An Evaluation of Factors Associated With Pathogenic PRSS1, SPINK1, CTFR, and/or CTRC Genetic Variants in Patients With Idiopathic Pancreatitis.

OBJECTIVES: We evaluated factors associated with pathogenic genetic variants in patients with idiopathic pancreatitis. METHODS: Genetic testing (PRSS1, CFTR, SPINK1, and CTRC) was performed in all eligible patients with idiopathic pancreatitis between 2010 to 2015. Patients were classified into the following groups based on a review of medical records: (1) acute recurrent idiopathic pancreatitis (ARIP) with or without underlying chronic pancreatitis; (2) idiopathic chronic pancreatitis (ICP) without a history of ARP; (3) an unexplained first episode of acute pancreatitis (AP)<35 years of age; and (4) family history of pancreatitis. Logistic regression analysis was used to determine the factors associated with pathogenic genetic variants. RESULTS: Among 197 ARIP and/or ICP patients evaluated from 2010 to 2015, 134 underwent genetic testing. A total of 88 pathogenic genetic variants were found in 64 (47.8%) patients. Pathogenic genetic variants were identified in 58, 63, and 27% of patients with ARIP, an unexplained first episode of AP <35 years of age, and ICP without ARP, respectively. ARIP (OR: 18.12; 95% CI: 2.16-151.87; P=0.008) and an unexplained first episode of AP<35 years of age (OR: 2.46; 95% CI: 1.18-5.15; P=0.017), but not ICP, were independently associated with pathogenic genetic variants in the adjusted analysis. CONCLUSIONS: Pathogenic genetic variants are most likely to be identified in patients with ARIP and an unexplained first episode of AP<35 years of age. Genetic testing in these patient populations may delineate an etiology and prevent unnecessary diagnostic testing and procedures.

Impact of Adjuvant Anticonvulsant Medications on Benzodiazepine Use and Delirium in Alcohol Withdrawal Syndrome.

Objective: To assess the benefits of anticonvulsant medications on benzodiazepine (BZD) use and delirium in patients with alcohol dependence at risk of alcohol withdrawal and admitted to the hospital without delirium.Methods: This was a resident-led retrospective study of prospectively collected data for patients admitted to the monitored unit of a general medical ward between June 2016 and March 2017 for a variety of medical conditions. Patients were assigned to the usual care group (BZD as needed) or the intervention group (scheduled anticonvulsants and BZD as needed) based on admission census and order of arrival. Of 75 patients, 44 were assigned to the usual care group and 31 to the intervention group.Results: Significantly lower BZD dosage (P = .0002) and lower Clinical Institute Withdrawal Assessment for Alcohol Scale-Revised scores were observed in the intervention group. Delirium occurred significantly less in the intervention group (0 versus 7 in the usual care group; P = .037).Conclusions: Adjuvant anticonvulsant medications for alcohol withdrawal were efficacious in reducing BZD use, severity of symptoms of alcohol withdrawal, and occurrence of delirium in patients admitted to the general medical ward without delirium for reasons other than alcohol detoxification.

Exploring faculty development opportunities and strategies in departments of medicine of U.S. community-based teaching hospitals.

Background: Faculty development (FD) activities are offered as a tool to health-care professionals to improve their knowledge, skills, and role as teachers and educators, leaders, researchers, and scholars. Formal FD activities have been more readily available at university-based teaching hospitals than at community-based hospitals. Yet the majority of Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs are sponsored by community-based teaching hospitals. Methods: An electronic survey along with the cover letter/consent form were sent via email to members of the Association of Program Directors of Internal Medicine (APDIM) of Community-Based Teaching Hospitals Assembly. Two researchers analyzed responses and reviewed all answers independently. Consensus was reached by comparison and discussion. Results: A total of 75 program or associate program directors from 53 U.S. Community-Based Teaching Hospitals with internal medicine residency programs participated in the survey. Eleven percent of the respondents reported that they had no faculty development activities in their departments, 44% reported occasional activities, and 45% reported ongoing activities. Forty-three percent reported making arrangements for faculty to attend FD offsite. However, 78% sent less than five people to those programs in the past 2 years. Discussion: The results of this study suggest that for the academic year 2014-2015 still a minority of non-university-based teaching hospitals had ongoing faculty development activities associated with their institution. Increased program commitment and adequate resources for FD instructors and funding can produce the desired increase in the number as well as the quality of the FD programs.