A Novel Approach to Mentorship in Pediatric Cardiology: A Group for Women.

Gender disparities for female physicians in academic medicine are longstanding. Female pediatric cardiologists experience inequities in scholarship opportunities, promotion, leadership positions, and compensation. Mentorship groups have been successfully implemented in other subspecialities with promising results. We created a peer mentorship group for female pediatric cardiologists in the Northeast and completed a needs assessment survey of eligible participants. Our goal was to better understand the current challenges and identify resources to overcome these barriers. Our objectives were to (1) describe the creation of a novel mentorship program for female pediatric cardiologists and trainees in the Northeast United States, and (2) report the results of a formal needs assessment survey of all eligible participants. All female pediatric cardiology fellows and practicing pediatric and adult congenital heart disease specialists from 15 academic centers in New England were invited to join a free group with virtual meetings. A formal needs assessment survey was provided electronically to all eligible members. The vast majority of respondents agreed that the Women in Pediatric Cardiology (WIPC) group is a valuable networking and mentorship experience (90%) and would recommend this group to a colleague (95%). Members have witnessed or experienced inequities in a broad range of settings. Common challenges experienced by respondents include dependent care demands, lack of mentorship, inadequate research support, and inequitable clinical responsibilities. Resources suggested to overcome these barriers include mentorship, sponsorship, transparency in compensation, and physician coaching. Mentorship groups have the potential to address many challenges faced by women in medicine. The WIPC Northeast program provides a forum for community, collaboration, education, and scholarship.

Association between pancreatitis and chronic kidney disease in cats: a retrospective review of 154 cats presented to a specialty hospital between October 1, 2017, and October 1, 2022.

OBJECTIVE: To investigate an association between pancreatitis and chronic kidney disease (CKD) in cats. ANIMALS: 154 client-owned cats: 77 cats with pancreatitis and 77 control cats with no evidence of pancreatitis. METHODS: Retrospective record review from October 1, 2017, to October 1, 2022, including cats with gastrointestinal clinical signs, pancreatic lipase immunoreactivity (PLI) ≥ 8.8 µg/L or PLI 4.5 to 8.7 µg/L with sonographic evidence of pancreatitis. Control cats had a PLI ≤ 4.4 µg/L with no sonographic evidence of pancreatitis. RESULTS: Cats with pancreatitis had significantly higher International Renal Interest Society CKD stages than controls (P < .001; OR, 13 [95% CI, 6.3 to 31]), and mean creatinine was on average 0.79 mg/dL (95% CI, 0.56 to 1.0) higher than controls (P < .001; age covariate ANCOVA, P = .003). Odds of CKD in cats with pancreatitis compared to controls increased significantly with age (P = .002). Cats aged 10 to < 15 years and 15 to 20 years with pancreatitis had significantly higher prevalence of CKD stage 2 to 4 compared to controls (P < .001; OR, 10.9 [95% CI, 3.4 to 44]; and P = .001; OR, 66 [95% CI, 4.6 to > 1,000], respectively). Cats with pancreatitis had significantly more sonographic renal infarcts (P = .004; OR, 6.9 [95% CI, 1.8 to 46]) and concurrent diabetes mellitus (P = .002; OR, 6 [95% CI, 1.9 to 27]). Cats with pancreatitis were fed more exclusively dry-food diets compared to controls (P = .014). CLINICAL RELEVANCE: Pancreatitis is associated with CKD in cats. Investigating and treating these diseases concurrently early in the disease process may reduce morbidity and mortality due to progressive disease and expensive hospitalizations. Renal infarcts may be associated with pancreatitis in cats without overt cardiac disease.

Detemir improves diabetic regulation in poorly controlled diabetic dogs with concurrent diseases.

OBJECTIVE: This study evaluated the use of detemir for treating diabetic dogs with comorbidities that were poorly controlled with intermediate-acting insulins. ANIMALS: 7 insulin-treated diabetic dogs. PROCEDURES: Retrospective pilot study. Dogs were treated with detemir for at least 3 months, and glycemia was assessed by the owners at home initially 2 to 4 times daily for 6 to 8 weeks and twice daily thereafter. Clinical evaluations occurred on days 7 to 14, day 30, and then every 60 to 90 days, and dosage adjustments of detemir occurred as needed to control glycemia. RESULTS: The mean, peak, nadir, morning, and evening preinsulin daily blood glucose concentrations were significantly lower after dosing with detemir for 1, 3, or 6 months and during the last month of treatment compared to the final month of treatment with intermediate-acting insulin. Intermediate-acting insulins resulted in significantly worse glycemic control than detemir in all 3 categories of control. The odds of a biochemical hypoglycemic measurement with detemir were not significantly different compared to intermediate-acting insulins. Clinical hypoglycemia did not occur following detemir treatment. When insulin was withheld because of low morning preinsulin blood glucose concentration < 6.7 mmol/L (≤ 120 mg/dL) and dogs were fed, mean blood glucose concentration was significantly higher 1 hour later. Glucose concentrations were also significantly higher 12 hours later on days when insulin was withheld in the morning or evening for either 1 or 12 hours. CLINICAL RELEVANCE: Detemir is useful in diabetic dogs with other comorbidities and can be considered an alternative treatment in poorly controlled diabetic dogs.

