Identifying Barriers to Precepting Health Professions Learners During the COVID-19 Pandemic.

Background and Objectives: The COVID-19 pandemic worsened the shortage of clinical training opportunities for health professions learners. During the pandemic, additional barriers to precepting health professions learners emerged. Understanding preceptors' perceptions of barriers is a first step to providing learners with the best clinical learning opportunities. Methods: In February 2021, the Emory Primary Care Consortium surveyed primary care providers eligible to precept health professions learners to determine their current precepting status and associated barriers encountered during and since COVID-19. Results: A total of 61 physicians and 11 nurse practitioners (NPs) or physician assistants (PAs) completed the survey. Of the 41 current preceptors, 29 precepted only MD students, 2 MD and PA students, 7 NP students only, and 3 PA students only. Of the 31 respondents who were not precepting, most (21) had precepted before March 2020 and not since. Pandemic-related precepting challenges included low patient volume (12), lack of comfort teaching in a telehealth setting (7), increased external pressure (eg, children at home; 8), and other reasons (12). Overall, 20 respondents were interested in training on incorporating students into the telehealth clinical workflow and 13 in training on teaching and providing feedback remotely. Conclusion: The COVID-19 pandemic placed additional burdens on preceptors in primary care. Preceptors could benefit from training on incorporating students into telehealth visits. Increased understanding of preceptor needs could lead to new resource offerings and improved future medical education.

Patients are unaware of clinical recommendations and resources.

AIMS: The Emory Family Medicine Clinic (EFMC) sought to identify perceptions of recent patient-provider communications for patients with diabetes, factors influencing patient compliance with clinical recommendations, and patients' desire for additional resources to facilitate diabetes management. METHODS: Four focus group discussions were held June-August 2018 (3-9 participants each, 21 total). EFMC patients with uncontrolled diabetes received a phone invitation. A template analytic strategy, characterized by an initial set of codes based on interview content and expected types of responses and inductive codes, was used to thematically code the data. RESULTS: Most participants were single (62%), college educated (62%), had incomes less than $60,000 (76%), and were younger than 50 years old (62%). For themes related to barriers to compliance the participants mentioned the "business of medicine," convenience factors, food choices, accountability, feeling overwhelmed, costs, location/transportation, and miscommunications. Prevailing themes regarding facilitating compliance included a desire for help with self-accountability and prioritization of recommendations. The major desired patient resource was peer-support groups. CONCLUSION: Patient understanding of the impact diabetes has on their life can affect adherence to treatment; hence patient education is critical. Payment policies should support innovative educational clinical visits with patients.

Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience.

AIMS: To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. METHOD: Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. RESULTS: During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. CONCLUSIONS: Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. SHORT SUMMARY: Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.

Short-term Impact of Meaningful Use Stage 1 Implementation: A Comparison of Health Outcomes in 2 Primary Care Clinics.

We studied a primary care clinic transitioning to Meaningful Use stage 1 and a comparison clinic within the same health system. In the 6 months following implementation, after adjusting for confounders, mean systolic blood pressure worsened (+3.3 mm Hg; P = .004) in the intervention clinic compared with the comparison clinic. We did not see a change in the mean or proportion of patients meeting target goals for diabetes (hemoglobin A1c) or obesity (body mass index). Our findings suggest that the worsening of systolic blood pressure associated with Meaningful Use implementation is likely due to distractions of system changes negatively impacting health outcomes.

Conjunctivitis.

Conjunctivitis is the most common cause of red eye in primary care. The 3 most common types of conjunctivitis are viral, allergic, and bacterial, and they can present in either acute or chronic forms; the age of the patient, time of year and physical examination findings are paramount to distinguish the different types of conjunctivitis. Distinguishing between acute viral and bacterial conjunctivitis remains difficult. Patients with prolonged symptoms, poor response to initial management, or evidence of severe disease should be referred to ophthalmology for consultation.

High-affinity neurotensin receptor is involved in phosphoinositide turnover increase by inhibition of sodium pump in neonatal rat brain.

