Teaching Internal Medicine Residents about Genetics: One topic at a Time - Breast Cancer

Background: Currently, the field of medicine is experiencing rapid changes in genetics and genomics information. While medical school curricula all include some genetics education, the content may vary from one school to another, leaving Internal Medicine (IM) residents with different skills and knowledge. In an IM residency where residents come from different medical schools, presenting an organized genetics curriculum may have value. Patients expect their physicians to be knowledgeable and current about their specific disease, including the genetic components and expect that they can inform them about terminology, inheritance, diagnostic testing, risks and benefits of testing. Physicians will need education about how to find current information about genetics factors in many diseases, and how to inform and counsel their patients using web-based tools. Purpose: The purpose of this project was to identify baseline genetics knowledge of Internal Medicine (IM) Residents at The George Washington University, and to determine if a 1-hour presentation can be used to improve their knowledge. Methods: We performed a literature review of currently available information on genetics curriculum for IM residents and residency programs in other specialties. Although there is no standardized curriculum in genetics for IM residents, we did identify a proposed curriculum in genetics for IM1.There has also been research in education about genetics in other residencies including Pediatrics, Obstetrics and Gynecology, Psychiatry and Surgery2,3,4,5,6,7,8,9. We propose to deliver a one-hour presentation about genetics and breast cancer to IM residents and medical students at GWU during Grand Rounds. The presentation will include concepts in genetics, as well as specific information about breast cancer and guidelines for testing. We plan a pre-test to assess knowledge about genetics and breast cancer, a one-hour presentation and a post-test. Pre-test and post-test scores will be compared using student’s t-test. Conclusion: We plan to evaluate the efficacy of a one-hour presentation for teaching genetics and use it as a possible model for other genetics education for IM residents. Possible topics for monthly presentations could include: colon cancer, ovarian cancer, emphysema, cardiology – long and short QT, among others

Provider Perception and Office Practices of the Initial Prenatal Visit Pre – Coronavirus 2019 Pandemic

Background Prenatal Care is a critical aspect of women’s health and current literature shows adequate care significantly reduces risk of adverse outcomes. With scientific advancement, the initial prenatal visit is increasingly tasked with more objectives that leave providers with barriers to provide appropriate and adequate care. Purpose The aim of this survey study was to determine clinical practices of the initial prenatal visit – regarding history taking, counseling, lab work and screening prior to the onset of COVID-19 Pandemic. Methods A one-time anonymous provider survey was distributed electronically to all obstetrics providers in the Tampa Bay Region in Florida. Descriptive statistics and bivariate analyses were performed for data analysis. Results A total of 67 responses were completed, and 58 responses analyzed after vetting for greater than 75% completion. Providers reported the initial visit most commonly occurring in the 1st trimester, and 90.2% reported the initial visit was completed via in-office visits. One provider reported completing this visit via nursing phone call. 32.5% of providers allocated 30-minutes and 34.1% reported allocating 45-minutes for an office visit. 50% of providers felt there were able to appropriately counsel patients in visits that lasted up to 1 hour. All providers reported collecting a patient’s history themselves for the majority of topics (90% or more). Discussion Providers reported the initial prenatal visit occurring most commonly in the 1st trimester as an in-office visit. Providers utilized routine blood work, and genetic screening per guidelines. Medical doctors reported the lowest rates of direct discussion and review of prenatal counseling topics when compared to mid-level practitioners. Given the onset and ongoing COVID-2019 pandemic since this survey study was completed, future studies should see how the implementation of telehealth medicine has impacted practices

Maternal inflammatory bowel disease, racial diversity and adverse birth outcomes

Background: Inflammatory bowel disease (IBD) is a term used to describe two conditions, Crohn’s disease and ulcerative colitis (UC), that currently have no definite cure. The incidence of IBD worldwide has increased, frequently affecting women during their reproductive years. Objectives: This study examines the association of Crohn\u27s disease and ulcerative colitis (UC) with adverse pregnancy outcomes and looks at the interactions of race/ethnicity on these associations. Study Design: We examined hospital birth records in the National Inpatient Sample (NIS) data sets in 2011 and 2012. We identified maternal demographics and clinical characteristics using international classification of disease-9 codes. Chi-square and Fisher exact tests were used to examine associations and logistic regression models were used to control for confounders. Results: Crohn\u27s disease is associated with small for gestational age, aOR 1.70(CI:1.53-1.89,p<0.001) but not premature delivery, whereas UC was associated with prematurity, aOR 1.5(CI:1.36-1.66,p<0.001) to a greater extent than with SGA. Analyses by race/ethnicity showed Crohn’s disease to be associated with SGA among newborns of all racial groups, but most evident among African Americans, aOR 2.55(CI:2.06-3.15,p<.001). Crohn’s disease was associated with prematurity only in Caucasian women, aOR 1.21(CI:1.10-1.34,p<.001). UC was associated with SGA newborns only in Hispanic mothers, aOR 3.40(CI:2.24-5.15,p<0.001), and with premature delivery only among Caucasian mothers, aOR 1.60(CI:1.42-1.80,p<.001). Conclusion: Both Crohn\u27s disease and ulcerative colitis are associated with prematurity and small for gestational age in a way that is significantly affected by maternal race. Qualitative studies are needed to understand mechanisms for these associations and the role of race/ethnicity

