Filling the Gap: An Innovative Lifestyle Medicine Curriculum for Medical Students.

Lifestyle medicine (LM) offers a unique opportunity to address chronic disease globally. Practitioners are able to provide evidence-based suggestions in a way that supports behavior change. One of the barriers to implementing LM more broadly is the lack of training in this rapidly growing field. To fill this gap in LM education, the authors have created Foundations of Lifestyle Medicine, a freely available online curricular template that can be quickly implemented in a variety of health education settings and timelines. This article provides an overview of the curriculum and a discussion of how it may be implemented. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-024-01985-2.

Lifestyle Medicine Electives: Options for Creating Curricula Within Medical School Training.

Lifestyle medicine (LM) offers future generations of clinicians practical tools to effectively prevent, manage and reverse chronic disease. Due to a variety of factors, introduction of such curricula in medical training has been slow. Until LM becomes more standard in medical schools, electives and tracks are an innovative way to introduce curricula in a time-efficient manner so students can have access to this valuable information during their formative training years. Creating a culture for the acceptance of LM is a critical first step and can be accomplished by collaborating with like-minded faculty as well as developing student interest groups. The latter can also be a strong driver for curricular change. This article provides an overview of several structures that can be implemented within existing curricula to offer students a foundation in LM. Included are offerings during the pre-clinical years, third/fourth year electives, culinary medicine rotations, online opportunities, and the development of a full track. Specific components of each structure are shared as well as examples of successful use of community partnerships, use of pre-existing educational resources, and activities implemented. The authors conclude that implementing electives is a promising avenue for educators to expose medical students to LM and can be molded to work within a variety of current educational structures.

Impact of a Whole-Foods, Plant-Based Nutrition Intervention on Patients Living with Chronic Disease in an Underserved Community.

The current study evaluated the impact of a whole-foods, plant-based nutrition intervention on metabolic markers of patients with chronic disease in an underserved community setting. A retrospective analysis of metabolic biomarkers preintervention and postintervention was conducted on 31 patients with metabolic disease who attended an Eating for Life group visit series. Significant decreases were found for body mass index (BMI; -0.66 [-0.91 to -0.40] kg/m2), systolic blood pressure (-12 [-19 to -5] mm Hg), total cholesterol (-20 [-29 to -10] mg/dL), low-density lipoprotein (LDL; -11.6 [-17.5 to -5.5] mg/dL), and high-density lipoprotein (HDL; -3.2 [-5.7 to -0.7] mg/dL, all Ps < .01). In participants with clinically abnormal preintervention data, the mean (95% CI) change significantly decreased for overweight (-0.45 [-0.85 to -0.05]) and obese (-0.76 [-1.13 to -0.39]) BMI, systolic blood pressure (-12 [-19 to -5] mm Hg), total cholesterol -22 [-40 to -4] mg/dL), and LDL (-15.6 [-23.8 to -7.4] mg/dL, all Ps ≤ .03). In conclusion, the Eating for Life model showed significant improvement in BMI, diastolic blood pressure, total cholesterol, and LDL in a federally qualified health center population. Group visits advocating for a whole-foods, plant-based diet may be effective in reducing chronic disease burden in underserved communities.

Undergraduate Medical Education: Lifestyle Medicine Curriculum Implementation Standards.

Lifestyle medicine (LM) is an emerging specialty that is gaining momentum and support from around the world. The American Medical Association passed a resolution to support incorporating LM curricula in medical schools in 2017. Since then, the American College of Lifestyle Medicine Undergraduate Medical Education Task Force has created a framework for incorporating LM into medical school curricula. This article provides competencies for medical school LM curriculum implementation and illustrates how they relate to the Association of American Medical College's Core Entrustable Professional Activities and the LM Certification Competencies from the American Board of Lifestyle Medicine. Finally, standards are presented for how medical schools may receive certification for integrating LM into their curriculum and how medical students can work toward becoming board certified in LM through an educational pathway.

National Survey Assessment of the United States' Pediatric Residents' Knowledge, Attitudes, and Practices Regarding Newborn Screening.

