Clinical and Metabolic Characterization of Women With Gestational Diabetes Mellitus Within the First Year Postpartum.

Context: Women with gestational diabetes mellitus (GDM) have an increased risk of long-term complications, including impaired glucose metabolism, type 2 diabetes (T2DM), cardiovascular disease, and obesity. In current clinical practice, a 1 size fits all approach to GDM is applied, although heterogeneity among women with GDM has been recognized. Objective: To give the most adequate preventive care and postpartum (PP) guidance, we aimed to make a metabolic characterization and identify subgroups of women with previous GDM within the first year PP. Methods: In this prospective cohort study, we collected data in gestational week 34-38, at 3 months, and 1 year PP on women with GDM who participated in a PP follow-up program in Central Region Denmark from April 2019 to December 2022. Results: In total, 1270 women were included in the program in late pregnancy. Of the 768 women participating in either the oral glucose tolerance test 3 months PP (n = 545) or the 1-year follow-up (n = 493) or both (n = 261), 608 (79.2%) were normoglycemic, 137 (17.8%) had prediabetes, 20 (2.6%) had T2DM, and 3 (.4%) had developed T1DM. More than 40% of the women gained weight in the first year PP compared with their pregestational weight. Conclusion: Our study shows that 20.8% of women with GDM who volunteered to participate in a clinical follow-up program developed prediabetes or diabetes (T1DM and T2DM) within the first year PP. The GDM diagnosis encompasses a heterogenetic group of women and a deeper characterization may provide an opportunity for a more personalized risk assessment to prevent the progression to T2DM.

Participation in a multicomponent lifestyle intervention for people with obesity improves glycated hemoglobin (HbA1c).

Introduction: Obesity is associated with compromised glucose metabolism. Hence, it is of interest to investigate if the lifestyle interventions used in the LIBRA-cohort, which aimed at not only weight loss, but also patient well-being, could also help obese patients improve glucose metabolism by evidence of reduced HbA1c. The aim of the study was to retrospectively investigate if patients who were referred to a lifestyle intervention for obesity, were able to alter HbA1c. Research design and methods: Patients with a BMI≥30 undergoing a 6-month lifestyle intervention, who also completed physical and mental health surveys and whose baseline and 6-month blood samples were available, were included in the analysis. For changes in HbA1c and body weight a clinically relevant change of 5≥mmom/mol and 5%≥, respectively, was chosen. Participants were divided into groups according to their baseline HbA1c level: "Diabetes": HbA1c of ≥6.5% (≥48 mmol/mol), "Prediabetes": HbA1c of 5.7% to 6.4% (39-47.99 mmol/mol) or "Normal" HbA1c <5.7% (<39 mmol/mol). Results: 180 patients met the stated inclusion criteria and these patients were divided into groups (median age (25th;75th quartile): Diabetes: n=47, age 54 (43;60), 51% women, Prediabetes: n=68, age 60 (50;66), 71% women and Normal: n=65, median age 61 (50;66), 85% women. Significant reductions were found in all three groups and specifically in the diabetes group HbA1c was reduced (mean [95%CI]) -5[-8;-2] mmol/mol from baseline to the end of the intervention. Furthermore, 35% of patients with prediabetes normalized their HbA1c (<39) and 30% patients with diabetes reduced their HbA1c <48. All groups had clinically relevant (≥5%) reductions in body weight (p<0.01). There was an association between body weight reduction and HbA1c reduction in the diabetes group (p<0.01). All groups reported improvements in physical health (p<0.01). Conclusion: In this retrospective cohort study, all patients achieved clinically relevant weight loss after participation in the lifestyle intervention and obese patients with diabetes achieved clinically relevant reductions in HbA1c after 6-months. More than 1/3 of patients with prediabetes normalized their HbA1c.

A new species of Crinoniscus Pérez, 1900 (Crustacea: Isopoda: Crinoniscidae) parasitising the pedunculate barnacle Heteralepas newmani Buhl-Mortensen & Mifsud (Cirripedia: Heteralepadidae) with notes on its ecology and a review of the genus.

