Faculty Entrustment of Students in the Core Clerkships: A Comparison between the Longitudinal Integrated Clerkship and the Block Clerkship

INTRODUCTION: Entrustable Professional Activities (EPAs) have been proposed for use in undergraduate medical education. The ability of faculty to entrust students with EPAs may differ between Longitudinal Integrated Clerkships (LICs) and traditional block clerkships. METHODS: Participants were core clerkship faculty, 64 in a LIC and 31 in a sequential block clerkship. We administered a web-based survey at the end of the core clerkship year to measure preceptors’ typical entrustment (on a scale of 0–10) in students for the 13 American Association of Medical Colleges Core EPAs. We compared entrustment between LIC and block faculty using a Mann-Whitney test. RESULTS:LIC faculty were more entrusting of students than block faculty in 12 out of 13 Core EPAs (p DISCUSSION: LIC faculty were more likely than block clerkship faculty to entrust core clerkship students with performance of most EPAs. This finding is likely the result of LIC faculty having increased familiarity with student abilities because of the continuity of supervision and education inherent to LIC. More research is needed to ascertain the specific features of longitudinal clerkships that increase faculty entrustment of students. CONCLUSIONS: Longitudinal educational experiences may facilitate the assessment of medical students with EPAs

Dietary Patterns and PFAS Plasma Concentrations in Childhood: Project Viva, USA

Children who adhered to a dietary pattern of primarily packaged foods and fish had higher plasma concentrations of select PFAS, reflective of food intake and/or correlated lifestyle factors.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1011/thumbnail.jp

Predictors of Plasma Fluoride Concentrations in Children and Adolescents

Despite increasing concerns about neurotoxicity of fluoride in children, sources of fluoride exposure apart from municipal water fluoridation are poorly understood. We aimed to describe the associations of demographics, drinking water characteristics, diet, and oral health behaviors with plasma fluoride concentrations in U.S. children. We used data from 3928 6–19-year-olds from the 2013–2016 National Health and Nutrition Examination Survey. We used a 24-h dietary recall to estimate recent consumption of fluoridated tap water and select foods. We estimated the associations of fluoridated tap water, time of last dental visit, use of toothpaste, and frequency of daily tooth brushing with plasma fluoride concentrations. The participants who consumed fluoridated (≥0.7 mg/L) tap water (n = 560, 16%) versus those who did not had 36% (95% CI: 22, 51) higher plasma fluoride. Children who drank black or green tea (n = 503, 13%) had 42% higher plasma fluoride concentrations (95% CI: 27, 58) than non-tea drinkers. The intake of other foods and oral health behaviors were not associated with plasma fluoride concentrations. The consumption of fluoridated tap water and tea substantially increases plasma fluoride concentrations in children. Quantifying the contribution of diet and other sources of fluoride is critical to establishing safe target levels for municipal water fluoridation

A Cervical Abnormality Risk Prediction Model

Objective—HPV infections and abnormal Pap tests are common, and most do not progress to cervical cancer. Since it is difficult to predict which mild Pap abnormalities will develop into precancerous lesions, many women undergo painful and costly evaluations, and even unnecessary treatment. The objective of this study was to develop a risk prediction model based on clinical and demographic information to identify women most likely to develop significant precancerous lesions (CIN2/3 or AIS) among women with mild Pap abnormalities (ASCUS/LSIL). Materials and Methods—The Abnormal Pap Smear Registry includes women who received treatment at the Brigham and Women’s Hospital/Dana Farber Cancer Institute Pap Smear Evaluation Center beginning in 2006. It includes 1,072 women with mild cervical dysplasia (ASCUS or LSIL Pap tests) on their referral Pap test. We derived a clinical prediction model to predict the probability of developing CIN2/3 or AIS using multivariate logistic regression with a split-sample approach. Results—By the end of follow-up, 93 of the 1,072 women developed CIN2/3 or AIS (8.7%). There were several differences between women who developed CIN2/3 or AIS and women who did not. However, once we put these into the regression model, the only variable that was significantly associated with CIN2/3 or AIS was having a prior history of an abnormal Pap or biopsy [OR=2.44, 95% CI (1.03 to 5.76)]. The resulting prediction model had poor discriminative ability and was poorly calibrated. Conclusions—Despite accounting for known risk factors, we were unable to predict individual patients’ probability for progression on the basis of available data

Electronic Cigarette Use in US Households With Children: The New Secondhand Smoke.