A pediatrician's approach to newborn screening (NBS) impacts patient care. Some physicians have reported not being well prepared to inform families about a positive NBS and recommend further follow-up. The knowledge and approach of categorical pediatric residents (RES) in the United States regarding NBS is not known. They were anonymously surveyed via listserv maintained by American Academy of Pediatrics. A total of 655 responses were analyzed. The mean composite knowledge score (CKS) was 17.7 (SD 1.8), out of maximum 21. Training level (p = 0.001) and completing NICU rotation (p < 0.001) predicted higher CKS. Most RES agreed that NBS is useful and pediatricians play an important role in the NBS process, however, only 62% were comfortable with counseling. Higher level RES were more likely to follow NBS results in clinic (p = 0.0027) and know the contact agency for results (p < 0.001). Most RES wanted more NBS training during residency and were not aware of clinical algorithms like ACTion sheets developed by American College of Medical Genetics. We concluded that although RES have sufficient knowledge about NBS, there is a need for earlier RES education on available tools for NBS to enhance their comfort level and improve practices such as educating parents about the NBS process.

Improving paediatric residents' knowledge and perspectives regarding the insulin pump using a novel educational workshop.

OBJECTIVES: As a pilot study, we aimed to investigate the knowledge and perceptions of categorical paediatric residents (RES) at our institution regarding insulin pumps (IPs) and the impact following a targeted workshop. METHODS: All RES at our institution in attendance at a routine noon conference participated in a workshop, completing an anonymous survey before and right after the intervention to evaluate knowledge, attitudes and self-reported comfort regarding IPs. The workshop consisted of a didactic lecture followed by an insulin pump (IP) device demonstration of three commonly available brands. Knowledge score (KS) was calculated for each RES based on the total correct responses. Attitudes were assessed via 5-point Likert scale. Frequencies, t-test and McNemar tests were used to analyse data. RESULTS: Thirty four completed surveys were analysed out of 49 RES (69.3%) who attended the workshop. Among them, there were 19 first-year, 8 second-year and 7 third-year residents. Following the intervention, KS increased significantly (p<0.001) with progression in residents' attitudes. Overall, more RES reported being comfortable with handling the IP, including looking up and changing the settings (p<0.001). CONCLUSION: There is scope for improvement in the knowledge and perceptions of RES regarding IPs. Educational interventions like ours are needed to familiarise our future physicians with IPs to allow hospitals to provide their systematic and safe inpatient use.

Differences between Metabolically Healthy vs Unhealthy Obese Children and Adolescents.

Obesity is on the rise worldwide. An obesity subtype, metabolically healthy obese (MHO), is resilient to unfavorable metabolic and cardiovascular effects. Factors predicting MHO phenotype are not well characterized. We aimed to identify MHO and metabolically unhealthy obese (MUO) children and adolescents with respect to metabolic factors, and to find predictors of MHO subtype. A retrospective chart review was done on children, ages 4-19 years, 99% African-American/Caribbean, with BMI ≥95th %tile. MUO was defined as meeting ≥1 of the following: fasting glucose ≥100 mg/dl, HbA1c >5.6%, BP ≥90th %tile, TG ≥150 mg/dl, or HDL <40 mg/dl. Study included 189 subjects, 37.6% were MHO and 62.4% MUO. MHO subjects were younger (mean ± SD, 11.6 ± 3.3 vs 12.9 ± 3.2 years; p < 0.009) and had lower BMI %tile (98.4 ± 1.4 vs 98.8 ± 2.1; p < 0.04), smaller waist (94.2 ± 15.2 vs 101.4 ± 17 cm; p < 0.003) and hip circumferences (105.3 ± 15.6 vs 113.5 ± 15.4 cm; p < 0.001), lower fasting insulin (18.5 ± 10.2 vs 24.2 ± 14.3 µU/ml; p < 0.022), and lower HOMA-IR (4.1 ± 2.4 vs 5.5 ± 3.6; p < 0.022). Acanthosis nigricans was noted less frequently in MHO than MUO (p < 0.005). In stepwise logistic regression, age and BMI %tile were significant predictors of MHO. We found that 38% of obese children are MHO. They are younger and have lower BMI %tiles. Lifestyle modification initiated at an early age may prevent metabolic abnormalities.

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

AIM: The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar. MATERIALS AND METHODS: Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome. RESULTS: Parameters assessed in this study were - mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1st, 3rd, and 7th postoperative day. Comparing both groups pain scores with (P < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference (P = 0.002). CONCLUSION: The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery.

Long-term Follow-up of Trigeminal Neuralgia Patients treated with Percutaneous Balloon Compression Technique: A Retrospective Analysis.