The new species Crinoniscus stroembergi n. sp. belonging to the parasitic isopod family Crinoniscidae Bonnier, 1900, is described from a pedunculate barnacle host collected in the Mediterranean Sea. This is the first species of Crinoniscus Pérez, 1900 described from a host in the genus Heteralepas Pilsbry. The male cryptoniscus larva is distinguished from congeneric species by having a dorsoventrally flattened body with the posterolateral margins of the cephalon scarcely extending beyond the anterior margin of pereomere 1 (in contrast to C. cephalatus Hosie, 2008 with extended margins); articles 1 and 2 of the antennule being subequal in width and the anterodistal angle of antennule article being low and rounded; propodus of pereopods 6 and 7 having a sinuous dorsal margin that is distally narrowing and the posterior margin of the pleotelson being short and rounded. The mature females of species in Crinoniscus are of two basic forms: those with ventrolateral lobes on the pereomeres (C. alepadis (Gruvel, 1901) n. comb., and C. politosummus Hosie, 2008) and those lacking such lobes (C. cephalatus and C. stroembergi n. sp.). The mature females of C. stroembergi n. sp. can be distinguished from other species of Crininiscus based on their lacking lobes on the anterior end. The material examined includes the male and three female developmental stages of the parasite in the host, Heteralepas newmani Buhl-Mortensen & Mifsud. The mouthparts of the immature female are described and the feeding biology and effects on the host are discussed along with a review of feeding modes in species of the Cryptoniscoidea. Leponiscus alepadis is transferred to Crinoniscus; the latter genus now contains five species. A modified diagnosis of Crinoniscus is provided.

Does grab size influence sampled macrofauna composition? A test conducted on deep-sea communities in the northeast Atlantic.

In deep-sea surveys, heavy gears are often preferred to effectively collect macro benthos while smaller samplers are sufficient in coastal and shallow areas. However, there are few comparative studies of the samples retained and results gained from different-sized grabs. To study the differences in sampling properties between a small (sampling area of 0.1 m2) and a large (0.25 m2) van Veen grab, 1 m2 of seafloor was sampled with each of the grab sizes at four test sites in the Barents- and Norwegian Sea; one inside a fjord and three offshore, across a depth range of 287-963 m. Overall, the small and large grab collected a comparable number of species and individuals: 248 and 233 species, and 6074 and 6143 individuals, respectively. The large grab retrieved the most species at the deepest location while the small grab collected more species at the other test sites. Based on internationally recommended 0.5 m2 sampling units, a variation in the total species richness per test site of 7-13% was found while the diversity indices (ES100 and H') varied by less than 10%. Independent of grab size, a cluster and nMDS analysis showed four clearly separated sample-groups that correspond to the four test stations although the multivariate dispersion was consistently higher for the small grab. A SIMPROF test showed no grab size-dependent differences. ANOSIM and PERMANOVA tests showed differences between grab sizes for the deepest station, where a similar difference occurred also between samples of the same grab size. This station displayed the least faunal heterogeneity, indicating that faunal patchiness may influence any grab-size differences. The results indicate that the two van Veen grabs tested deliver comparable quantitative faunal compositions. For the small grab, however, numerous samples were rejected due to poor performance, resulting in increased sampling time, ship costs and a suggested biased sampling towards less heterogeneous sediments at the fjord site.

How to play the game of medical education: Sociocultural analyses of educational difficulties among medical residents.

