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Author: Brian S McGowan, PhD

ABSTRACT: A Patient-centered Approach to Managing Patients with Type 2 Diabetes

Despite the availability of a number of therapeutic options, management of type 2 diabetes (T2DM) and hyperglycemia remains suboptimal. Evidence shows that physicians are not adequately individualizing incretin-based therapies as there is lack of clear understanding of the similarities and differences between various incretin-based therapies. Additionally, sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors, a very recent addition to the therapeutic armamentarium, are not adequately utilized in managing patients with T2DM due to a lack of awareness or an increased concern regarding their safety, efficacy, and the mechanism of action. Insulin therapy is also not initiated or intensified appropriately due to a lack of clear understanding on when to add and how to intensify them and, more importantly, due to fear of increasing the risk of hypoglycemia in patients. To address these gaps, in the first section of this educational activity, the expert faculty will review the current understanding of the risks associated with hypoglycemia-one of the main factors that limit the successful use of insulin therapy-and when to initiate insulin therapy, as well as the available data on the risk of hypoglycemia with emerging agents. The expert faculty will also provide practical strategies on how to minimize the risk of hypoglycemia in patients. In the second section, the expert faculty will highlight the differences between the various incretin-based therapies in addition to providing strategies for physicians to individualize their choice of incretin-based therapy. The expert faculty will also review the mechanism of action, safety, efficacy, and the appropriate place for this class of therapies in the treatment continuum. In the third section, the expert faculty will discuss the mechanism of action, safety, and efficacy of the currently available SGLT2 inhibitors as well as the appropriate use of these newer agents in T2DM management.

via A Patient-centered Approach to Managing Patients with Type 2 Diabetes. – PubMed – NCBI.

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ABSTRACT: Polycystic ovary syndrome: A review for dermatologists: Part II. Treatment

Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman’s specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence.

via Polycystic ovary syndrome: A review for dermatologists: Part II. Tr… – PubMed – NCBI.

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ABSTRACT: Polycystic ovary syndrome: A review for dermatologists: Part I. Diagnosis and manifestations.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women who are of reproductive age. The pathogenesis involves several associated hormonal pathways that culminate in metabolic, reproductive, and cardiovascular effects. The hallmark features of hyperandrogenism and hyperinsulinemia have systemic long-term implications. Dermatologists frequently evaluate and manage the cutaneous manifestations of PCOS (ie, acanthosis nigricans, hirsutism, acne, and alopecia), and therefore play a key role in its diagnosis and management. In part I of this continuing medical education article, we review the definition, etiology, pathogenesis, and clinical features of PCOS.

via Polycystic ovary syndrome: A review for dermatologists: Part I. Dia… – PubMed – NCBI.

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ABSTRACT: Embedding Quality and Safety in Otolaryngology-Head and Neck Surgery Education

Education in patient safety (PS) and quality improvement (QI) helps both medical students and residents understand the health care environment in the United States, where these concepts are now incorporated into virtually every aspect of patient care. The Accreditation Council of Graduate Medical Education has made PS/QI a mandatory component of resident education, and a number of specialties have published their experiences with incorporating PS/QI into their training programs. In otolaryngology-head and neck surgery, a strong curriculum can be built by teaching residents about the principles of PS/QI through both didactic and experiential learning, and morbidity and mortality and QI conferences can serve as the cornerstone of this curriculum. Understanding the potential challenges in PS/QI education can allow training programs to plan their strategy effectively for successful incorporation into their existing curricula.

via Embedding Quality and Safety in Otolaryngology-Head and Neck Surger… – PubMed – NCBI.

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ABSTRACT: Variability in Spine Surgery Procedures Performed During Orthopaedic and Neurological Surgery Residency Training: An Analysis of ACGME Case Log Data

BACKGROUND:

Current spine surgeon training in the United States consists of either an orthopaedic or neurological surgery residency, followed by an optional spine surgery fellowship. Resident spine surgery procedure volume may vary between and within specialties.

METHODS:

The Accreditation Council for Graduate Medical Education surgical case logs for graduating orthopaedic surgery and neurosurgery residents from 2009 to 2012 were examined and were compared for spine surgery resident experience.

RESULTS:

The average number of reported spine surgery procedures performed during residency was 160.2 spine surgery procedures performed by orthopaedic surgery residents and 375.0 procedures performed by neurosurgery residents; the mean difference of 214.8 procedures (95% confidence interval, 196.3 to 231.7 procedures) was significant (p = 0.002). From 2009 to 2012, the average total spinal surgery procedures logged by orthopaedic surgery residents increased 24.3% from 141.1 to 175.4 procedures, and those logged by neurosurgery residents increased 6.5% from 367.9 to 391.8 procedures. There was a significant difference (p < 0.002) in the average number of spinal deformity procedures between graduating orthopaedic surgery residents (9.5 procedures) and graduating neurosurgery residents (2.0 procedures). There was substantial variability in spine surgery exposure within both specialties; when comparing the top 10% and bottom 10% of 2012 graduates for spinal instrumentation or arthrodesis procedures, there was a 13.1-fold difference for orthopaedic surgery residents and an 8.3-fold difference for neurosurgery residents.

