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Continuous Glucose Monitoring User-Wear Experience Fosters Empathy and Learning
No full textOBJECTIVE: To determine if a continuous glucose monitoring (CGM) user-wear experience brings value to an advanced diabetes elective course by assessing the impact on empathy and knowledge.
METHODS: This was a quasi-experimental pre-post intervention study, conducted over 2 offerings of an advanced diabetes elective course. Third-year pharmacy students participated in a 2-part didactic education and user-wear experience involving CGM devices. Students completed a survey at 3 prespecified time points to assess empathy and knowledge (foundational and counseling knowledge). Empathy was assessed using the Kiersma-Chen empathy scale. Knowledge was assessed using predefined multiple-choice questions. Statistical tests include repeated measures analysis of variance and Bonferroni tests for overall and subsection scores on the empathy and knowledge surveys. A partial eta squared was also used to measure effect size for the repeated measures analysis of variance test.
RESULTS: Twenty-nine out of the 36 enrolled students completed all 3 surveys. Compared with a traditional lecture, the CGM user-wear experience demonstrated a significant increase in student self-perceived empathy and counseling knowledge. No change in foundational knowledge was observed.
CONCLUSION: A CGM user-wear experience provides educational value beyond a traditional lecture. Our study showed that educational outcomes such as empathy and counseling knowledge can be achieved by implementing a CGM user-wear experience. An advanced diabetes elective course provides an ideal environment to optimize CGM learning outcomes with a user-wear experience
Fluoroscopy-Guided Intracardiac Echocardiography Navigation: A Novel Landmark-Based Imaging Technique for Transcatheter Tricuspid Valve Replacement
No full textSalary Differences by Gender, Race, and Ethnicity Among Assistant Professors at US Medical Schools
No full textIMPORTANCE: Salary inequities by gender are well documented in medicine, but there is limited understanding of racial and ethnic disparities or how these intersect with gender across clinical specialties.
OBJECTIVE: To determine whether salaries for assistant professors at US medical schools differ by gender, race and ethnicity, and gender-race-ethnicity intersections across clinical specialties.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of medical school assistant professor faculty salary data assessed 19 clinical specialties by gender, race and ethnicity, and gender-race-ethnicity intersections. Aggregated data were obtained from the Association of American Medical Colleges Faculty Salary Report for 2022 to 2023 for assistant professors at 153 US medical schools.
EXPOSURES: Gender, race and ethnicity, and gender-race-ethnicity.
MAIN OUTCOMES AND MEASURES: Median annual salary and salary ratios were calculated for assistant professors across gender, race and ethnicity, and at their intersections for the 2022-2023 academic year. Salary ratios compared women with men, Asian and underrepresented in medicine (URIM) faculty to White faculty, and various gender-race-ethnicity subgroups to White men.
RESULTS: In this cross-sectional study of 45 906 assistant professor faculty members from 19 clinical specialties in 2022 and 2023, there were 23 538 (51%) men and 22 368 (49%) women, with a racial and ethnic composition of 10 294 (27%) Asian, 4543 (12%) URIM, and 23 781 (62%) White. Across all specialties, women (median annual salary, 0.81:330 000). Asian (median annual salary, 0.97:278 010; salary ratio, 1.00) physicians were paid less than White physicians (median annual salary, 259 570; salary ratio, 1.00) compared with White men (median annual salary, $333 800).
CONCLUSIONS AND RELEVANCE: This cross-sectional study of assistant professor faculty across 19 clinical specialties found salary disparities, with Asian and URIM, both men and women, receiving lower pay than White men. These findings suggest the need to address salary inequities in academia using an intersectional approach that considers both gender and race and ethnicity
A Comparison of Outcomes With Apixaban, Rivaroxaban, and Warfarin for Atrial Fibrillation and/or Venous Thromboembolism
No full textBACKGROUND: Apixaban and rivaroxaban are commonly used direct oral anticoagulants for atrial fibrillation (AF) and venous thromboembolism (VTE). Both have been compared to warfarin, but there are insufficient comparative outcome data.
OBJECTIVES: The purpose of this study was to assess outcomes of apixaban, rivaroxaban, and warfarin.
METHODS: This is a registry-based cohort study with data from 6 centers in Michigan, 2009 to 2023. Patients were adults with AF and/or VTE with at least 3 months of follow-up. Outcomes included rates of bleeding, thrombosis, healthcare utilization, and death.
RESULTS: A total of 13,435 patients met the study inclusion criteria (average age 66.7 years, 58.0% on anticoagulation for AF, average follow-up 28.2 months). After matching, 2 groups of 3,527 patients on apixaban and warfarin were compared. Any bleeding was similar between groups, but major bleeding was less with apixaban. Thrombotic event rates were higher with apixaban. Mortality, rates of emergency room visits, and hospitalizations for bleeding were higher with warfarin. After matching, 1,395 patients on rivaroxaban were compared to 4,185 patients on warfarin. Any bleeding and major bleeding were higher with rivaroxaban. Thrombotic event rates were similar, aside from a higher rate of other thrombosis with rivaroxaban. After matching, 2 groups of 1,395 patients on apixaban and rivaroxaban were compared. Any bleeding, major bleeding, and mortality were higher with rivaroxaban. Thrombotic event rates were similar.
CONCLUSIONS: For patients with AF and/or VTE, we observed that bleeding was highest with rivaroxaban, followed by warfarin, and then apixaban. Rates of thrombosis were higher with apixaban than with warfarin, largely driven by other thrombotic events
EFFICACY OF SPLIT-THICKNESS THIN AMNIOTIC MEMBRANE GRAFT FOR CLOSURE OF REFRACTORY OR LARGE MACULAR HOLES
No full textPURPOSE: To assess the effectiveness of split-thickness amniotic membrane grafts in achieving closure of refractory or large macular holes (MH).