Measuring and controlling medical record abstraction (MRA) error rates in an observational study.

BACKGROUND: Studies have shown that data collection by medical record abstraction (MRA) is a significant source of error in clinical research studies relying on secondary use data. Yet, the quality of data collected using MRA is seldom assessed. We employed a novel, theory-based framework for data quality assurance and quality control of MRA. The objective of this work is to determine the potential impact of formalized MRA training and continuous quality control (QC) processes on data quality over time. METHODS: We conducted a retrospective analysis of QC data collected during a cross-sectional medical record review of mother-infant dyads with Neonatal Opioid Withdrawal Syndrome. A confidence interval approach was used to calculate crude (Wald's method) and adjusted (generalized estimating equation) error rates over time. We calculated error rates using the number of errors divided by total fields ("all-field" error rate) and populated fields ("populated-field" error rate) as the denominators, to provide both an optimistic and a conservative measurement, respectively. RESULTS: On average, the ACT NOW CE Study maintained an error rate between 1% (optimistic) and 3% (conservative). Additionally, we observed a decrease of 0.51 percentage points with each additional QC Event conducted. CONCLUSIONS: Formalized MRA training and continuous QC resulted in lower error rates than have been found in previous literature and a decrease in error rates over time. This study newly demonstrates the importance of continuous process controls for MRA within the context of a multi-site clinical research study.

Screening and counseling for nicotine use in youth with diabetes.

OBJECTIVE: To assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e-cigarette use in youth with diabetes. INTRODUCTION: Electronic cigarettes (e-cigarettes) are the most used tobacco product among adolescents and may be associated with an increased risk of progression to combustible cigarette smoking, cardiovascular disease, and stroke. Diabetes mellitus is a known risk factor for cardiovascular disease, and nicotine products can increase this risk. We sought to assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e-cigarette use in youth with diabetes. RESEARCH DESIGN AND METHODS: We conducted an anonymous, online-based survey of Pediatric Endocrine Society members who provide care to youth with Type 1 or Type 2 diabetes. The survey collected information about provider demographics and smoking habits, knowledge and attitudes regarding screening and counseling for combustible tobacco and e-cigarette use, and current practice patterns. RESULTS: The survey was completed by 106 individuals of whom 64 reported providing care to youth with diabetes mellitus and ever asking about combustible tobacco or e-cigarette use. The majority of respondents were female, attending providers, and working in academic medical centers. None reported a history of formal training in e-cigarette counseling but recognized the harms of e-cigarette use. Nearly all (98%) who ever screen for nicotine use reported routinely screening for combustible tobacco use, while 18% never screen for e-cigarette use (p < 0.01). Over 80% of respondents reported feeling confident or very confident about discussing the harms of combustible tobacco, compared to 58% reporting the same confidence in discussing harms of e-cigarette use (p < 0.0001). Over 90% of respondents agreed that pediatric endocrinology providers should ask about nicotine use with over half agreeing that counseling reduces the risk of initiating nicotine product use, and 30% reported lack of change with counseling as a barrier to discussing nicotine use. Lack of visit time was the most reported barrier to discussing nicotine use. More providers cited lack of knowledge regarding e-cigarettes compared to combustible tobacco as a barrier to discussing its use. CONCLUSIONS: Pediatric endocrinology providers recognize the harms of e-cigarette use, but more frequently ask about combustible tobacco use compared to e-cigarette use. This may be related to lower reported confidence and provider knowledge in counseling about e-cigarette use. Increased utilization of existing resources and expanding opportunities for providers to learn more about e-cigarettes may increase provider confidence and comfort in screening and counseling.

Preparticipation Physical Exams: The Rhode Island Perspective, A Call for Standardization.