CONCLUSIONS:

Spine surgery procedure volumes in orthopaedic and neurosurgery residency training programs vary greatly both within and between specialties. Although orthopaedic surgery residents had an increase in the number of spine procedures that they performed from 2009 to 2012, they averaged less than half of the number of spine procedures performed by neurological surgery residents. However, orthopaedic surgery residents appear to have greater exposure to spinal deformity than neurosurgery residents. Furthermore, orthopaedic spine fellowship training provides additional spine surgery case exposure of approximately 300 to 500 procedures; thus, before entering independent practice, when compared with neurosurgery residents, most orthopaedic spine surgeons complete as many spinal procedures or more. Although case volume is not the sole determinant of surgical skills or clinical decision making, variability in spine surgery procedure volume does exist among residency programs in the United States.

via Variability in Spine Surgery Procedures Performed During Orthopaedi… – PubMed – NCBI.

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ABSTRACT: Happiness, stress, a bit of vulgarity, and lots of discursive conversation: A pilot study examining nursing students’ tweets about nursing education posted to Twitter.

BACKGROUND:
The use of social media platforms like Twitter within/for nursing education has become more common in recent years. Regardless, it is unclear how nursing students use technology like Twitter during the course of their nursing education.
AIM:
The aim of this paper was to explore how nursing students describe elements of their nursing education via the social media platform, Twitter.
METHODS:
Tweets about nursing courses, classes, and clinical were collected in October 2011 and analyzed for themes. Overall, 498 tweets were collected over a collective six day period, and 189 tweets were codified into five thematic representations.
FINDINGS:
Nursing students were found to discuss a variety of elements related to their nursing education, including events and situations they perceived to be positive or exciting. Stress and annoyance messaging was also noted as a salient theme expressed by nursing students when describing their education. Vulgarity and derogative messaging targeting elements of nursing education (including courses, students, and faculty) were found in a subset of tweets. The majority of the tweets collected in this study contained random discursive conversations regarding nursing education, including information seeking requests and declarative statements about temporal events.
CONCLUSIONS:
The findings of this study point to a need for educators to explore aspects surrounding eProfessionalism within nursing education. Similarly, this paper also highlights the growing requirement for nursing educators to learn more about how social media is being used by nursing students within/for their education, in order to better develop learning and networking opportunities for students. Without this, nursing education may miss a significant opportunity to help shape students’ professional use of social media technology like Twitter.

via Happiness, stress, a bit of vulgarity, and lots of discursive conve… – PubMed – NCBI.

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ABSTRACT: An exploration of the use of social media by surgical colleges

Background: Social media use has become common for organisations in surgery, however the nature and reach of these communications is unknown. This study aimed to characterise and compare the use of “Twitter” by five prominent organisations in surgery. Study Design: Data were collected from Twitter and the scale, reach, nature and sentiment of messages analysed. Message influence was determined and content analysed by frequency and association using hierarchical clustering and network analysis. Poisson regression was used to compare institutional message and “re-tweet” counts. Results: 7712 messages were analysed from a four-year period up to 13th April 2013. The American College of Surgeons (ACS) had tweeted most and posted the greatest number of messages per day (3.3/day). The number of followers reflects social reach and the Royal College of Surgeons of England (RCSEng) had the greatest number (11,600) followed by the ACS (7320). The number of “retweets” a message receives is a measure of influence with the RCSEng (2.0) demonstrating a significantly greater count than the Royal College of Surgeons of Ireland (RCSI; 0.8, p < 0.001) and the ACS (1.3, p < 0.001). Followers of the RCSEng and ACS appeared most influential. Terms relating to education feature prominently in messages posted by the RCSEng and RCSEd, but less so in those from the RCSI and ACS. Education and training terms were highly correlated with “events”. Conclusions: Surgical colleges have significant international reach through social media. UK colleges frequently communicate about education/training opportunities while the ACS focuses on patient-related matters. Only one organisation was found to have an explicit social media policy, which would be considered best practice and can focus on-line activity.

via An exploration of the use of social media by surgical colleges. – PubMed – NCBI.

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ABSTRACT: The impact of social media on readership of a peer-reviewed medical journal.

