Category: Nevin Manimala

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002250. Online ahead of print.

ABSTRACT

OBJECTIVES: We examined the relationship between a prior history of gestational diabetes mellitus (pGDM) and risk of incident nonalcoholic fatty liver disease (NAFLD) and investigated the effect of insulin resistance or development of diabetes as mediators of any association.

METHODS: We performed a retrospective cohort study of 64,397 Korean parous women without NAFLD. The presence of, and the severity of NAFLD at baseline and follow-up were assessed using liver ultrasonography. Cox proportional hazards models were used to determine adjusted hazard ratios (aHRs) for incident NAFLD according to a self-reported GDM history, adjusting for confounders as time-dependent variables. Mediation analyses were performed to examine whether diabetes or insulin resistance may mediate the association between pGDM and incident NAFLD.

RESULTS: During a median follow-up of 3.7 years, 6,032 women developed incident NAFLD (of whom 343 had moderate-to-severe NAFLD). Multivariable aHRs (95% confidence intervals) comparing women with time-dependent pGDM to the reference group (no pGDM) was 1.46 (1.33-1.59) and 1.75 (1.25-2.44) for incident overall NAFLD and moderate-to-severe NAFLD, respectively. These associations remained significant in analyses restricted to women with normal fasting glucose <100 mg/dl or that excluded women with prevalent diabetes at baseline or incident diabetes during follow-up. Diabetes and insulin resistance (HOMA-IR) each mediated <10% of the association between pGDM and overall NAFLD development.

CONCLUSIONS: A prior history of GDM is an independent risk factor for NAFLD development. Insulin resistance, measured by HOMA-IR, and development of diabetes each explained only <10% of the association between GDM and incident NAFLD.

PMID:36940424 | DOI:10.14309/ajg.0000000000002250

Am J Gastroenterol. 2023 Mar 20. doi: 10.14309/ajg.0000000000002258. Online ahead of print.

ABSTRACT

IntroductionIntrahepatic cholangiocarcinoma (iCCA) is a primary liver malignancy with poor prognosis. Current prognostic methods are most accurate for patients with surgically-resectable disease. However, a significant proportion of patients with iCCA are not surgical candidates. We aimed to develop a generalizable staging system based on clinical variables to determine prognosis of all iCCA patients.MethodsThe derivation cohort included 436 patients with iCCA seen between 2000 and 2011. For external validation, 249 patients with iCCA seen from 2000 to 2014 were enrolled. Survival analysis was performed to identify prognostic predictors. All-cause mortality was the primary end-point.ResultsEastern Cooperative Oncology Group (ECOG) status, tumor number, tumor size, metastasis, albumin, and CA 19-9 were incorporated into a 4-stage algorithm. Kaplan Meier estimates for 1-year survival were 87.1% (95%CI 76.1-99.7), 72.7% (95%CI 63.4-83.4), 48.0% (95%CI 41.2-56.0) and 16% (95%CI 11-23.5), respectively for stages I, II, III, and IV. Univariate analysis yielded significant differences in risk of death for stages II (HR:1.71; 95%CI 1.0-2.8), III (HR:3.32; 95%CI 2.07-5.31), and IV (HR:7.44; 95%CI 4.61-12.01) compared to stage I (reference). Concordance indices showed the new staging system was superior to the TNM staging for predicting mortality in the derivation cohort, p-value <0.0001. In the validation cohort however, the difference between the 2 staging systems was not significant.DiscussionThe proposed independently-validated staging system uses non-histopathologic data to successfully stratify patients into four stages. This staging system has better prognostic accuracy compared to the TNM staging and can assist physicians and patients in treatment of iCCA.

PMID:36940423 | DOI:10.14309/ajg.0000000000002258

J Osteopath Med. 2023 Mar 21. doi: 10.1515/jom-2021-0102. Online ahead of print.

ABSTRACT

CONTEXT: The language proficiencies of Michigan State University College of Osteopathic Medicine (MSUCOM) medical students are unknown. As of 2015, approximately 8% (or roughly 25 million) of the US population over the age of five were considered “limited English proficient”. Research indicates, however, that it is valuable to patients to be able to communicate in their primary language with their primary care physician. If medical students’ language proficiencies were known, the medical school curriculum could be adapted to leverage or enhance a student’s language proficiencies, preparing students to serve in communities where their patients language proficiencies align.

OBJECTIVES: The aim of this pilot study was to survey MSUCOM medical students in order to assess their language proficiencies with two goals in mind: first, to develop medical school curriculum that would leverage student’s language proficiencies, and second, to encourage student placement within diverse communities throughout the state of Michigan where these physicians-in-training speak or understand the primary language of the local community to better serve patients.

METHODS: For this cross-sectional descriptive pilot study, a short, author-created survey was sent to 1,226 osteopathic medical students (OMS-I to OMS-IV) at MSUCOM. Participants were asked questions pertaining to language proficiency, number of languages spoken, prior exposure to education abroad, and demographic information. All participant data were only reported in grouped, collective, de-identified terms. Descriptive statistical analyses (frequencies, percentages) were calculated utilizing SPSS Version 25 software.

