Sustained Improvement in Type 2 Diabetes Mellitus is Common After Treatment of Hepatitis C Virus With Direct-acting Antiviral Therapy.

GOALS: To determine whether diabetic patients with hepatitis C virus (HCV) treated with direct-acting antiviral agents have improved diabetes, accounting for change in both hemoglobin A1c (HbA1c) and diabetes medications, and whether any improvement was sustained. BACKGROUND: HCV infection is associated with an increased risk of diabetes, with improvement in glycemic control after eradication. There remains uncertainty about the durability and magnitude of this effect. STUDY: HbA1c and diabetes medications were recorded at 6-month intervals for 1.5 years pretreatment and posttreatment for 122 patients. Subjects were classified as having improved diabetes if there was a decrease in HbA1c≥0.5% with no increase in diabetes medications or a decrease in diabetes medications with a stable HbA1c. RESULTS: HbA1c at the nearest time point before treatment was 8.4%±1.9%, compared with 7.8%±1.7% after treatment, a mean difference of 0.6% [95% CI (0.2, 0.9), P<0.01]. A linear mixed effects model incorporating each subject's repeated measurements over time also demonstrated a reduction after treatment of 0.5% [95% CI, (0.3, 0.8), P<0.001]. Accounting for both HbA1c and diabetes medications, 42 of 122 (34%) had an improvement in diabetes after HCV treatment, and 20 of 28 (71%) of these subjects sustained improvement at 1.5 years follow-up. Prescription of insulin was associated with improved diabetes. CONCLUSIONS: Treatment of HCV with direct-acting antiviral agents was associated with improved diabetes in a significant portion of patients with an average reduction in HbA1c of clinically significant magnitude. Among responders, this effect was sustained over 1.5 years of follow-up.

Foraging behavior of an urban bird species: molt gaps, distance to shelter, and predation risk.

Predation cost (Pc) is often regarded as a pivotal component determining foraging behavior. We hypothesized that variations in two of its major constituents, predation risk (mu) and the marginal value of energy ([see text for symbol]Fs/ [see text for symbol]e, where Fs is the survivor's fitness and e represents the amount of acquired energy), will translate into variations in patch use behavior of ground-foraging birds. We studied patch use behavior of House Sparrows (Passer domesticus), as affected by the proximity to shelter, in two large outdoor aviaries. Proximity to shelter should affect mu. We manipulated the birds' flight performance by clipping primary flight feathers from their wings to increase mu, but the clipping may also increase [see text for symbol]Fs/ [see text for symbol]e. To help distinguish between the birds' response to these confounding effects, we further augmented food in the aviaries to reduce [see text for symbol]Fs/ [see text for symbol]e. Patch use, as measured by giving-up densities (GUD, the amount of food left behind in a resource patch following exploitation) was affected by distance from shelter only slightly and mainly when the birds were feather-clipped and food was not augmented. Food augmentation had a homogenizing effect on foraging costs by increasing GUDs and washing out the effects of distance and feather clipping. We argue that mu increases with distance from shelter but that, for the highly urban House Sparrow, this increase is only slight. Feather clipping then increased mu further to the point at which patch use discernibly decreased with distance from shelter. Our experimental manipulation of feather clipping also acted to increase [see text for symbol]Fs/ [see text for symbol]e and resulted in an overall lowering of GUDs. The seed augmentation counteracted the effect of feather clipping on [see text for symbol]Fs/ [see text for symbol]e, allowing the birds to reduce their foraging efforts and washing out the qualitative effect of mu with respect to distance from shelter.

Obstructive Sleep Apnea in Children With Down Syndrome: Screening and Effect of Guidelines.

Previous studies have shown low rates of screening for obstructive sleep apnea in children with Down syndrome (DS), a high-prevalence population. Our study investigated the impact of the 2011 American Academy of Pediatrics guidelines, which recommends screening for obstructive sleep apnea with polysomnogram by age 4 years. We conducted a retrospective chart review of patients 0 to 18 years of age with DS seen at a medical center between 2006 and 2016. Polysomnogram screening frequency was investigated and compared pre- and post-guideline publication. A total of 136 participants were identified. Thirty-two percent (44/136) of children with DS were referred for polysomnogram, all of whom had symptoms. Although overall referral frequency was unaffected, completion frequency by age 18 years improved after publication (30% [21/69] vs 19% [13/67]; P < .05). Notably, polysomnogram completion frequency by age 4 years improved after guidelines publication compared with prior (25% [17/69] vs 0% [0/67]; P < .0001).