Teaching obstetric ultrasound at Mulago Hospital - Kampala, Uganda

Background: Mulago Hospital is a high volume referral hospital under the Makerere University School of Medicine and Health Sciences. Basic obstetric ultrasound is a useful skill that can aid patient care.Objectives: The purpose of the study was to assess the effectiveness of an intervention implemented to teach basic ultrasound skills to medical students and house officers at Mulago Hosptial, Kampala, Uganda.Methods: Forty participants, including medical students, junior house officers (JHOs), and senior house officers (SHOs) were enrolled in the study. A didactic and practical hands-on teaching session was evaluated using a pre- and post-test that was administered to all participants.Results: Participants included 12 medical students, 23 JHOs, and 5 SHOs. A significant difference in pre- and post-test scores was demonstrated in the medical students and JHOs (34% to 76%, p &lt;0.0001) and this was retained when the results were stratified into the basic definitions and practical sections of the survey (33% to 71%, p&lt;0.0001). The scores for the senior house officers had a mean increase of 2.3 points.Conclusion: This original teaching intervention is an effective method to improve knowledge and skills for medical students and house officers at Mulago Hospital in the area of basic obstetric ultrasound.Keywords: Ultrasound; obstetric; teaching; Uganda; low-resource; curriculum

Healthcare Provider and Patient Knowledge, Attitudes and Practices (KAP) Regarding Zika Virus

Introduction: Zika virus emergence in the western hemisphere has prompted the critical need for tailored risk counseling. Our team created a KAP survey in order to assess provider and patient awareness of Zika virus symptoms, transmission, treatment, and current and future concerns in order to inform local risk counseling efforts. Methods: The cross-sectional survey was issued in Medical Faculty Associates (MFA) clinics and via online link to healthcare providers and community members. The REDCap Data Collection tool was used to capture responses with subsequent SAS data analysis. Results: A total of 172 responses were collected. Most respondents (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% will restrict travel to Zika endemic regions. 51% will take mosquito protective measures in the US versus 91% in Zika endemic areas. 35% of pregnant women would abstain from sex if their partners traveled to a Zika endemic area whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% are concerned about eventually having a child with microcephaly. Of the healthcare providers sampled, about one-fifth could not identify Zika infection symptoms, 16% were unaware of symptom treatment options and 5.4% did not know that Zika virus could be passed transplacentally. 34% believed DEET to be unsafe in pregnancy and 52% were unsure about permethrin safety in pregnancy. Of the 172 survey respondents, most (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% would restrict travel to Zika endemic regions. 51% would practice mosquito safety in the US versus 91% in Zika endemic countries. 35% of pregnant women would abstain from intercourse if their partners traveled to Zika endemic areas whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% worry about future children with microcephaly. Of the healthcare providers, 20% could not identify Zika infection symptoms, 16% were unaware of symptom treatment options, 5% were unaware that Zika virus passes transplacentally, and 34% believed DEET to be unsafe in pregnancy. Conclusion: The survey results provide novel insight into the KAP of patients and healthcare providers regarding Zika virus. This data will be used to optimize information distribution to our community, address large knowledge gaps in both patients and providers, and prepare medical providers to offer needed counseling

Three-dimensional imaging and detection efficiency performance of orthogonal coplanar CZT strip detectors

We report on recent three-dimensional imaging performance and detection efficiency measurements obtained with 5 mm thick prototype CdZnTe detectors fabricated with orthogonal coplanar anode strips. In previous work, we have shown that detectors fabricated using this design achieve both very good energy resolution and sub-millimeter spatial resolution with fewer electronic channels than are required for pixel detectors. As electron-only devices, like pixel detectors, coplanar anode strip detectors can be fabricated in the thickness required to be effective imagers for photons with energies in excess of 500 keV. Unlike conventional double-sided strip detectors, the coplanar anode strip detectors require segmented contacts and signal processing electronics on only one surface. The signals can be processed to measure the total energy deposit and the photon interaction location in three dimensions. The measurements reported here provide a quantitative assessment of the detection capabilities of orthogonal coplanar anode strip detectors

Teaching obstetric ultrasound at Mulago Hospital - Kampala, Uganda

Background: Mulago Hospital is a high volume referral hospital under the Makerere University School of Medicine and Health Sciences. Basic obstetric ultrasound is a useful skill that can aid patient care. Objectives: The purpose of the study was to assess the effectiveness of an intervention implemented to teach basic ultrasound skills to medical students and house officers at Mulago Hosptial, Kampala, Uganda. Methods: Forty participants, including medical students, junior house officers (JHOs), and senior house officers (SHOs) were enrolled in the study. A didactic and practical hands-on teaching session was evaluated using a pre- and post-test that was administered to all participants. Results: Participants included 12 medical students, 23 JHOs, and 5 SHOs. A significant difference in pre- and post-test scores was demonstrated in the medical students and JHOs (34% to 76%, p &lt;0.0001) and this was retained when the results were stratified into the basic definitions and practical sections of the survey (33% to 71%, p&lt;0.0001). The scores for the senior house officers had a mean increase of 2.3 points. Conclusion: This original teaching intervention is an effective method to improve knowledge and skills for medical students and house officers at Mulago Hospital in the area of basic obstetric ultrasound

A 15.65 solar mass black hole in an eclipsing binary in the nearby spiral galaxy Messier 33

Stellar-mass black holes are discovered in X-ray emitting binary systems, where their mass can be determined from the dynamics of their companion stars. Models of stellar evolution have difficulty producing black holes in close binaries with masses >10 solar masses, which is consistent with the fact that the most massive stellar black holes known so all have masses within 1 sigma of 10 solar masses. Here we report a mass of 15.65 +/- 1.45 solar masses for the black hole in the recently discovered system M33 X-7, which is located in the nearby galaxy Messier 33 (M33) and is the only known black hole that is in an eclipsing binary. In order to produce such a massive black hole, the progenitor star must have retained much of its outer envelope until after helium fusion in the core was completed. On the other hand, in order for the black hole to be in its present 3.45 day orbit about its 70.0 +/- 6.9 solar mass companion, there must have been a ``common envelope'' phase of evolution in which a significant amount of mass was lost from the system. We find the common envelope phase could not have occured in M33 X-7 unless the amount of mass lost from the progenitor during its evolution was an order of magnitude less than what is usually assumed in evolutionary models of massive stars.Comment: To appear in Nature October 18, 2007. Four figures (one color figure degraded). Differs slightly from published version. Supplementary Information follows in a separate postin

The HST Key Project on the Extragalactic Distance Scale. XXII. The Discovery of Cepheids in NGC 1326-A

We report on the detection of Cepheids and the first distance measurement to the spiral galaxy NGC 1326-A, a member of the Fornax cluster of galaxies. We have employed data obtained with the Wide Field and Planetary Camera 2 on board the Hubble Space Telescope. Over a 49 day interval, a total of twelve V-band (F555W) and eight I-band (F814W) epochs of observation were obtained. Two photometric reduction packages, ALLFRAME and DoPHOT, have been employed to obtain photometry measures from the three Wide Field CCDs. Variability analysis yields a total of 17 Cepheids in common with both photometry datasets, with periods ranging between 10 and 50 days. Of these 14 Cepheids with high-quality lightcurves are used to fit the V and I period-luminosity relations and derive apparent distance moduli, assuming a Large Magellanic Cloud distance modulus (m-M) (LMC) = 18.50 +- 0.10 mag and color excess E(B-V) = 0.10 mag. Assuming A(V)/E(V-I) = 2.45, the DoPHOT data yield a true distance modulus to NGC 1326-A of (m-M)_0 = 31.36 +- 0.17 (random) +- 0.13 (systematic) mag, corresponding to a distance of 18.7 \pm 1.5 (random) \pm 1.2 (systematic) Mpc. The derived distance to NGC 1326-A is in good agreement with the distance derived previously to NGC 1365, another spiral galaxy member of the Fornax cluster. However the distances to both galaxies are significantly lower than to NGC 1425, a third Cepheid calibrator in the outer parts of the cluster.Comment: 33 pages A gzipped tar file containing 12 figures can be obtained from http://www.ipac.caltech.edu/H0kp/n1326a/n1326a.htm

The HST Key Project on the Extragalactic Distance Scale XVII. The Cepheid Distance to NGC 4725

The distance to NGC 4725 has been derived from Cepheid variables, as part of the Hubble Space Telescope Key Project on the Extragalactic Distance Scale. Thirteen F555W (V) and four F814W (I) epochs of cosmic-ray-split Wide Field and Planetary Camera 2 observations were obtained. Twenty Cepheids were discovered, with periods ranging from 12 to 49 days. Adopting a Large Magellanic Cloud distance modulus and extinction of 18.50+/-0.10 mag and E(V-I)=0.13 mag, respectively, a true reddening-corrected distance modulus (based on an analysis employing the ALLFRAME software package) of 30.50 +/- 0.16 (random) +/- 0.17 (systematic) mag was determined for NGC 4725. The corresponding of distance of 12.6 +/- 1.0 (random) +/- 1.0 (systematic) Mpc is in excellent agreement with that found with an independent analysis based upon the DoPHOT photometry package. With a foreground reddening of only E(V-I)=0.02, the inferred intrinsic reddening of this field in NGC 4725, E(V-I)=0.19, makes it one of the most highly-reddened, encountered by the HST Key Project, to date.Comment: To be published in The Astrophysical Journal, Vol. 512 (1999). 34 pages, LaTeX, 9 jpg figure