RESULTS: Over the course of several months, 698 (58.7%) current MSUCOM medical students participated in the study. Of those students, 382 (54.7%) responded that they were multilingual. The top three second languages reported spoken were: English 332 (47.6%), Spanish 169 (24.2%), and Arabic 64 (9.2%). In addition, 249 (37.2%) said they had prior exposure to education abroad, and 177 (26.4%) said they had lived in another country for more than 6 months.

CONCLUSIONS: The majority, 382 (54.7%), of the MSUCOM students who participated in the survey have some degree of multilingual capabilities. The student population at MSUCOM may benefit from completing primary care rotations in diverse communities within the state of Michigan. Likewise, the communities throughout Michigan may benefit from having bilingual and multilingual medical students serve in their medical facilities. Further research on the efficacy of leveraging language skills in various communities, as well as broadening the population sample, is warranted to refine and validate the observed pilot study results.

PMID:36940418 | DOI:10.1515/jom-2021-0102

Acad Med. 2023 Mar 17. doi: 10.1097/ACM.0000000000005212. Online ahead of print.

ABSTRACT

Translational research is a data-driven process that involves transforming scientific laboratory- and clinic-based discoveries into products and activities with real-world impact to improve individual and population health. Successful execution of translational research requires collaboration between clinical and translational science researchers, who have expertise in a wide variety of domains across the field of medicine, and qualitative and quantitative scientists, who have specialized methodologic expertise across diverse methodologic domains. While many institutions are working to build networks of these specialists, a formalized process is needed to help researchers navigate the network to find the best match and to track the navigation process to evaluate an institution’s unmet collaborative needs. In 2018, a novel analytic resource navigation process was developed at Duke University to connect potential collaborators, leverage resources, and foster a community of researchers and scientists. This analytic resource navigation process can be readily adopted by other academic medical centers. The process relies on navigators with broad qualitative and quantitative methodologic knowledge, strong communication and leadership skills, and extensive collaborative experience. The essential elements of the analytic resource navigation process are as follows: (1) strong institutional knowledge of methodologic expertise and access to analytic resources, (2) deep understanding of research needs and methodologic expertise, (3) education of researchers on the role of qualitative and quantitative scientists in the research project, and (4) ongoing evaluation of the analytic resource navigation process to inform improvements. Navigators help researchers determine the type of expertise needed, search the institution to find potential collaborators with that expertise, and document the process to evaluate unmet needs. Although the navigation process can create a basis for an effective solution, some challenges remain, such as having resources to train navigators, comprehensively identifying all potential collaborators, and keeping updated information about resources as methodologists join and leave the institution.

PMID:36940408 | DOI:10.1097/ACM.0000000000005212

Clin Transl Gastroenterol. 2023 Mar 20. doi: 10.14309/ctg.0000000000000583. Online ahead of print.

ABSTRACT

INTRODUCTION: Population health interventions to increase colorectal cancer (CRC) screening rates often exclude individuals with a family history of CRC, and interventions to increase screening in this high-risk group are rare. We aimed to determine the screening rate and barriers and facilitators to screening in this population to inform interventions to increase screening participation.

METHODS: We performed a retrospective chart review and cross-sectional survey of patients excluded from mailed fecal immunochemical test (FIT) outreach due to a family history of CRC in a large health system. We used Chi-square, Fisher’s exact, and Student’s t-tests to compare demographic and clinical characteristics of individuals overdue and not overdue for screening. We then administered a survey (mailed and telephone) to overdue patients to assess barriers and facilitators to screening.

RESULTS: There were 296 patients excluded from mailed FIT outreach and 233 had a confirmed family history of CRC. Screening participation was low (21.9%), and there were no significant demographic or clinical differences between those overdue and not overdue for screening. There were 79 survey participants. Major patient-reported barriers to screening colonoscopy were patient forgetfulness (35.9%), fear of pain during colonoscopy (17.7%), and hesitancy about bowel preparation (29.4%). To facilitate screening colonoscopy, patients recommended reminders (56.3%), education about familial risk (50%), and colonoscopy education (35.9%).

CONCLUSIONS: Patients with a family history of CRC that are excluded from mailed FIT outreach have low screening rates and report multiple mutable barriers to screening. They warrant targeted efforts to increase screening participation.

PMID:36940400 | DOI:10.14309/ctg.0000000000000583

Adv Skin Wound Care. 2023 Apr 1;36(4):201-204. doi: 10.1097/01.ASW.0000919480.14665.e7.

ABSTRACT

OBJECTIVE: To determine (1) if offloading with a felt foot plate heals a diabetic foot ulcer, (2) the rate of healing with the felt foot plate, and (3) the impact on rate of healing from the confounding factors of patient weight and growth factors on healing times.

METHODS: The researchers conducted a retrospective chart cohort review over 3 years.

RESULTS: Using a multivariable linear and logistic regression model, the data showed a statistically significant reduction in the diabetic foot ulcer area over time. Confounding factors of patient weight and growth factors did not impact healing times.

