Innovations in Diabetes Device Training: A Scoping Review.

OBJECTIVE: The coronavirus disease 2019 pandemic highlighted a pre-existing need for alternatives to traditional in-person diabetes device trainings. Barriers to care, which include the heavy burden of training, pose a threat to optimal adoption and utilization of these devices. We searched the literature for alternative methods of training, evaluated user satisfaction, and compared short-term clinical outcomes with guideline-based glucometric targets and historical training results. METHODS: A scoping review of Embase articles from 2019 to 2021 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines using key words relevant to diabetes technologies. Original full-text articles investigating training of new users on devices were included. Titles and abstracts were screened for eligibility by 2 independent reviewers, and results were summarized. RESULTS: Of 25 articles retrieved from the database, 11 met the criteria. Alternative training strategies included video conferencing, phone calls, mobile applications, and hybrids with traditional trainings. Overall, there was a high degree of user satisfaction with virtual visits, with a preference for hybrid approaches (6 articles). Although glucometrics varied between articles, short-term glucometrics were satisfactory overall (8 articles), including improved glycated hemoglobin measurements and time in range. Two articles compared time in range over various time points after traditional and remote training. One found equivalency, and the other identified a 5% improvement with remote training. CONCLUSION: Alternative training approaches are a viable option to reduce the barriers to care and to alleviate training burden. Intentional implementation of alternatives should be considered a solution to address current barriers.

THE ROLE OF HETEROPLASMY IN THE DIAGNOSIS AND MANAGEMENT OF MATERNALLY INHERITED DIABETES AND DEAFNESS.

Objective: Maternally inherited diabetes and deafness (MIDD) is a rare diabetic syndrome mainly caused by a point mutation in the mitochondrial DNA (mtDNA), mt3243 adenine to guanine (A>G). The objective of this paper is to review the genetic inheritance, clinical manifestations, and treatment of patients with MIDD. Methods: The current review used a literature search of scientific papers on this rare syndrome. Results: mtDNA is primarily inherited through the maternal oocyte; therefore, the genetic abnormalities in MIDD are associated with maternal inheritance. Mitochondria contain circular mtDNA, which codes for various mitochondrial genes. The mtDNA can be heteroplasmic, containing more than one type of mtDNA sequence; if one of the mtDNAs contains the mt3243 A>G mutation, a patient may develop MIDD. Patients can inherit different amounts of mutated mtDNA and normal mtDNA that affect the severity of the clinical manifestations of MIDD. The most common clinical manifestations include diabetes mellitus, deafness, ophthalmic disease, cardiac disease, renal disease, gastrointestinal disease, short stature, and myopathies. In order to effectively treat patients with MIDD, it is important to recognize the underlying pathophysiology of this specific form of diabetes and the pathophysiology associated with the organ-specific complications present in this disease. Conclusion: The heteroplasmic inheritance of mutated mtDNA plays an important role in the clinical manifestations of various mitochondrial diseases, specifically MIDD. This review will alert endocrinologists of the signs and symptoms of MIDD and important clinical considerations when managing this disease. Abbreviations: ATP = adenosine triphosphate; CoQ10 = coenzyme Q10; MELAS = mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke; MIDD = maternally inherited diabetes and deafness; mtDNA = mitochondrial DNA; tRNA = transfer ribonucleic acid; ROS = reactive oxygen species; T2DM = type 2 diabetes mellitus.

Managing older patients with cancer.

With the growing population of adults over age 70 years, clinicians must know how to care appropriately for the increasing number of older patients with cancer. Although older adults have higher rates of surgical complications and chemotherapy-related toxicity, they should not be excluded from treatment opportunities based on age alone. Rather, patients should be assessed for fitness, or functional age, for a more accurate estimation of how they will tolerate treatment. This article discusses considerations clinicians should take into account when developing effective treatment plans that do not compromise quality of life for older patients with cancer.

Service-Learning in Physician Assistant Education: A Scoping Review.

INTRODUCTION: Service-learning (SL) is a pedagogy that can be used in healthcare education to develop students who are better prepared to address the various social determinants of health and to provide compassionate care to the diverse populations they will serve. Yet, an assessment of the quality and scope of the SL activities used in physician assistant (PA) education is not available. The purpose of this scoping review is to review the literature and identify and summarize articles about SL courses in PA education. METHODS: We performed a scoping literature search of 4 databases (CINAHL, PubMed, Embase, and Scopus) to identify peer-reviewed journal articles about SL in PA education. Studies that did not include PA students, were not a service-learning activity (but instead an interprofessional activity, simulation, or volunteerism), or were not a full article were all excluded. RESULTS: Nine articles were included in this scoping review after independent evaluation by 2 investigators based on specific inclusion and exclusion criteria. The most common reason for exclusion was lack of distinct learning objectives specific to the service learning and/or a lack of a structured, guided critical reflection that helped realize and demonstrate the desired learning outcomes. DISCUSSION: Although service-learning is considered to be a high-impact teaching practice, it is still an underutilized tool in PA education. Training faculty in the implementation of SL to align the hands-on activity with specific course learning objectives and in the effective use of structured critical reflection can create a more impactful and authentic SL educational experience.

Comparing the Ability of Two Comprehensive Clinical Staging Systems to Predict Mortality: EOSS and CMDS.

OBJECTIVE: Differences in discriminative and predictive ability for all-cause mortality of two clinical staging systems, the Edmonton Obesity Staging System (EOSS) and Cardiometabolic Disease Staging (CMDS), were estimated. METHODS: Data for nonpregnant persons aged 40 to 75 years were extracted from the National Health and Nutrition Examination Survey. Predictive and discriminative ability was assessed using pseudo-R2 and C-statistics. Median years of life lost were also computed for each score. RESULTS: Differences in out-of-sample estimates of pseudo-R2 and C-statistics (EOSS model as reference) were 0.02 (95% CI: 0.01-0.04) (Kent pseudo-R2 ), 0.03 (0.01-0.04) (Royston pseudo-R2 ), and 0.02 (0.01-0.02) (C-statistics). The median years of life lost for EOSS scores 2 and 3 (low to high risk) for a reference person were 1.19 and 6.76 years. Those for CMDS scores 1, 2, 3, and 4 (low to high risk) were 1.53, 2.90, 3.91, and 8.51 years. Consistent results from the in-sample estimates were observed. CONCLUSIONS: CMDS had statistically significantly greater predictive and discriminative ability than EOSS for persons aged 40 to 75. While the clinical relevance of these differences is unknown, CMDS may have greater clinical utility given that it uses fewer items to risk stratify. The clinical relevance and utility need to be studied further.

Hyperandrogenism and intersex controversies in women's olympics.

International sports governing bodies such as the International Association for Athletics Federation and the International Olympic Committee have recently revised their policies for inclusion of athletes competing in women's international sports competitions. Previously, the focus was on verification of gender or femininity. The mishandling of Caster Semanya's case brought the complex issues of fairness with regard to athletes with disorders of sexual development or hyperandrogenism into both public and private debates. The new International Association for Athletics Federation and International Olympic Committee policies for inclusion in women's sporting events rest largely on the serum testosterone level, mandating that it be less than the lower limit of normal for men as the defining criteria. This report provides an overview of past problems and an update of the newly adopted policies for eligibility for competition in women's events. Endocrinologists will play a key role in the evaluation and treatment of women athletes who have elevated androgen levels, regardless of the underlying cause.