This article was migrated. The article was marked as recommended. Medical residents in difficulty struggle to comply with educational requirements. They pose a liability to patient safety and they have problems to adapt to the professional role of a doctor. Consequently, being a resident in difficulty may cause identity crisis and have the potential to disrupt the resident's professional identity as a doctor. Only few studies explore the tipping point between becoming a resident in difficulty or not, and these studies rarely reflect the surrounding sociocultural aspects of the residents' difficulties such as organisational culture in the workplace. This article explores how medical residency training culture influence on residents' risk of ending in difficulty. Our study was based on six focus-group interviews with residents (n=28) and in-depth interviews with residents in difficulty (n=10). The interpretation of data employed sociologist Pierre Bourdieu's theoretical framework around dispositions. Across the data, we identified four themes: Conflicting games in the field of medical education, altruism, organisational hierarchy, and coping with stress. We found a (mis)match between legitimate rules in the field of medicine and the residents' dispositions to appreciate those rules. These results can inform clinical supervisors and consultants in their decisions for supporting residents in difficulty and increasing educational achievement among struggling residents.

Bottom trawl fishing footprints on the world's continental shelves.

Bottom trawlers land around 19 million tons of fish and invertebrates annually, almost one-quarter of wild marine landings. The extent of bottom trawling footprint (seabed area trawled at least once in a specified region and time period) is often contested but poorly described. We quantify footprints using high-resolution satellite vessel monitoring system (VMS) and logbook data on 24 continental shelves and slopes to 1,000-m depth over at least 2 years. Trawling footprint varied markedly among regions: from <10% of seabed area in Australian and New Zealand waters, the Aleutian Islands, East Bering Sea, South Chile, and Gulf of Alaska to >50% in some European seas. Overall, 14% of the 7.8 million-km2 study area was trawled, and 86% was not trawled. Trawling activity was aggregated; the most intensively trawled areas accounting for 90% of activity comprised 77% of footprint on average. Regional swept area ratio (SAR; ratio of total swept area trawled annually to total area of region, a metric of trawling intensity) and footprint area were related, providing an approach to estimate regional trawling footprints when high-resolution spatial data are unavailable. If SAR was ≤0.1, as in 8 of 24 regions, there was >95% probability that >90% of seabed was not trawled. If SAR was 7.9, equal to the highest SAR recorded, there was >95% probability that >70% of seabed was trawled. Footprints were smaller and SAR was ≤0.25 in regions where fishing rates consistently met international sustainability benchmarks for fish stocks, implying collateral environmental benefits from sustainable fishing.

Amphipod family distributions around Iceland.

Amphipod crustaceans were collected at all 55 stations sampled with an epibenthic sledge during two IceAGE expeditions (Icelandic marine Animals: Genetics and Ecology) in 2011 and 2013. In total, 34 amphipod families and three superfamilies were recorded in the samples. Distribution maps are presented for each taxon along with a summary of the regional taxonomy for the group. Statistical analyses based on presence/absence data revealed a pattern of family distributions that correlated with sampling depth. Clustering according to the geographic location of the stations (northernmost North Atlantic Sea and Arctic Ocean) can also be observed. IceAGE data for the Amphilochidae and Oedicerotidae were analysed on species level; in case of the Amphilochidae they were compared to the findings from a previous Icelandic benthic survey, BIOICE (Benthic Invertebrates of Icelandic waters), which also identified a high abundance of amphipod fauna.

Marine litter in the Nordic Seas: Distribution composition and abundance.

Litter has been found in all marine environments and is accumulating in seabirds and mammals in the Nordic Seas. These ecosystems are under pressure from climatic change and fisheries while the human population is small. The marine landscapes in the area range from shallow fishing banks to deep-sea canyons. We present density, distribution and composition of litter from the first large-scale mapping of sea bed litter in arctic and subarctic waters. Litter was registered from 1778 video transects, of which 27% contained litter. The background density of litter in the Barents Sea and Norwegian Sea is 202 and 279 items/km2 respectively, and highest densities were found close to coast and in canyons. Most of the litter originated from the fishing industry and plastic was the second most common litter. Background levels were comparable to European records and areas with most littering had higher densities than in Europe.

Early Assessment of Cost-effectiveness of Gastric Electrical Stimulation for Diabetic Nausea and Vomiting.