CONCLUSIONS: Offloading a diabetic foot ulcer with a felt foot plate is adequate for healing.

PMID:36940376 | DOI:10.1097/01.ASW.0000919480.14665.e7

J Clin Ethics. 2023 Spring;34(1):103-109. doi: 10.1086/723321.

ABSTRACT

AbstractPurpose: Tolerance for ambiguity (TFA) is a character trait that is associated with a multitude of benefits for physicians, including increased empathy, greater desire to work in underserved areas, fewer medical errors, enhanced psychological well-being, and lower rates of burnout. Furthermore, it has been shown that TFA is a malleable trait that can be enhanced with interventions such as art courses and group reflection. This study describes the utility of a six-week medical ethics elective course in increasing TFA in first- and second-year medical students.Methods: First- and second-year medical students were enrolled in an elective medical ethics course at Cooper Medical School of Rowan University that guided students in critical thinking, group discussion, and respectful debate regarding various ethical dilemmas in medicine. Students took a validated survey before and after course completion to measure TFA. The average pre- and post-course scores for each semester, as well as the total cohort of 119 students, were compared using paired t-tests.Results: A statistically significant improvement in TFA scores was observed in the overall cohort, as well as in each individual semester of the medical ethics elective course offering.Conclusion: A six-week elective course in medical ethics can significantly improve medical students’ TFA.

PMID:36940358 | DOI:10.1086/723321

Proc Natl Acad Sci U S A. 2023 Mar 28;120(13):e2214382120. doi: 10.1073/pnas.2214382120. Epub 2023 Mar 20.

ABSTRACT

The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) matter for older people in taking on precautionary behaviors (e.g., wearing a mask) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June to September 2020 and June to August 2021) with pre-COVID information (October 2019 to March 2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance and to accounting for coresidence with kin. Our findings suggest that policymakers and practitioners may differently address kinless individuals when promoting public policy measures.

PMID:36940329 | DOI:10.1073/pnas.2214382120

Proc Natl Acad Sci U S A. 2023 Mar 28;120(13):e2221311120. doi: 10.1073/pnas.2221311120. Epub 2023 Mar 20.

ABSTRACT

Leveraging a scientific infrastructure for exploring how students learn, we have developed cognitive and statistical models of skill acquisition and used them to understand fundamental similarities and differences across learners. Our primary question was why do some students learn faster than others? Or, do they? We model data from student performance on groups of tasks that assess the same skill component and that provide follow-up instruction on student errors. Our models estimate, for both students and skills, initial correctness and learning rate, that is, the increase in correctness after each practice opportunity. We applied our models to 1.3 million observations across 27 datasets of student interactions with online practice systems in the context of elementary to college courses in math, science, and language. Despite the availability of up-front verbal instruction, like lectures and readings, students demonstrate modest initial prepractice performance, at about 65% accuracy. Despite being in the same course, students’ initial performance varies substantially from about 55% correct for those in the lower half to 75% for those in the upper half. In contrast, and much to our surprise, we found students to be astonishingly similar in estimated learning rate, typically increasing by about 0.1 log odds or 2.5% in accuracy per opportunity. These findings pose a challenge for theories of learning to explain the odd combination of large variation in student initial performance and striking regularity in student learning rate.

PMID:36940328 | DOI:10.1073/pnas.2221311120

Telemed J E Health. 2023 Mar 20. doi: 10.1089/tmj.2022.0483. Online ahead of print.

ABSTRACT

Purpose: To understand provider preferences regarding telemedicine across clinical departments and provider demographic groups. Methods: A cross-sectional online survey was distributed to providers at Johns Hopkins Medicine who had completed at least one outpatient telemedicine encounter. The survey included questions about clinical appropriateness and preferred use of telemedicine. Demographic data were obtained from institutional records. Descriptive statistics provided a profile of provider responses. Wilcoxon rank sum tests evaluated departmental and demographic differences. Results: A total of 1,342 of 3,576 providers responded (37.5%). Providers indicated that telemedicine was clinically appropriate for new patients a median of 31.5% of the time (Range: 20% in pediatrics, 80% in psychiatry/behavioral sciences). For existing patients, providers indicated that telemedicine was clinically appropriate a median of 70% of the time (Range: 50% in physical medicine, 90% in psychiatry/behavioral sciences). Providers desired a median of 30% of their schedule template be dedicated to telemedicine (Range: 20% in family medicine, 70% in psychiatry/behavioral sciences). Providers who were female, had fewer than 15 years in practice, or were psychiatrists/psychologists tended to find telemedicine more clinically appropriate (p < 0.05). Conclusions: A majority of providers across clinical departments felt that high-quality care could be delivered through telemedicine, although the amount of care varied widely based on department and patient type. Preferences for future telemedicine similarly showed wide variety across and within departments. These findings indicate that in this early adoption phase of widespread telemedicine integration, there is lack of consensus among providers about the amount of telemedicine appropriate for everyday practice.

PMID:36940314 | DOI:10.1089/tmj.2022.0483