PURPOSE:
Social media microblogging has made major inroads in physician education and information exchange. The authors evaluated their early experience with Twitter “tweet chat” sessions as a medium to expand the reach and audience of a peer-reviewed radiology journal.
METHODS:
The authors analyzed Twitter activity metadata tagged with the #JACR hashtag from the first 6 tweet chat sessions sponsored and promoted by JACR. The assessment included multiple metrics: radiologist versus nonradiologist session participants, individual tweets, tweets with embedded web links, common words, retweets, and impressions. We correlated Twitter metrics with temporally related journal website activity.
RESULTS:
Each session generated a mean of 444 ± 172 tweets contributed by a mean of 33 ± 14 participants (45.4% nonradiologists) and resulted in a mean of 1,163,712 ± 441,971 impressions. Per session, a mean of 19 ± 7.6 tweets contained web links, and 138 ± 35.6 tweets were retweets. Monthly journal website article views increased from 31,220 to 41,017 (+31.4%), journal website visits increased from 9,192 to 11,539 (+25.5%), and unique visitors increased from 7,368 to 8,841 (+20%). Since JACR tweet chats were initiated, mean monthly journal website visits and page views per month directly from twitter.com increased from 24 to 101 (+321%) and from 38 to 159 (+318%), respectively.
CONCLUSIONS:
Early experience with JACR tweet chats demonstrates that organizing Twitter microblogging activities around topics of general interest to their target readership bears the potential for medical journals to increase their audiences and reach.

via The impact of social media on readership of a peer-reviewed medical… – PubMed – NCBI.

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ABSTRACT: Embedding Patient Simulation in a Pediatric Cardiology Rotation: A Unique Opportunity for Improving Resident Education

OBJECTIVE:
High-fidelity patient simulation (HFPS) has been used in medical education to bridge gaps in medical knowledge and clinical skills. Few studies have analyzed the impact of HFPS in subspecialty rotations for pediatric residents. We hypothesized that pediatric residents exposed to HFPS with a structured content curriculum would perform better on a case quiz than residents without exposure to HFPS.
DESIGN:
Prospective randomized controlled SETTING: Tertiary-care free standing children’s hospital INTERVENTIONS: During a cardiology rotation, senior pediatric residents completed an online pediatric cardiology curriculum and a cardiology quiz. After randomization into two groups, the study group participated in a fully debriefed HFPS session. The control group had no HFPS.
OUTCOME MEASURE:
Both groups completed a case quiz. Confidence surveys pre- and postsimulation were completed.
RESULTS:
From October 2010 through March 2013, 55 residents who rotated through the pediatric cardiology rotation were used in the final analysis (30 control, 25 in the study group). There was no significant difference between groups on the initial cardiology quiz. The study group scored higher on the case quiz compared with the control group (P = .024). Based on pre- and postsimulation questionnaires, residents’ confidence in approaching a pediatric cardiology patient improved from an average Likert score of 5.1 to 7.5 (on scale of 0-10) (P < .001).
CONCLUSIONS:
Incorporation of HFPS into a preexisting pediatric cardiology rotation was feasible and well received. Our study suggests that simulation promotes increased confidence and may modestly improve clinical reasoning compared to traditional educational techniques. Targeted simulation sessions may readily be incorporated into pediatric subspecialty rotations.

via Embedding Patient Simulation in a Pediatric Cardiology Rotation: A … – PubMed – NCBI.

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MANUSCRIPT: Physician as teacher: Promoting health and wellness among elementary school students

BACKGROUND:
Every day, physicians engage in teaching during their patient encounters. It may be that medical students who are introduced to the principles of teaching and learning are more likely to become good communicators and learners. Service-learning may be an effective way for medical students to practice skills in teaching and communication in a real-world setting, while also filling a need within the community. The purpose of this study was to identify common themes within medical students’ reflections on what they learned through participating in a teaching exercise with local elementary school children.
METHODS:
As a required component of a longitudinal prevention and public health course that spans the first and second years of undergraduate medical education, second year students at the Oakland University William Beaumont School of Medicine, in Detroit, Michigan, in the USA completed a service-learning activity, which included teaching a standardized curricular module to local elementary school children. Students were required to complete a reflection assignment based on their teaching experience. Medical students’ responses to assignment’s three guided questions were qualitatively coded to identify common themes among the responses related to the teaching activity.
RESULTS:
Qualitative analysis of students’ reflections revealed several themes regarding what the students learned and viewed as the benefits of the activity: The importance of early education and parental involvement; the importance of understanding your audience when teaching; the importance of simplifying complex concepts to the audience’s level; and the importance of preparation for teaching. Medical students identified the difficulties of communicating at an audience appropriate level and providing patient education outside the confines of a controlled classroom setting.
DISCUSSION:
This activity provided medical students with hands-on experience presenting to an audience age-appropriate, health-related topics. Presenting in an elementary school environment helped students better understand what health information various age groups knew about and the importance of clarifying information when communicating with a younger audience.

via Physician as teacher: Promoting health and wellness among elementar… – PubMed – NCBI.

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