This study explores the prevalence of electronic cigarette use among US adults in households with children

Out-of-hospital births and infant mortality in the United States: Effect measure modification by rural maternal residence

BACKGROUND: Out-of-hospital births have been increasing in the United States, and home births are almost twice as common in rural vs. urban counties. Planned home births and births in rural areas have each been associated with an increased risk of infant mortality. OBJECTIVES: To estimate the effect of birth setting on infant mortality in the United States and how this is modified by rural-urban county of maternal residence. METHODS: We conducted a population-based cohort study of infants born in the United States during 2010-2017 using the National Center for Health Statistics\u27 period-linked birth-infant death files. Unadjusted and adjusted Poisson regression models were used to calculate infant mortality rate ratios and 95% confidence intervals for out-of-hospital births vs. hospital births stratified by maternal residence. Relative excess risk due to interaction (RERI) was calculated to assess effect measure modification on the additive scale. RESULTS: The study included 25,210,263 live births. Of rural births, 97.8% was in hospitals, 0.5% was in birth centres, and 1.5% was planned home births; of urban births, 98.6% was in hospitals, 0.5% was in birth centres, and 0.7% was planned home births. After adjusting for maternal demographics and markers of high-risk pregnancy and stratifying by maternal residence, infant mortality rates were generally higher for out-of-hospital as compared to hospital births (e.g. rural planned home births aRR 1.62, 95% confidence interval [CI] 1.42, 1.85, and rural birth centre aRR 1.33, 95% CI 1.05, 1.68). There were positive additive effects of rural residence on infant mortality for planned home births and birth centre births. CONCLUSIONS: Within both rural and urban areas, out-of-hospital births generally had higher rates of infant mortality than hospital births after accounting for maternal demographics and markers of high-risk pregnancy. The risks associated with planned home births and birth centre births were more pronounced for women in rural counties

Trends in Diagnoses of Neonatal Abstinence Syndrome at Newborn Hospitalization in Maine, 2009-2018

Introduction: Incidence rates of neonatal abstinence syndrome (NAS) have increased in Maine, but whether this increase can be explained by use of different diagnosis codes over time is unknown. Our objective was to estimate trends in diagnoses of NAS at newborn hospitalization in Maine using different NAS case definitions. Methods: We used International Classification of Diseases (ICD) diagnosis codes to identify newborns diagnosed with NAS in Maine between 2009 and 2018 using state-level hospital discharge data (n = 123 519). First, we considered only ICD-9 and ICD-10 codes used for confirmed NAS. Then we used an expanded ICD-10 NAS case definition that included codes for neonates suspected to have NAS and affected by an unspecified “other maternal medication.” We used joinpoint regression to model trends over time and identified changes in slope. Results: Using the case definition for confirmed NAS, diagnoses of NAS increased from 2009 to 2013 (from 20 to 38 per 1000 births), and then decreased from 2013 to 2018 (from 38 to 28 per 1000 births). Using our expanded ICD-10 NAS case definition, NAS increased linearly from 2009 to 2018 (from 24 to 50 per 1000 births). Discussion: The trends in diagnoses of NAS were different when based on the expanded or confirmed NAS case definition. Conclusions: Validation studies are needed to understand which infants are coded using the expanded versus confirmed NAS case definition. Caution should be used when interpreting rates of NAS in Maine using hospital discharge data