Managing Sexual and Reproduction Complications of Diabetes in Men.

Male reproductive disorders are a less discussed complication of diabetes. These disorders can include balanitis, erectile dysfunction, decreased libido, erectile impotence, and infertility. This article reviews the epidemiology, pathophysiology, classic presentation, and treatment of balanitis, erectile dysfunction, and sperm dysfunction.

Considerations for Transgender People With Diabetes.

This article offers clinicians resources and an overview for supporting gender-diverse individuals with diabetes. Creating a supportive office environment is crucial to providing optimal diabetes care for patients who identify as transgender.

Accelerated Education Intervention: A Pilot Study to Assess the Effectiveness of a Brief, Self-Paced Intervention to Prevent Burnout in Physician Assistant Students.

PURPOSE: Physician assistant (PA) programs have an academically rigorous curriculum, which places a myriad of pressures on students and contributes to burnout. The benefits of optimal quality and quantity of sleep are well documented, yet students still view sacrificing sleep as a necessary step in academic success. The purpose of this pilot study was to create behavior changes to promote optimal sleep hygiene in PA school and decrease measurements of burnout. METHODS: 39 PA students from a single institution volunteered to take part in an 8-week study. Wrist actigraphy was used to measure students' sleeping habits, resting heart rate, and physical activity. Additionally, the students completed a questionnaire regarding stimulant and sleep aid use and burnout (Maslach Burnout Inventory) at two time points. The intervention was 8 weeks in duration split into 2, 4-week blocks separated by a 1-hour, evidence-based education intervention to promote beneficial behavior change and sleep hygiene. RESULTS: Sleep duration, wake time, and bedtime remained consistent across the study period with no changes post-intervention (p > 0.05). Moderate to high levels of cynicism and emotional exhaustion were seen in more than three-quarters of students. There was no relationship between sleep duration and exam scores, heart rate, or steps. Shorter sleep duration predicted increased emotional exhaustion and cynicism (p < 0.05). CONCLUSION: Sleeping habits influence emotional well-being and are likely minimally affected by educational interventions alone. Combatting the high prevalence of burnout in PA schools can begin with targeting environmental and policy-level changes that can influence student recovery and well-being opportunities throughout the academic year.

Conquering diabetes therapeutic inertia: practical tips for primary care.

Diabetes is a complex condition that is largely self-managed. Decades of scientific evidence has proved that early glycemic control leads to improved microvascular and macrovascular outcomes in people with diabetes mellitus. Despite well-established management guidelines, only about half of the patients with diabetes achieve glycemic targets, and only one in five patients achieve metabolic control (blood pressure, lipid, and glucose targets), and both patients and physicians find themselves stuck in a rut called therapeutic inertia (TI). The authors present several practical strategies that can be tailored to different practice settings and facilitate reducing TI.

Physician Assistant School Applicants' Perceptions of Virtual Interviews.

PURPOSE: To evaluate the attitudes of applicants of virtual physician assistant (PA) school interviews during the 2021-2022 cycle which was impacted by the COVID-19 pandemic. METHODS: This quasi-experimental design studied applicants to PA programs in the United States. The study recruited applicants who interviewed virtually between March 2020 and January 2022 via an anonymous online survey. In addition to demographic information, the survey contained 20 questions regarding virtual PA school interviews. RESULTS: Study population n= 164. Most of the study participants were interviewed using a Zoom platform (n=147). Overall, there was an above-neutral satisfaction with virtual interviews (3.7 ±1.0, X2= 91.2, p=0.00001). The majority of participants preferred a virtual platform (56%) versus an in-person interview (44%). When stratified by race, 87% of non-White participants preferred a virtual platform for admissions. Ranked order benefits of attending virtual interviews included lower travel cost, less time away from work, ability to interview at more PA programs, and comfort interviewing at home. CONCLUSION: Virtual interviews were adopted by many medical education programs during the COVID-19 pandemic. This study provides support that PA applicants prefer a virtual platform due to lower cost and less time away from work. Further research is needed to determine preferences outside PA admissions.

Multi-Institutional Physician Assistant Student Perception of Simulated Emergency Room Cases.

INTRODUCTION: During clinical experiences, physician assistant (PA) students are required to participate in the management of multiple patients simultaneously. One method of preparing students for clinical experiences is through the use of simulation. Simulation allows development of decision-making and teamwork skills. 1,2 A previous study of nursing students in a multiple-patient simulation demonstrated improved student readiness to care for multiple patients. 2 The present study evaluated the effect of using simulation on PA student comfort with managing multiple patients in an emergency room setting. METHODS: Four PA programs participated in this quasi-experimental pretest-posttest design. Four simulation days were held, each with 4 standardized cases. Half of the students acted as standardized patients, while the remainder of the students managed patients in small groups. Surveys were administered before and after the emergency medicine course. Descriptive statistics and statistical analysis for significance were performed using Excel and SPSS. RESULTS: Posttest results indicated significant improvement in student confidence in emergency scenarios, ability to perform a focused medical history, ability to choose and interpret laboratory values, time management, prioritizing patients in a simulated environment, and selecting appropriate treatment. Students reported satisfaction with the experience, feedback, and debriefing. Participation in these simulations increased student interest in pursuing a position in emergency medicine upon graduation. DISCUSSION: In clinical rotations, PA students are expected to manage multiple patients with a variety of conditions. In this study, students were initially uncomfortable managing multiple patients. Student comfort increased after a simulation experience. Increased opportunities for students to select appropriate diagnostics and treatment may increase their overall comfort in management of patients during rotations.

Associations between diabetes-related distress and predicted cardiovascular complication risks in patients with type 2 diabetes.

CONTEXT: Diabetes-related distress (DRD) is experienced by nearly 50% of people with diabetes at any given time in their diagnosis. The effects of low socioeconomic status (SES) and lacking access to resources can increase DRD. In addition, cardiovascular (CV) complications associated with diabetes are associated with higher DRD scores. OBJECTIVES: This study evaluated the associations between DRD and predicted CV risks in participants with type 2 diabetes. METHODS: This cross-sectional study included 234 individuals with low SES who were Medi-Cal (California version of Medicaid) beneficiaries and sought medical care at a safety-net clinic system. The Problem Areas in Diabetes (PAID) questionnaire assessed DRD levels. The United Kingdom Prospective Diabetes Study Risk Engine was utilized to predict 10-year risks for coronary heart disease (CHD), fatal CHD, stroke, and fatal stroke. A multivariate linear regression model was constructed between the two variables, including other variables to control for potential confounding factors, for assessing the associations. RESULTS: After controlling for potential confounders, participants' total PAID questionnaire scores were significantly associated with their 10-year predicted fatal CHD risks (B=0.060, 95% CI: [0.00084, 0.12], p=0.047). CONCLUSIONS: After controlling for covariates, DRD levels exhibited a significant association with increased 10-year predicted fatal CHD risks in patients with type 2 diabetes and lower SES. Screening for DRD and provision of appropriate psychosocial interventions may reduce the risks of CHD in those with type 2 diabetes.