Observing Pediatric Residents\u27 Communication Skills During Sick Visits: Do They Determine Concern and Their Reasons for Concern and Are Caregivers Satisfied?

Fifty years ago, Dr. Barbara Korsch published her seminal work on pediatric resident communication skills, demonstrating that residents did not always ascertain the caregivers’ main concern for the visit was and specifically, why those caregivers were concerned. Repeating her study using a direct observation methodology, the authors evaluated 103 pediatric sick visits at a large children’s hospital primary care clinic to determine 1) if residents elicited the caregiver’s main concern about their child’s acute illness, 2) why they were concerned, and 3) whether asking these questions was statistically associated with caregiver satisfaction, which was determined by an exit survey. Results of the study revealed that residents determined the caregivers’ main concern in 84.5% of visits. However, residents established why the caregiver was concerned in only 38.6% of visits. Caregiver satisfaction with the visits was high, with 90.3% rating it “one of the best” or “very “very good.” Higher satisfaction was associated with the resident asking why the caregiver was concerned (z = 2.76, p = .006). We conclude that pediatric residents often ask caregivers about their main concern, but less frequently elicit why caregivers are concerned. Not understanding caregivers’ reasons for concerns about their children, biologically based or not, may be related to unnecessary ongoing anxiety about the illness as noted in Korsch’s studies. Probing the root of caregiver concern may be important for their satisfaction and should highlight this important aspect of communication to those responsible for medical student and pediatric resident communication skills training

Prevalence and Trends in Transmitted and Acquired Antiretroviral Drug Resistance, Washington, DC, 1999-2014.

Background Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC. Methods We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral. Results Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0–1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis. Conclusions In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered

Anti-inflammatory effects of nicotine in obesity and ulcerative colitis

Cigarette smoke is a major risk factor for a number of diseases including lung cancer and respiratory infections. Paradoxically, it also contains nicotine, an anti-inflammatory alkaloid. There is increasing evidence that smokers have a lower incidence of some inflammatory diseases, including ulcerative colitis, and the protective effect involves the activation of a cholinergic anti-inflammatory pathway that requires the α7 nicotinic acetylcholine receptor (α7nAChR) on immune cells. Obesity is characterized by chronic low-grade inflammation, which contributes to insulin resistance. Nicotine significantly improves glucose homeostasis and insulin sensitivity in genetically obese and diet-induced obese mice, which is associated with suppressed adipose tissue inflammation. Inflammation that results in disruption of the epithelial barrier is a hallmark of inflammatory bowel disease, and nicotine is protective in ulcerative colitis. This article summarizes current evidence for the anti-inflammatory effects of nicotine in obesity and ulcerative colitis. Selective agonists for the α7nAChR could represent a promising pharmacological strategy for the treatment of inflammation in obesity and ulcerative colitis. Nevertheless, we should keep in mind that the anti-inflammatory effects of nicotine could be mediated via the expression of several nAChRs on a particular target cell

Prevalence and trends in transmitted and acquired antiretroviral drug resistance, Washington, DC, 1999-2014

© 2017 The Author(s). Background: Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC. Methods: We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral. Results: Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0-1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis. Conclusions: In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered

Outcomes from an elective medical student Research Scholarly Concentration program

© American Federation for Medical Research 2019. No commercial re-use. See rights and permissions. Published by BMJ. To examine how to increase research career outcomes among medical graduates, we analyzed the impact of the Research Scholarly Concentration at The George Washington University School of Medicine and Health Sciences. Residency placement, subsequent scholarship, and career outcomes were compared among 670 graduates who participated in the elective Clinical and Translational Research Scholarly Concentration or no Concentration between 2009 and 2018. We conducted a retrospective study of residency match (highly selective vs less selective), job type (academic vs non-academic), and postmedical school publications (any vs none). We compared the outcomes between Research Scholarly Concentration graduates and those with no Concentration, matched by graduation year (n=335). For Research Scholarly Concentration graduates, we examined the association between research outcomes and duration of research experience before medical school (n=232). Research Scholarly Concentration graduates were more likely to place in a highly selective residency (40.2% vs 21.6%, p\u3c0.0001), 68% more likely to publish after medical school (OR=1.68, 95% CI 1.10 to 2.58), and almost four times as likely to have taken an academic health center job (OR=3.82, 95% CI 1.72 to 8.46) than graduates with no Concentration. Surprisingly, the length of research experience before medical school was not associated with these outcomes among Research Scholarly Concentration graduates. This suggests that a medical school Research Scholarly Concentration is effective in training physician researchers and should be available to both novices and research-experienced matriculants. These data suggest how other medical schools might plan Scholarly Concentration programs to improve research outcomes among medical graduates

Constitutionality of Reappointment of Presidents and Vicepresidents of Courts

218 Constitutionality of Reappointment of Presidents and Vice- Presidents of Courts Abstract This diploma thesis deals with the interdisciplinary topics of administrative and constitutional law, especially with questions of re-appointment of presidents and vice-presidents of courts in connection with time-limited periods of office. The main hypothesis considered in the context of the given topic is the unconstitutionality of the current administrative practice associated with repeated appointment as well as time-limited periods of office. The current practice of empowering the judges by performing the individual tasks of the judicial administration under the Act on Courts and Judges also constitutes deficit in the rule of law. This is quite unfortunate in the case of the judiciary, especially in the sense that the Ministry of Justice is not very active in its supervisory role. Therefore, the secondary purpose of this work is also to offer alternative, more efficient models of the current bureaucratic judicial administration. For this purpose, the thesis is based not only on theoretical legal aspects represented by primary sources in the form of laws, other regulations and jurisprudence, together with secondary sources in the form of expert articles and other publications, but also based on its own analysis...217 Ústavnost opakovaného jmenování soudních funkcionářů Abstrakt Předkládaná diplomová práce se zabývá interdisciplinárně tématy správního a ústavního práva, a to zejména otázkami opakovaného ustanovování soudních funkcionářů ve spojení s časově omezenými funkčními obdobími. Hlavní posuzovanou hypotézou je v kontextu daného tématu deklarovaná protiústavnost současné správní praxe spojená s opakovaným jmenováním i časově omezenými funkčními obdobími. Současná praxe pověřování soudců či předsedů senátu výkonem jednotlivých úkolů soudní správy dle zákona o soudech a soudcích též představuje deficity v oblasti právního státu. Toto je v případě moci soudní poměrně nešťastné, zvláště prismatem toho, že Ministerstvo spravedlnosti není ve své dozorčí úloze příliš aktivní. Proto je vedlejším účelem této práce též nabídnout alternativní efektivnější modely současné byrokratické soudní správy. Za tímto účelem práce vychází nejen z teoretickoprávních hledisek reprezentovaných primárními prameny ve formě zákonů, jiných předpisů a judikatury spolu se sekundárními prameny ve formě odborných článků a jiných publikací, nýbrž také vychází z vlastní analýzy aktuální správní praxe, ve které je čerpáno zejména z bezpočtu žádostí o informace dle zákona č. 106/1999 Sb., o svobodném přístupu k informacím. Na popis české úpravy...Katedra ústavního právaDepartment of Constitutional LawFaculty of LawPrávnická fakult

Prevalence and trends in transmitted and acquired antiretroviral drug resistance, Washington, DC, 1999–2014

Abstract Background Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC. Methods We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral. Results Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0–1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis. Conclusions In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered