Effect of Carelink, an Internet-Based Insulin Pump Monitoring System, on Glycemic Control in Children with Type 1 Diabetes Mellitus

Objective : To determine whether use of the internet-based Carelink system improved glycemic control in children on insulin pump therapy. Research Design and Methods - We reviewed records of 146 children treated with insulin pump therapy between the years 2004-2007, and compared glycemic control and diabetes self-care measures associated with Carelink use. Forty percent of the patients resided one hour or more from our clinic. Results: Patients who used the Carelink software and website showed significant improvement in HbA1c levels following use (8.0 ± 0.1 (SE) vs 7.7 ± 0.1 (SE), p=0.002). They uploaded data from their pump and glucometer 2.2 ± 1.8 times per month over 0.8 ± 0.4 (SD) years. Patients who had no access to Carelink software and were followed in a conventional manner showed no change in HbA1c ( 8.0 ± 0.1 (SE) vs 8.1 ± 0.1 (SE), p=0.27) during the study period. These patients did not differ significantly from Carelink users in diabetes self care behaviors. Patients who had Carelink access but did not use it had a higher HbA1c level at the onset and did not change over the study period (HbA1c 8.9 ± 0.2 (SE) vs 8.9 ± 0.3 (SE), p=0.76). These patients differed significantly from Carelink users in self-care behaviors, but not in the frequency of blood glucose monitoring. Patients in a rural location benefited equally as compared to patients who lived within one hour of our clinic. Conclusions: The Carelink software program is a powerful tool that can be used by diabetes care providers and parents to manage insulin pump therapy in children and to improve glycemic control, especially in states with a large rural population

A simple flip of an obstetrics clerkship lecture focusing on interactive learning

Abstract Objective: To determine the value of interactive learning after a low-tech flip of a traditional lecture during an obstetrics and gynecology clerkship. Design: All third-year medical students completed a flipped learning experience between May 2014 and April 2016. Central to the change was replacement of a mid-clerkship lecture ("late term and prolonged gestation") with interactive learning at seven stations by student pairs (one each on separate obstetrics and gynecology services). Before class, students electronically received a handout that described learning objectives, subject background, and interactive stations. The stations featured manipulative models, instruments, data, and images involving prenatal care, fetal growth and testing, and labor and delivery decision-making. Results: The flipped model was easily executed with proper preparation. The 178 consecutive students completed the two mandated surveys. The median score given by students about the same instructor's effectiveness increased from 4.0 (previous two years) to 4.4 (on a 5-point scale). Compared with traditional lectures by other clerkship faculty, the flipped classroom was judged by students to be easier for understanding and more interactive. Students perceived being more responsible for learning with better recall and application to practice. Conclusions: A low-tech approach to the flipped classroom was easily executed with favorable responses from students about interactive learning

The Prevalence of ADHD in a Population-Based Sample

Few studies of ADHD prevalence have used population-based samples, multiple informants, and DSM-IV criteria. In addition, children who are asymptomatic while receiving ADHD mediction often have been misclassified. Therefore, we conducted a population-based study to estimate the prevalence of ADHD in elementary school children using DSM-IV critera

The Shifting Subtypes of ADHD: Classification Depends on How Symptom Reports are Combined

Research on the correlates of ADHD subtypes has yielded inconsistent findings, perhaps because the procedures used to define subtypes vary across studies. We examined this possibility by investigating whether the ADHD subtype distribution in a community sample was sensitive to different methods for combining informant data. We conducted a study to screen all children in grades 1–5 (N=7847) in a North Carolina County for ADHD. Teachers completed a DSM-IV behavior rating scale and parents completed a structured telephone interview. We found substantial differences in the distribution of ADHD subtypes depending on whether one or both sources were used to define the subtypes. When parent and teacher data were combined, the procedures used substantially influenced subtype distribution. We conclude the ADHD subtype distribution is sensitive to how symptom information is combined and that standardization of the subtyping process is required to advance our understanding of the correlates of different ADHD subtypes

Core Competencies Addressed in Grand Rounds of Academic Departments

Background: The Accreditation Councils of Graduate Medical Education (ACGME) and Continuing Medical Education (ACCME) require that educational activities support professional development of health professionals. Core competencies include medical knowledge, patient care and procedural skills, practice-based learning and improvement, professionalism, systems-based practice, and interprofessional communication. Although a review of the Institute of Medicine (IOM) core competencies is a required component of graduate medical education, the frequencies in which the competencies are addressed during grand rounds is unknown. Purpose: To evaluate academic department grand rounds lecture series for content of the IOM recommended core competencies. Methods: This retrospective study involves a review of learning objectives from grand rounds lectures in the five core departments (internal medicine, pediatrics, psychiatry, obstetrics and gynecology (OB/GYN) and family medicine) between January 2014 and June 2015. Each learning objective was reviewed by a senior medical student, acting intern, and faculty member and by consensus assigned to the appropriate core competency. Results: Complete information was available for 271 grand rounds presentations, with 74% having 3 to 4 objectives per lecture. Two or more competencies were covered in 35% of all lectures. Medical knowledge was the primarily addressed core competency, regardless of specialty. About 50% or less of lectures involved solely medical knowledge. Other core competencies are not adequately covered on grand rounds. The fewest objectives were consistently dedicated to interprofessional communication, professionalism, systems-based practice, and practice-based learning. Professionalism was highlighted most by the internal medicine department (p \u3c .01), because one month of lectures was dedicated to the subject. Conclusions: Grand rounds lectures offer educational opportunities to cover the core competencies especially those that do not deal with medical knowledge. In the future, presenters will be provided information about core competencies before their lecture and as a part of their post lecture feedback

School-Based Health Center Intervention Improves Body Mass Index in Overweight and Obese Adolescents

Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION) was undertaken to determine feasibility of a school-based health center (SBHC) weight management program. Two urban New Mexico SBHCs were randomized to deliver ACTION or standard care. ACTION consisted of eight visits using motivational interviewing to improve eating and physical activity behavior. An educational nutrition and physical activity DVD for students and a clinician toolkit were created for use as menu of options. Standard care consisted of one visit with the SBHC provider who prescribed recommendations for healthy weight. Sixty nondiabetic overweight/obese adolescents were enrolled. Measures included BMI percentile, waist circumference, insulin resistance by homeostasis model assessment (HOMA-IR), blood pressure, triglycerides, and HDL-C levels. Pre- to postchanges for participants were compared between groups. Fifty-one students (mean age 15 years, 62% female, 75% Hispanic) completed pre- and postmeasures. ACTION students (n=28) had improvements in BMI percentile (P=0.04) and waist circumference (P=0.04) as compared with students receiving standard care (n=23). No differences were found between the two groups in blood pressure, HOMA-IR, triglycerides, and HDL-C. The ACTION SBHC weight management program was feasible and demonstrated improved outcomes in BMI percentile and waist circumference

Student specialty plans, clinical decision making, and health care reform.

BACKGROUND AND OBJECTIVES: Health care reform aims to increase evidence-based, cost-conscious, and patient-centered care. Family medicine is seen as central to these aims in part due to evidence of lower cost and comparable quality care compared with other specialties. We sought evidence that senior medical students planning family medicine residency differ from peers entering other fields in decision-making patterns relevant to these health care reform aims. METHODS: We conducted a national, anonymous, internet-based survey of senior medical students. Students chose one of two equivalent management options for a set of patient vignettes based on preventive care, medication selection, or initial chronic disease management scenarios, representing in turn evidence-based care, cost-conscious care, and patient-centered care. We examined differences in student recommendations, comparing those planning to enter family medicine with all others using bivariate and weighted, multilevel, multivariable analyses. RESULTS: Among 4,656 surveys received from seniors at 84 participating medical schools, students entering family medicine were significantly more likely to recommend patient management options that were more cost conscious and more patient centered. We did not find a significant difference between the student groups in recommendations for evidence-based care vignettes. CONCLUSIONS: This study provides preliminary evidence suggesting that students planning to enter family medicine may already have clinical decision-making patterns that support health care reform goals to a greater extent than their peers. If confirmed by additional studies, this could have implications for medical school admission and training processes

Racial, gender, and socioeconomic status bias in senior medical student clinical decision-making: a national survey.

BACKGROUND: Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE: The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN: We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS: The study included senior medical students. MAIN MEASURES: We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS: Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p = .03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p \u3c .001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS: In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions between patient race and gender on student recommendations