As of 2015, 98% of U.S. states require preparticipation exams (PPE) before participating in scholastic sports. Despite widespread availability of a PPE monograph endorsed by six medical societies, a lack of uniformity exists regarding implementation of the PPE among Rhode Island health care providers (HCPs). Consequently, significant variability exists regarding how comprehensive a history and physical exam screening is conducted for adolescent athletes looking for sports participation clearance. The purpose of this document is to: 1) establish a uniform screening process in Rhode Island for the PPE utilizing a peer-reviewed history and physical exam; 2) familiarize HCPs with the 2010 PPE monograph, with emphasis on the cardiovascular and musculoskeletal (MSK) systems; 3) encourage HCPs to treat the PPE as a separate entity from the annual wellness visit; 4) engage HCPs and sports medicine providers in Rhode Island to improve the quality and process of evaluating adolescent athletes for sports participation. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].

Temporal Profile of Early Pulmonary Hypertension in Preterm Infants.

Objective The objective of this study was to study the temporal profile of pulmonary hypertension (PH) in preterm infants. Study Design Infants < 28 weeks were screened for early PH at 10 to 14 days of life. Infants with early PH (n = 10) and gestationally matched controls (n = 18) underwent serial echocardiography every 7 to 10 days until 36 weeks postmenstrual age. Results Groups with and without early PH were comparable except for higher Fio 2 by day 10 among infants with early PH. Early PH was moderate in extent and resolved in all infants with recurrence in one infant. Among infants without early PH, five infants developed late PH. In both groups, development of late PH occurred in association with important neonatal morbidities, such as patent ductus arteriosus, bronchopulmonary dysplasia, and infection. Conclusion Early moderate PH among preterm infants resolves over a variable time period but recurrence is possible. Late PH can appear during the course of hospitalization in association with other clinical morbidities.

Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia.

OBJECTIVE: To determine whether early pulmonary hypertension (PH) at 10-14 days of life in preterm infants is associated with bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age (PMA). STUDY DESIGN: This was a prospective observational cohort study of infants <28 weeks' gestation. Exclusion criteria were any major anomaly, genetic syndrome, or death before the initial echocardiogram. Echocardiograms were performed between 10 and 14 days of life and at 36 weeks' PMA to assess PH. BPD and its severity were determined at 36 weeks PMA by the National Institutes of Health workshop definition. RESULTS: From March 2011 to April 2013, of 146 consecutively admitted infants <28 weeks, 120 were enrolled. One infant was excluded, 17 did not consent, and 8 died before undergoing a study echocardiogram. At 10-14 days of life, 10 infants had early PH (8%). Male sex (56% vs 40%), gestational age (26(+2) ± 1(+2) vs 25(+6) ± 1(+4) weeks), birth weight (837 ± 205 g vs 763 ± 182 g), and small for gestational age (14% vs 20%) were not significantly different among infants with no PH and early PH, respectively. Infants with early PH required >0.3 fraction of inspired oxygen by day 10 of life (70% vs 27%, P < .01). Moderate/severe BPD or death was greater among infants with early PH (90%) compared with no PH (47%, relative risk 1.9, 95% CI 1.43-2.53). CONCLUSION: In this prospective, single-center cohort, early PH was associated with moderate/severe BPD or death at 36 weeks' PMA.

Practical use of home blood glucose monitoring in feline diabetics.

With the use of handheld glucometers, most owners are able to regularly monitor their cat's blood glucose at home. The data generated from this protocol can be used by the clinician to better tailor insulin therapy to the patient. Along with improvements in long-acting insulin, and available low-carbohydrate, high-protein diets for cats, home blood glucose monitoring (home monitoring) allows for safe, intensive insulin therapy, which results in tighter glycemic control and improved case outcome, often including remission of the diabetic state.

Myocardial function following cold ischemic storage is improved by cardiac-specific overexpression of A1-adenosine receptors.

Cold ischemic storage of hearts for transplantation is limited to 4-6 h, and therefore the development of strategies to extend preservation time may increase the donor pool of hearts. Overexpression of A1-adenosine receptors (A1AR) can protect hearts from acute ischemic injury, and the purpose of this study was to test the hypothesis that overexpression of A1AR will improve tolerance to longer periods of cold ischemic preservation. Hearts from 18 wild type and 16 transgenic mice with overexpression of A1AR (A1AR Trans) were isolated and perfused, and then subjected to 18 h of preservation in 5 degrees C University of Wisconsin solution followed by 2 h of reperfusion. Left ventricular end diastolic pressure and left ventricular developed pressure were measured as indices of ventricular function. Cell viability was assessed by determination of infarct size and myocardial cell apoptosis. A1AR Trans hearts showed improved function following 18 h of ischemia, as shown by lower end diastolic pressure (p < 0.05) and higher recovery of left ventricular developed pressure (p < 0.05) during reperfusion. A1AR Trans hearts had markedly reduced infarct size (p < 0.05) and decreased apoptosis (p < 0.05). Overexpression of cardiac A1AR imparts cardioprotection during long-term cold ischemic preservation.