Quality Improvement Virtual Practicum: The QI Simulator.

Introduction: In recent years, undergraduate and graduate medical education has been rightfully emphasizing education in quality improvement and patient safety (QIPS). However, the best methods for teaching the foundational principles of QIPS and associated skills are unknown. Methods: In collaboration with the Institute for Healthcare Improvement Open School, we developed an approachable simulation for teams of health care trainees at any level and any discipline. The simulation is based on the investigation of a case regarding a psychiatric patient admitted to a fictional hospital for medical treatment who has eloped. In teams, participants investigate the incident by collecting data and using basic QI principles to brainstorm and design interventions. Participants are guided through this paper-based simulation by QI facilitators who have working knowledge of basic QI principles and techniques. Results: The simulation has been successfully used with hundreds of medical students and other health professional trainees. While working in teams, participants gained exposure to patient-safety incident reporting and investigation, process mapping, plan-do-study-act cycles, run charts, intervention design, and interactions with hospital administrators. Surveyed participants reported that they had learned QI principles, gained confidence in their ability to do QI work, and increased their likelihood of leading a QI initiative in the future. Discussion: Simulation has become a standard way to teach many clinical topics in undergraduate and graduate medical education, and QIPS should be no exception. This simulation has been shown to be effective in increasing understanding of and interest in QIPS.

Quantifying Medical Student Education and Exposure to Otolaryngology.

OBJECTIVES: Evaluate the educational and exposure opportunities provided to students by national otolaryngology organizations. METHODS: Twenty-four otolaryngology organizations and subspecialty societies were reviewed for medical student involvement opportunities, educational and enrichment opportunities, costs of involvement, and available research and travel scholarships. RESULTS: Nine organizations (37.5%) offered membership; 6 charged a membership fee, averaging $73 ± $30 (mean ± SD). Membership was limited to associate status for 7 organizations (77.8%; 7/9). Three organizations (12.5%) provided service opportunities, 4 (16.7%) allowed students to vote, and 1 (4.2%) allowed students to endorse others for membership. Most organizations allowed students to attend conferences (95.8%), and 19 (79.2%) allowed students to present research. Twenty-one (87.5%) organizations charged a conference registration fee ($366 ± $300). Seven organizations (29.2%) offered research scholarships, and 5 (20.8%) offered travel awards. CONCLUSIONS: Opportunities exist for medical students to attend conferences and present research; however, educational and enrichment activities in other areas were limited. Future efforts may be warranted to increase the number and type of opportunities for students.

Resident Involvement in Professional Otolaryngology Organizations: Current Trends in the United States.

Involvement by residents in professional medical organizations can enrich their training, but little data exist regarding the number and types of involvement opportunities available to otolaryngology residents. We sought to fill this gap in knowledge by quantifying the extent to which major otolaryngology-related organizations in the United States provide involvement opportunities to otolaryngology residents. Our analysis included 23 organizations and subspecialty societies. Results showed that many opportunities exist for residents to attend conferences and present research; however, fewer involvement and funding opportunities existed in any other leadership, health policy, or service-learning experiences. These findings were consistent across general and subspecialty societies. Given the many purported benefits of resident involvement in otolaryngology outside of the standard training environment, future efforts may be warranted to increase the number and type of involvement opportunities currently available in professional societies.

Patient education materials assessment tool for laryngectomy health information.

BACKGROUND: The decision to undergo laryngectomy carries medical, social, and emotional consequences. This study evaluates the understandability and actionability of current laryngectomy information. METHODS: Laryngectomy-related educational materials from an online search were evaluated using the validated Patient Education Materials Assessment Tool (PEMAT). Reading difficulty was calculated using the Flesch-Kincaid Level, Flesch Reading Ease, Gunning-Fog Index (GFI), Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook (SMOG) score. Interrater agreement was assessed using Cohen's kappa. Pearson's correlation coefficient was used to determine the relationship among readability, understandability, and actionability. RESULTS: Forty-four articles were included. Interrater agreement was substantial (κ = 0.71). Mean understandability was 68.3% ± 17% and mean actionability was 66.3% ± 24%. Average reading difficulty exceeded the ability of an average American adult. There was a negative correlation between readability and understandability (R = -0.49; P < .05). CONCLUSION: Most laryngectomy information is too difficult for the average person to read, understand, or act upon. Revisions may be warranted to benefit a larger readership.