BACKGROUND: Trigeminal neuralgia (TN) refers to sharp, lancinating pain in the areas supplied by trigeminal nerve. Both pharmacological and surgical lines of treatments are available for the treatment of TN. Percutaneous balloon compression (PBC) is one such surgical technique that is usually advocated for the treatment of TN occurring in elderly patients. Hence, we aim to evaluate the follow-up results of the TN patients treated by the PBC technique. MATERIALS AND METHODS: A total of 400 patients were selected for the study who had undergone surgical treatment of TN by percutaneous balloon decompression technique. All the postoperative follow-up records of the patients, clinical history, and complication records of the patients were studied and evaluated. RESULTS: Of all the patients included in the study, 353 patients showed improvement clinically after PBC therapy. Out 400, 180 were males and 220 were females. Postoperative complications of the patients during their follow-up were also recorded and it was observed that the most common complication arising after treatment with this technique included facial numbness, masseter muscle weakness, paresthesia, diplopia, and corneal anesthesia. CONCLUSION: One of the most common neuralgic pains affecting the face is the pain of TN. Although numerous lines of treatment options are available for its treatment, all these have one or the other drawbacks. From our results, we can conclude that PBC technique offers more advantages than other surgical modalities and, therefore, should be preferred over other techniques of treatment.

Quality Improvement Measures for Increasing the Colorectal Cancer Screening Rates at a Community Health Center.

INTRODUCTION: Direct recommendation from health care professionals has been shown to generally increase colorectal cancer screening rates in the United States. However, data for rural, underserved communities are limited. OBJECTIVE: To increase colorectal cancer screening rates at a rural community health center (CHC) by increasing health care professionals' awareness of patients' screening eligibility. METHODS: Participants were health care professionals at a CHC treating patients eligible for colorectal cancer screening (defined as patients aged 50-74 years who visited the CHC between February 24, 2014, and March 15, 2014, and whose electronic medical records [EMRs] had no recording of colorectal cancer screening). For a 3-week period, these participants added electronic reminders to eligible patients' EMRs. Data reports for the screening rates of each participant, in addition to the overall CHC, were generated 4 weeks after the study period and compared with screening rates in 2013. RESULTS: Five health care professionals volunteered to participate. No statistically significant difference was found in screening rates of participants compared with overall clinic rates between the 2013 (P=.639) and 2014 (P=.583) sample dates. No statistically significant difference was found in the overall CHC screening rates (P=.052), which were 47.69% and 40.84% in 2013 and 2014, respectively. During the study period, 99 eligible patients were seen. An incidental finding revealed a substantial EMR flaw in uniform data system reporting measures: self-reported colorectal cancer screenings by patients, without official documentation provided, were documented in an EMR section that is not retrieved during uniform data system reporting. CONCLUSION: No associated change in colorectal cancer screening rates was found at the CHC after increasing participants' awareness of patients' screening eligibility using electronic flagging. However, colorectal cancer screening results cannot be reported with certainty given that incidental documentation and data collection discrepancies were found.

Presence of 21-Hydroxylase Antibodies in a Boy with X-Linked Adrenal Hypoplasia Congenita.

BACKGROUND: X-linked adrenal hypoplasia congenita is a rare cause of primary adrenal insufficiency (PAI) in children due to mutations in NR0B1/DAX1 (nuclear receptor subfamily 0, group B, member 1/dosage-sensitive sex reversal-adrenal hypoplasia congenita at the critical region of the X chromosome, gene 1). Another rare cause of PAI in children is autoimmune adrenal disease (AAD) which could be either isolated or as part of autoimmune polyglandular syndrome. Antibody to major auto-antigen, 21-hydroxylase, is highly specific for AAD. METHODS: We report a now 19-month-old male with PAI due to NR0B1 gene mutation and positive adrenal antibodies. Initially, he presented at 15 days of life with isolated hypoaldosteronism which later unfolded into complete PAI. Data analysis was done via retrospective chart review. RESULTS: Genetic analysis of the NR0B1 gene revealed a known hemizygous mutation in c.1069C>T; p.Gln357X. Simultaneously, he was noted to have positive 21-hydroxylase antibodies. CONCLUSION: According to our knowledge, this is the first case in the literature with NR0B1 mutation causing adrenal insufficiency with coexistent positive adrenal antibodies. In addition to his already compromised adrenal function due to NR0B1 mutation, he is now at risk for the development of associated autoimmune conditions requiring close follow-up.

Unilateral pulmonary edema during laparoscopic resection of adrenal tumor.

Despite technological, therapeutic and diagnostic advancements, surgical intervention in pheochromocytoma may result in a life-threatening situation. We report a patient who developed unilateral pulmonary edema during laparoscopic resection of adrenal tumor.