BACKGROUND/AIMS: Recurrent nausea and/or vomiting are common complications of diabetes mellitus. The conditions severely impact the quality of life of patients and often cause repeated admissions to hospital incurring significant healthcare costs. If standard treatment fails, gastric electrical stimulation (GES) may be offered in selected cases, as a minimally invasive, but expensive, therapeutic option. Our aims are to evaluate the clinical effect and the cost-utility of GES as a treatment for severe diabetic recurrent nausea and/or vomiting. METHODS: Among 33 diabetes patients implanted with GES because of recurrent nausea and/or vomiting, 30 were available for evaluation. The effect of treatment was assessed prospectively using symptom-diaries and the SF-36 questionnaires at baseline, after 6 and 12 months, and thereafter yearly. The number of days in hospital due to symptoms related to gastrointestinal dysfunction was calculated using hospital records 12 months prior to and 12 months after implantation. RESULTS: The surgical procedures were performed without mortality or major complications. Six months after surgery 78% of the respondents had at least 50% reduction in time with nausea and 48% had at least 50% reduction in days with vomiting. Symptom relief persisted at follow-up after at least 4 years. Quality adjusted life years improved after GES, which was cost-effective after 24 months. CONCLUSIONS: GES reduces symptoms and improves quality of life in diabetes patients with recurrent nausea and/or vomiting. The procedure is supposed as cost-effective over a 2-year time horizon.

Residents in difficulty: a mixed methods study on the prevalence, characteristics, and sociocultural challenges from the perspective of residency program directors.

BACKGROUND: The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding of the topic. METHODS: We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399) of residents, and analyzed statistically (Chi-squared test (Χ (2)) or Fisher's exact test). Secondly, we performed a qualitative interview study involving three focus group interviews with residency program directors. The analysis of the interview data employed qualitative content analysis. RESULTS: 73.2 % of the residency program directors completed the e-survey and 22 participated in the focus group interviews. The prevalence of residents in difficulty was 6.8 %. We found no statistically significant differences in the prevalence of residents in difficulty by gender and type of specialty. The results also showed two important themes related to the workplace culture of the resident in difficulty: 1) belated and inconsistent feedback on the resident's inadequate performance, and 2) the perceived culturally rooted priority of efficient patient care before education in the workplace. These two themes were emphasized by the program directors as the primary underlying causes of the residents' difficulty. CONCLUSIONS: More work is needed in order to clarify the link between, on the one hand, observable markers of residents in difficulty and, on the other hand, immanent processes and logics of practice in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents' and doctors' socialization into the healthcare system.

Residents in difficulty--just slower learners? A case-control study.

BACKGROUND: Recent meta-analyses have found small-moderate positive associations between general performance in medical school and postgraduate medical education. In addition, a couple of studies have found an association between poor performance in medical school and disciplinary action against practicing doctors. The aim of this study was to examine if a sample of Danish residents in difficulty tended to struggle already in medical school, and to determine whether administratively observable performance indicators in medical school could predict difficulties in residency. METHODS: The study design was a cumulative incidence matched case-control study. The source population was all active specialist trainees, who were medical school graduates from Aarhus University, in 2010 to June 2013 in two Danish regions. Cases were doctors who decelerated, transferred, or dropped out of residency. Cases and controls were matched for graduation year. Medical school exam failures, grades, completion time, and academic dispensations as predictors of case status were examined with conditional logistic regression. RESULTS: In total 89 cases and 343 controls were identified. The total number of medical school re-examinations and the time it took to complete medical school were significant individual predictors of subsequent difficulties (deceleration, transferral or dropout) in residency whereas average medical school grades were not. CONCLUSIONS: Residents in difficulty eventually reached similar competence levels as controls during medical school; however, they needed more exam attempts and longer time to complete their studies, and so seemed to be slower learners. A change from "fixed-length variable-outcome programmes" to "fixed-outcome variable-length programmes" has been proposed as a way of dealing with the fact that not all learners reach the same level of competence for all activities at exactly the same time. This study seems to support the logic of such an approach to these residents in difficulty.

Acute differential effects of dietary protein quality on postprandial lipemia in obese non-diabetic subjects.

Non-fasting triglyceridemia is much closer associated to cardiovascular risk compared to fasting triglyceridemia. We hypothesized that there would be acute differential effects of four common dietary proteins (cod protein, whey isolate, gluten, and casein) on postprandial lipemia in obese non-diabetic subjects. To test the hypothesis we conducted a randomized, acute clinical intervention study with crossover design. We supplemented a fat rich mixed meal with one of four dietary proteins i.e. cod protein, whey protein, gluten or casein. Eleven obese non-diabetic subjects (age: 40-68, body mass index: 30.3-42.0 kg/m(2)) participated and blood samples were drawn in the 8-h postprandial period. Supplementation of a fat rich mixed meal with whey protein caused lower postprandial lipemia (P = .048) compared to supplementation with cod protein and gluten. This was primarily due to lower triglyceride concentration in the chylomicron rich fraction (P = .0293). Thus, we have demonstrated acute differential effects on postprandial metabolism of four dietary proteins supplemented to a fat rich mixed meal in obese non-diabetic subjects. Supplementation with whey protein caused lower postprandial lipemia compared to supplementation with cod and gluten. As postprandial lipemia is closely correlated to cardiovascular disease, long-term dietary supplementation with whey protein may prove beneficial in preventing cardiovascular disease in obese non-diabetic subjects.

Differential effects of dietary protein sources on postprandial low-grade inflammation after a single high fat meal in obese non-diabetic subjects.

BACKGROUND: Obesity is a state of chronic low-grade inflammation. Chronic low-grade inflammation is associated with the pathophysiology of both type-2 diabetes and atherosclerosis. Prevention or reduction of chronic low-grade inflammation may be advantageous in relation to obesity related co-morbidity. In this study we investigated the acute effect of dietary protein sources on postprandial low-grade inflammatory markers after a high-fat meal in obese non-diabetic subjects. METHODS: We conducted a randomized, acute clinical intervention study in a crossover design. We supplemented a fat rich mixed meal with one of four dietary proteins - cod protein, whey isolate, gluten or casein. 11 obese non-diabetic subjects (age: 40-68, BMI: 30.3-42.0 kg/m2) participated and blood samples were drawn in the 4 h postprandial period. Adiponectin was estimated by ELISA methods and cytokines were analyzed by multiplex assay. RESULTS: MCP-1 and CCL5/RANTES displayed significant postprandial dynamics. CCL5/RANTES initially increased after all meals, but overall CCL5/RANTES incremental area under the curve (iAUC) was significantly lower after the whey meal compared with the cod and casein meals (P = 0.0053). MCP-1 was initially suppressed after all protein meals. However, the iAUC was significantly higher after whey meal compared to the cod and gluten meals (P = 0.04). CONCLUSION: We have demonstrated acute differential effects on postprandial low grade inflammation of four dietary proteins in obese non-diabetic subjects. CCL5/RANTES initially increased after all meals but the smallest overall postprandial increase was observed after the whey meal. MCP-1 was initially suppressed after all 4 protein meals and the whey meal caused the smallest overall postprandial suppression. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT00863564.

The use of benthic indicators in Europe: from the Water Framework Directive to the Marine Strategy Framework Directive.

The Water Framework Directive (WFD) and the Marine Strategy Framework Directive (MSFD) are the European umbrella regulations for water systems. It is a challenge for the scientific community to translate the principles of these directives into realistic and accurate approaches. The aim of this paper, conducted by the Benthos Ecology Working Group of ICES, is to describe how the principles have been translated, which were the challenges and best way forward. We have tackled the following principles: the ecosystem-based approach, the development of benthic indicators, the definition of 'pristine' or sustainable conditions, the detection of pressures and the development of monitoring programs. We concluded that testing and integrating the different approaches was facilitated during the WFD process, which led to further insights and improvements, which the MSFD can rely upon. Expert involvement in the entire implementation process proved to be of vital importance.

Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments.

BACKGROUND: The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. METHODS: The study was a trans-sectional correlation study. The educational climate was investigated by a survey among all doctors (specialists and trainees) in the departments. Leadership skills of the consultants responsible for education were measured by multi-source feedback scores from heads of departments, peer consultants, and trainees. RESULTS: Doctors from 42 clinical departments representing 21 specialties participated. The response rate of the educational climate investigation was moderate 52% (420/811), Response rate was high in the multisource-feedback process 84.3% (420/498). The educational climate was scored quite high mean 3.9 (SD 0.3) on a five-point Likert scale. Likewise the leadership skills of the clinical consultants responsible for education were considered good, mean 5.4 (SD 0.6) on a seven-point Likert scale. There was no significant correlation between the scores concerning the educational climate and the scores on leadership skills, r = 0.17 (p = 0.29). CONCLUSIONS: This study found no relation between the educational climate and the leadership skills of the clinical consultants responsible for postgraduate medical education in clinical departments with the instruments used. Our results indicate that consultants responsible for education are in a weak position to influence the educational climate in the clinical department. Further studies are needed to explore, how heads of departments and other factors related to the clinical organisation could influence the educational climate.

What is the impact of a national postgraduate medical specialist education reform on the daily clinical training 3.5 years after implementation? A questionnaire survey.

BACKGROUND: Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice. METHODS: The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents. RESULTS: Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects. CONCLUSIONS: The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture.

Effects of different protein sources on plasminogen inhibitor-1 and factor VII coagulant activity added to a fat-rich meal in type 2 diabetes.

BACKGROUND: Exaggerated postprandial triglyceride concentration is believed to be atherogenic, and to influence the risk of thrombosis. Both elevated plasminogen inhibitor 1 (PAI-1) and increased factor VII coagulant activity (FVIIc) are potential important contributors to the increased risk of cardiovascular disease in type 2 diabetes. AIM: We aimed to investigate the effect of adding four different protein types (i.e. casein, whey, cod, and gluten) to a fat-rich meal on postprandial responses of PAI-1 and FVIIc in type 2 diabetic patients. METHODS: Twelve type 2 diabetic patients ingested four isocaloric test meals in random order. The test meals contained 100 g of butter and 45 g of carbohydrate in combination with 45 g of casein (Cas-meal), whey (Whe-meal), cod (Cod-meal), or gluten (Glu-meal), respectively. Plasma concentrations of PAI-1 and FVIIc were measured before meal, and at regular intervals for 8-h postprandially. RESULTS: The postprandial PAI-1 concentration decreased significantly by 49% to 56% in response to the four test meals. There were no significant differences between the outcomes from the four test-meals. The FVIIc levels decreased by 8% to 11% after the meals. Again, we observed no significant differences in outcomes between the four protein-enriched meals. CONCLUSIONS: The four proteins casein, whey, cod, and gluten, added to a fat-rich meal, all decreased the PAI-1 and FVIIc concentrations postprandially in type 2 diabetic subjects. However, postprandial levels of PAI-1 and FVIIc were not acutely influenced by the protein source.

Combining a leadership course and multi-source feedback has no effect on leadership skills of leaders in postgraduate medical education. An intervention study with a control group.