METHODS: This retrospective study reviewed data from patients who underwent surgical repair of MHs using split-thickness amniotic membrane grafts between January 2019 and December 2023. Key parameters, including best-corrected visual acuity and MH size, were evaluated both preoperatively and postoperatively.
RESULTS: The study included 13 patients (nine females; mean age 63.5 years). Before surgery, the median best-corrected visual acuity was 1.30 ± 0.56 logarithmic measure of angle of resolution (approximate Snellen equivalent: 20/400) and the median MH size measured 717 ± 246.6 µ m. After an average follow-up period of 28 months, the median best-corrected visual acuity improved significantly to 1.00 ± 0.52 logarithmic measure of angle of resolution ( P \u3c 0.05) (approximate Snellen equivalent: 20/200). All MHs were successfully closed, and no intraoperative complications were observed.
CONCLUSION: Split-thickness amniotic membrane grafting is a safe and reliable option for closing refractory or large MHs, resulting in significant improvements in best-corrected visual acuity and successful hole closure. Compared with full-thickness grafts, split-thickness amniotic membrane grafts offer advantages such as increased flexibility in placement and ease of removal post-closure, due to their thinner and more pliable nature, which facilitates easier handling and positioning within the MH
Improved patient outcomes and range of motion following primary and revision reverse total shoulder arthroplasty utilizing a custom glenoid implant for glenoid deficiency
No full textDocosahexaenoic acid (DHA) supplementation attenuates changes in the concentration, phenotype, and response of immune peripheral blood cells in breast cancer patients undergoing neoadjuvant therapy. Secondary findings from the DHA-WIN trial
No full textBACKGROUND: Breast cancer neoadjuvant therapy may negatively impact the immune system. As a secondary outcome of the docosahexaenoic acid (DHA) for women with breast cancer in the neoadjuvant setting (DHA-WIN trial), we sought to assess the effects of an intervention with DHA on parameters of immune function of women undergoing neoadjuvant therapy.
METHODS: Women with early-stage breast cancer in the neoadjuvant setting were recruited for the DHA-WIN trial and randomly assigned to receive either 4.4 g/day of DHA or a placebo for 18 weeks in conjunction with their neoadjuvant chemotherapy for breast cancer. Venous blood was collected to isolate peripheral blood mononuclear cells. Immune parameters were assessed by measuring white blood cell concentration, flow cytometry, and cytokines concentration after mitogen-stimulated immune response.
RESULTS: In the placebo group the proportion of T cells (CD3 +), and functionally active monocytes (CD14 + HLA-DR +) was reduced at the last cycle of chemotherapy (15 weeks) but remained constant in the DHA group (P interaction \u3c 0.05). The neutrophil-to-lymphocyte ratio (NLR) was maintained in the DHA group but increased in the placebo at the end of chemotherapy (P-interaction = 0.02). An increase in this ratio was associated with lower chance of achieving pathological complete response (OR = 0.32, 95% CI [0.14,0.16], P = 0.01). After 15 weeks of therapy, the DHA-supplemented group had higher concentrations of stimulated cytokines IL-4, IL-10, and the T helper type 1 cytokine IFN-γ after phytohemagglutinin (PHA) challenge, and higher concentrations of TNF-α and IFN-γ cytokines after lipopolysaccharide exposure (P \u3c 0.05).
CONCLUSION: Supplementing DHA during breast cancer neoadjuvant chemotherapy improved systemic immune function by attenuating changes in blood cell concentrations, preventing depletion of immune cells, and enhancing ex vivo cytokine secretion after stimulation
Global Andrology Forum (GAF) Clinical Guidelines on the Management of Non-obstructive Azoospermia: Bridging the Gap between Controversy and Consensus
No full textPURPOSE: Non-obstructive azoospermia (NOA), defined as the absence of sperm in the ejaculate due to testicular failure, is observed in 5% to 15% of infertile men and accounts for two-thirds of azoospermia cases. The management of NOA is marked by significant controversy and global variation in diagnostic and therapeutic approaches, highlighting the crucial need for well-designed and standardized clinical practice guidelines. We present comprehensive graded clinical practice recommendations and statements for diagnosing and treating NOA, aiming to establish standardized strategies that can globally help guide practitioners in their practice.
MATERIALS AND METHODS: A comprehensive literature review was conducted to gather evidence on the epidemiological, diagnostic, and therapeutic aspects of NOA. The Global Andrology Forum (GAF) recommendations were developed through the collaboration of a global panel of experts using the Delphi method and surveys to achieve consensus. Statements were graded according to the Oxford Centre for Evidence-Based Medicine GRADE classification as either Strong or Weak. Statements receiving at least 80% expert consensus were graded as Strong, while others were categorized as Weak.
RESULTS: The GAF has formulated a total of 49 recommendations and statements on the diagnosis and treatment of NOA, including 21 for diagnosis and 28 for treatment. The recommendations and statements were evaluated and graded by a panel of 48 GAF experts from 25 countries worldwide. The majority of experts (60.5%) had more than 10 years of clinical experience in managing NOA.
CONCLUSIONS: The GAF guidelines address discrepancies in NOA management across diverse clinical settings and provide comprehensive graded recommendations to guide clinicians in its diagnosis and treatment. Developed and graded by a large worldwide panel of experts, the current guidelines present simplified, high-standard strategies that can be seamlessly integrated into the daily global practice, offering practitioners a clear framework for managing NOA