Physician assistant education program director attrition and consideration to leave.

BACKGROUND: This study explores factors related to physician assistant (PA) education program directors' (PD) consideration to leave their leadership role. This is important to better understand, with the need for additional PA education PDs as the number of PA programs grows in addition to current PA program leaders considering leaving their PD role. METHODS: Data from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey were used to analyze factors related to consideration for leaving the PD position. Multiple logistic regression analyses were utilized to identify predictors of PD consideration for leaving their position. Multiple regression analyses were also used to explore factors related to burnout. RESULTS: The study found burnout was a modest predictor for consideration of leaving the PD position, while underrepresented minority status was not. Additional job stress, job satisfaction, and job experience variables were found to have a modest relationship with consideration of leaving, with odds ratios between 0.28 (lack of faculty respecting each other) and 5.29 (stress from lack of personal time) for those with statistically significant relationships. CONCLUSIONS: PD consideration of leaving is a complex phenomenon with many variables and confounding factors likely at play, including, as demonstrated by this study, level of burnout. Study implications include a further understanding of how effective strategies might be designed and implemented to address the drivers of PA PD attrition. Further exploration of burnout as a possible mediating variable as well as more specific data collection directed at better understanding predictors of PD attrition would be valuable future research directions.

Entinostat, a novel histone deacetylase inhibitor is active in B-cell lymphoma and enhances the anti-tumour activity of rituximab and chemotherapy agents.

Histone deacetylases (HDACs) inhibitors are active in T-cell lymphoma and are undergoing pre-clinical and clinical testing in other neoplasms. Entinostat is an orally bioavailable class I HDAC inhibitor with a long half-life, which is under evaluation in haematological and solid tumour malignancies. To define the activity and biological effects of entinostat in B-cell lymphoma we studied its anti-tumour activity in several rituximab-sensitive or -resistant pre-clinical models. We demonstrated that entinostat is active in rituximab-sensitive cell lines (RSCL), rituximab-resistant cell lines (RRCL) and primary tumour cells isolated from lymphoma patients (n = 36). Entinostat exposure decreased Bcl-XL (BCL2L1) levels and induced apoptosis in cells. In RSCL and RRCL, entinostat induced p21 (CDKN1A) expression leading to G1 cell cycle arrest and exhibited additive effects when combined with bortezomib or cytarabine. Caspase inhibition diminished entinostat activity in some primary tumour cells suggesting that entinostat has dual mechanisms-of-action. In addition, entinostat increased the expression of CD20 and adhesion molecules. Perhaps related to these effects, we observed a synergistic activity between entinostat and rituximab in a lymphoma-bearing severe combined immunodeficiency (SCID) mouse model. Our data suggests that entinostat is an active HDAC inhibitor that potentiates rituximab activity in vivo and supports its further clinical development in B-cell lymphoma.

Diabetes distress among healthcare providers: A qualitative study.

AIMS: Diabetes-related distress stemming from the burden of managing diabetes has been measured in multiple patient populations; however, the medical management of diabetes also presents unique challenges for health care providers. The purpose of this study was to conduct a qualitative evaluation of the experiences of healthcare providers in caring for people with diabetes (PWD). METHODS: Interviews and focus groups were conducted in a sample of 22 healthcare providers. Participants were drawn from medical residency and fellowship programs, diabetes healthcare provider networks and professional organizations. Participants were queried about their experiences working with PWD. RESULTS: Themes were extracted and discussed by the investigator team until consensus was reached. Themes included: adherence (frustration that patients don't follow recommendations), emotions associated with treating PWDs (frustration with redundancy of treatment topics, overwhelmed by social needs of patients, worry for patient outcomes), fatigue (emotionally and physically worn-out), role definition (role as supporter and perceived responsibility for medical outcomes), and work environment (limitations of time or resources to provide care). CONCLUSIONS: Diabetes related distress was described as a component of the caregiving experience among health care providers who treat PWD. These data indicate an emotional impact that warrants further investigation and intervention.

Hypoglycemia in a Patient With a Polyhormonal Pancreatic Neuroendocrine Tumor With Evidence of Endocrine Progenitors.

A 55-year-old woman with a large polyhormonal neuroendocrine tumor with unusual pathology is described. The patient presented with intermittent neuroglycopenic symptoms between more protracted asymptomatic periods occurring over the preceding 4 years. During a diagnostic 72-hour inpatient fast, she exhibited hypoglycemia at 70 hours after initiation. On computed tomography scan, a 6-cm mass was identified at the pancreatic head. The patient underwent a pylorus-preserving pancreaticoduodenectomy, and pathology was positive for cells staining for pancreatic polypeptide, insulin, and occasional double hormone (insulin plus pancreatic polypeptide)-positive cells. In addition, the tumor exhibited broad staining for ALDH1A3, a new marker of endocrine progenitors. This case serves to highlight the clinical and pathologic variability of insulin-producing tumors and raises the potential for cells in these tumors to exhibit hormone interconversion and progenitor-like states.