BACKGROUND: Leadership courses and multi-source feedback are widely used developmental tools for leaders in health care. On this background we aimed to study the additional effect of a leadership course following a multi-source feedback procedure compared to multi-source feedback alone especially regarding development of leadership skills over time. METHODS: Study participants were consultants responsible for postgraduate medical education at clinical departments. STUDY DESIGN: pre-post measures with an intervention and control group. The intervention was participation in a seven-day leadership course. Scores of multi-source feedback from the consultants responsible for education and respondents (heads of department, consultants and doctors in specialist training) were collected before and one year after the intervention and analysed using Mann-Whitney's U-test and Multivariate analysis of variances. RESULTS: There were no differences in multi-source feedback scores at one year follow up compared to baseline measurements, either in the intervention or in the control group (p = 0.149). CONCLUSION: The study indicates that a leadership course following a MSF procedure compared to MSF alone does not improve leadership skills of consultants responsible for education in clinical departments. Developing leadership skills takes time and the time frame of one year might have been too short to show improvement in leadership skills of consultants responsible for education. Further studies are needed to investigate if other combination of initiatives to develop leadership might have more impact in the clinical setting.

Differential effects of protein quality on postprandial lipemia in response to a fat-rich meal in type 2 diabetes: comparison of whey, casein, gluten, and cod protein.

BACKGROUND: Enhanced and prolonged postprandial triglyceride responses involve increased cardiovascular disease risk in type 2 diabetes. Dietary fat and carbohydrates profoundly influence postprandial hypertriglyceridemia, whereas little information exists on the effect of proteins. OBJECTIVE: The objective was to compare the effects of the proteins casein, whey, cod, and gluten on postprandial lipid and incretin responses to a high-fat meal in persons with type 2 diabetes. DESIGN: A crossover study was conducted in 12 patients with type 2 diabetes. Blood samples were collected over 8 h after ingestion of a test meal containing 100 g butter and 45 g carbohydrate in combination with 45 g casein (Cas-meal), whey (Whe-meal), cod (Cod-meal), or gluten (Glu-meal). We measured plasma concentrations of triglycerides, retinyl palmitate (RP), free fatty acids, insulin, glucose, glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide. RESULTS: The incremental area under the curve for triglyceride was significantly lower after the Whe-meal than after the other meals. The RP response was lower after the Whe-meal than after the Cas-meal and Cod-meal in the chylomicron-rich fraction and higher after the Whe-meal than after Cod- and Glu-meals in the chylomicron-poor fraction. Free fatty acids were most pronouncedly suppressed after the Whe-meal. The glucose response was lower after the Whe-meal than after the other meals, whereas no significant differences were found in insulin, glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide responses. CONCLUSION: The data suggest that as a supplement to a fat-rich meal in patients with type 2 diabetes, whey protein seems to outperform other proteins in terms of postprandial lipemia improvement, possibly because of the formation of fewer chylomicrons or increased clearance of chylomicrons. The trial was registered at ClinicalTrials.gov as NCT00817973.

Effects of multi-source feedback on developmental plans for leaders of postgraduate medical education.

OBJECTIVES: Multi-source feedback (MSF) is a widely used developmental tool for leaders in organisations including those dealing with health care. This study was performed to examine the effects of an MSF process on developmental plans made by leaders of postgraduate medical education (PGME) in clinical departments. METHODS: An MSF instrument was developed based on literature on the subject and previous investigations. The instrument was used by consultants responsible for PGME in clinical departments (CREs). Apart from CREs' self-ratings, MSF responses were collected from heads of departments, consultants and young doctors-in-training. The MSF process included individual feedback as well as guidance on drafting developmental plans for both the department and the CREs. Themes emerging in the developmental plans were analysed and compared with the areas in need of improvement identified by the MSF process. RESULTS: The MSF instrument was found to be feasible, valid and reliable (Cronbach's alpha = 0.98). The study included 52 CREs from various specialties and 498 MSF respondents. The response rate was 84%. Low ratings and negative gaps between others' ratings and self-ratings were identified for both management and leadership performance areas. The developmental plans mainly focused on management initiatives, whereas plans for the development of leadership performance were few. Areas rated low by all respondents were scarcely represented in CREs' developmental plans. CONCLUSIONS: An MSF process might in itself lead to development in administrative areas. However, MSF carried through as a single stand-alone procedure was not sufficient to foster plans for the development of leadership performance.