EMR) chart review of resident notes corroborated survey data. RESULTS:Sixty-three residents of an eligible 153 responded to the survey (41% participation). Sixty-five per cent reported never receiving formal GME about social connection as a SDOH. Familiarity with validated screening tools was low. Although 51% of respondents reported often/always documenting patients' social support systems, few chart notes explicitly mentioned social contacts. Respondents agreed that physicians are responsible for assessing and documenting social connection and noted key challenges of time constraints, inadequate screening and documentation norms and EMR navigation difficulty. Targeted didactics, EMR improvements and interdisciplinary learning opportunities were identified as potential solutions. CONCLUSIONS:This study identified notable gaps in resident physician KAB to address social connection as a SDOH. Challenges could be addressed with standardised screening and documentation norms and skill development in patient communication and interdisciplinary teamwork.

OBJECTIVE:Chronic social isolation is a risk factor for all-cause mortality and disease progression, but is not routinely screened for in clinical settings. This study analyzed provider-patient communication patterns about social influences during primary care encounters, to identify opportunities to screen for objective or perceived social isolation. METHODS:Content analysis was conducted on transcripts of 97 audiotaped, English-speaking patient encounters with 27 primary care providers at 3 safety-net primary care centers in New York City. Conversations were first coded for specific social isolation screening, then more broadly to quantify and qualify how social influences were discussed in relation to health. RESULTS:Transcripts included no explicit examples of social isolation screening. Social influences on health were discussed meaningfully in only 28 % of transcripts, compared to medication adherence (93 %) and diet (64 %). Patients initiated conversations about social influences on health twice as often as providers, however providers did not acknowledge 67% of these prompts. CONCLUSION:Social influences on health, including social isolation, were uncommonly discussed in this sample of primary care visits. When social influences were discussed meaningfully, providers utilized relationship-centered communication strategies. PRACTICE IMPLICATIONS:Strategic conversations about social influences, even when brief and informal, can effectively screen patients for social isolation.

In isolation, we are physically apart; in solidarity, we are together. The COVID-19 pandemic emphasizes our social responsibility to maintain physical distance from one another. In doing so, we solidify our collective strength.

During spaceflight, the human cardiovascular system undergoes major changes primarily related to the effects of decreased gravitational force, or microgravity, on the human body. These changes present challenges to human adaptation and operation in space. This article reviews the knowledge gained in human experiments in the past half century of spaceflight, and summarizes our knowledge on the effects of short- and long-duration microgravity exposure on cardiovascular physiology and functioning, including fluid redistribution, autonomic reflexes, cardiac parameters, orthostatic intolerance, arrhythmias, aerobic capacity, and cardiac atrophy. This review also discusses current countermeasures for risk reduction during spaceflight, as well as future directions in cardiovascular research in space.