Phosphoinositide (PI) metabolism is enhanced in neonatal brain by activation of neurotransmitter receptors and by inhibition of the sodium pump with ouabain or endogenous inhibitor termed endobain E. Peptide neurotensin inhibits synaptosomal membrane Na(+), K(+)-ATPase activity, an effect blocked by SR 48692, a selective antagonist for high-affinity neurotensin receptor (NTS1). The purpose of this study was to evaluate potential participation of NTS1 receptor on PI hydrolysis enhancement by sodium pump inhibition. Cerebral cortex miniprisms from neonatal Wistar rats were preloaded with [(3)H]myoinositol in buffer during 60 min and further preincubated for 0 min or 30 min in the absence or presence of SR 48692. Then, ouabain or endobain E were added and incubation proceeded during 20 or 60 min. Reaction was stopped with chloroform/methanol and [(3)H]inositol-phosphates (IPs) accumulation was quantified in the water phase. After 60-min incubation with ouabain, IPs accumulation values reached roughly 500% or 860% in comparison with basal values (100%), if the preincubation was omitted or lasted 30 min, respectively. Values were reduced 50% in the presence of SR 48692. In 20-min incubation experiments, IPs accumulation by ouabain versus basal was 300% or 410% if preincubation was 0 min or 30 min, respectively, an effect blocked 23% or 32% with SR 48692. PI hydrolysis enhancement by endobain E was similarly blocked by SR 48692, being this effect higher when sample incubation with the endogenous inhibitor lasted 60 min versus 20 min. Present results indicate that PI hydrolysis increase by sodium pump inhibition with ouabain or endobain E is partially diminished by SR 48692. It is therefore suggested that NTS1 receptor may be involved in cell signaling system mediated by PI turnover.

Phosphoinositide hydrolysis increase by angiotensin-(1--7) in neonatal rat brain.

Angiotensin (Ang)-(1-7) is an endogenous peptide hormone of the renin-angiotensin system which exerts diverse biological actions, some of them counterregulate Ang II effects. In the present study potential effect of Ang-(1-7) on phosphoinositide (PI) turnover was evaluated in neonatal rat brain. Cerebral cortex prisms of seven-day-old rats were preloaded with [(3)H]myoinositol, incubated with additions during 30 min and later [(3)H]inositol-phosphates (IPs) accumulation quantified. It was observed that PI hydrolysis enhanced 30% to 60% in the presence of 0.01 nM to 100 nM Ang-(1-7). Neither 10 nM [D-Ala(7)]Ang-(1-7), an Ang-(1-7) specific antagonist, nor 10 nM losartan, an angiotensin II type 1 (AT(1)) receptor antagonist, blocked the effect of 0.1 nM Ang-(1-7) on PI metabolism. The effect of 0.1 nM Ang-(1-7) on PI hydrolysis was not reduced but it was even significantly increased in the simultaneous presence of [D-Ala(7)]Ang-(1-7) or losartan. PI turnover enhancement achieved with 0.1 nM Ang-(1-7) decreased roughly 30% in the presence of 10 nM PD 123319, an angiotensin II type 2 (AT(2)) receptor antagonist. The antagonists alone also enhanced PI turnover. Present findings showing an increase in PI turnover by Ang-(1-7) represent a novel action for this peptide and suggest that it exerts a function in this signaling system in neonatal rat brain, an effect involving, at least partially, angiotensin AT(2) receptors.

Developmental changes in the spatial pattern of mesencephalic trigeminal nucleus (Mes5) neuron populations in the developing chick optic tectum.

The developing mesencephalic trigeminal nucleus (nucleus of the fifth cranial nerve; Mes5) is composed of four neuron populations: 1) the medial group, located at the tectal commissure; 2) the lateral group distributed along the optic tectum hemispheres; 3) a group outside the neural tube; and 4) a population located at the posterior commissure. The present work aims to elucidate the site of appearance, temporal evolution, and spatial distribution of the four Mes5 populations during development. According to detailed qualitative observations Mes5 neurons appear as a primitive unique population along a thin dorsal medial band of the mesencephalon. According to quantitative analyses (changes in cell density along defined reference axes performed as a function of time and space), the definitive spatial pattern of Mes5 neurons results from a process of differential cell movements along the tangential plane of the tectal hemispheres. Radial migration does not have a relevant developmental role. Segregation of medial and lateral group populations depends on the intensity of the lateral displacements. The mesenchymal population appears as an outsider subset of neurons that migrate from the cephalic third of the neural tube dorsal midregion to the mesenchymal compartment. This process, together with the intensive lateral displacements that the insider subset undergoes, contributes to the disappearance of this transient population. We cannot find evidence indicating that neural crest-derived precursors enter the neural tube and differentiate into Mes5 neurons. Our results can be better interpreted in terms of the notion that a dorsal neural tube progenitor cell population behaves as precursor of both migrating peripheral descendants (neural crest) and intrinsic neurons (Mes5).