Type 2 diabetes in a 5-year-old and single center experience of type 2 diabetes in youth under 10.

The worrisome rise in pediatric type 2 diabetes (T2DM) is most prevalent among minority ethnic/racial populations. Typically, T2DM occurs during puberty in high risk obese adolescents with evidence of insulin resistance. Screening for T2DM in obese youth can be a daunting task for pediatricians and differentiating between pediatric T1DM and T2DM in obese youth can be challenging for pediatric endocrinologists. There is very limited data regarding the prevalence of T2DM among youth < 10 years of age. Here we present the case of a 5-year-old Hispanic male diagnosed with T2DM after referral by his pediatrician for abnormal weight gain, acanthosis nigricans and an elevated HbgA1c. He subsequently became symptomatic for diabetes with confirmed hyperglycemia and HbgA1c of 9.7% (83 mmol/mol) at the time of formal diagnosis. Type 1 diabetes autoantibodies (GAD65, Islet, and ZincT8) and monogenic diabetes genetic tests were negative. Due to elevated liver enzymes and baseline HbgA1c, he received basal insulin as his initial therapy. In this paper, we will discuss this case and present an IRB approved retrospective review of the characteristics of the 20 T2DM patients <10 years of age identified to date in our pediatric diabetes center. This review highlights that while uncommon, the diagnosis of T2DM merits consideration even in prepubertal children. This is especially true when working with a high risk population, such as our Hispanic South Texas youth.

Bridging the gap: increasing collaboration between research mentors and career development educators for PhD and postdoctoral training success.

National reports and funding mandates have called for trainee-centered PhD and postdoctoral training and the need to support diverse career outcomes. As a result, career and professional development (CPD) resources have expanded at several institutions. Despite the growth of innovative and impactful CPD resources, access to and awareness of resources have been inconsistent and inequitable for graduate and postdoctoral trainees. In the current model, core education occurs in two unconnected ways: faculty research mentors provide scientific competencies training, while CPD educators provide transferable competencies training, which is separate from the curriculum and optional at most institutions. Research mentors are influential in supporting trainee engagement with CPD programs; however, most are either unaware of the rapidly growing opportunities or may not see the direct benefit to scientific development and productivity. Due to this disconnect, some trainees can be inadvertently distanced from CPD resources, leading to more inequities among groups. To bridge this gap, here we propose a realignment of the current model via a set of practical and collaborative solutions providing benefit to all stakeholders. With greater awareness and collaboration, research mentors and CPD educators can complement each other's expertise to better support trainee experiences and outcomes.

TAILORING SCIENTIFIC COMMUNICATIONS FOR AUDIENCE AND RESEARCH NARRATIVE.

For success in research careers, scientists must be able to communicate their research questions, findings, and significance to both expert and nonexpert audiences. Scientists commonly disseminate their research using specialized communication products such as research articles, grant proposals, poster presentations, and scientific talks. The style and content of these communication products differ from language usage of the general public and can be difficult for nonexperts to follow and access. For this reason, it is important to tailor scientific communications to the intended audience to ensure that the communication product achieves its goals, especially when communicating with nonexpert audiences. This article presents a framework to increase access to research and science literacy. The protocol addresses aspects of communication that scientists should consider when producing a scientific communication product: audience, purpose, format, and significance (research narrative). The factors are essential for understanding the communication scenario and goals, which provide guidance when tailoring research communications to different audiences.

Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy.

BACKGROUND: Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. METHODS: A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-of-Life care and satisfaction with treatment scale (QUEST) once upon enrollment in an outpatient setting and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation statistics and percent agreement were used for analysis. RESULTS: Data from 39 patients were analyzed. Mean (SD) quality of care summary score was 41.95 (2.75) for physicians and 42.23 (5.42) for nurses (maximum score was 45; p = 0.76 for difference in score between providers). Mean (SD) satisfaction of care summary score was 29.03 (1.92) for physicians and 29.28 (1.70) for nurses (maximum score was 30; p = 0.49 for difference between providers). Test-retest for 33 patients who completed both QUEST surveys had high percent agreement (74-100%), with the exception of the question regarding the provider arriving late (45 and 53%). There was no correlation between quality and satisfaction of care and symptom severity. Weakness was the most common symptom reported. Symptom severity correlated with depression (r = 0.577 p < 0.01). There was a trend towards a larger proportion of patients reporting pain who had three or more prior chemotherapy regimens (p = 0.075). Prior number of chemotherapy regimens or time since diagnosis was not correlated with symptom severity score. Anxiety and depression were correlated with each other (r = 0.711, p < 0.01). There was no difference in symptom severity score at enrollment between those patients who have since died (n = 19) versus those who are still alive. CONCLUSION: The QUEST Survey has test-retest reliability when used as a written instrument in an outpatient setting. However, there was no correlation between this measure and symptom severity. Patient evaluation of care may be more closely related to the interpersonal aspects of the health care provider relationship than it is to physical symptoms.

Indicators of survival duration in ovarian cancer and implications for aggressiveness of care.

BACKGROUND: Ovarian cancer patients frequently receive chemotherapy near the end of life. The purpose of the current study was to develop indicators that characterize those ovarian cancer patients who have a short life span. METHODS: The medical charts of deceased epithelial ovarian cancer patients were retrospectively reviewed from 2000 through 2006. All patients received primary debulking surgery and adjuvant chemotherapy. Aggressiveness of cancer care within the last month of life was measured by chemotherapy regimens, emergency room visits, and hospitalizations. Significant clinical events (SCE) were defined as ascites, bowel obstruction, and pleural effusion. Survival quartiles were compared using chi-square and Student t test statistics. Multiple regression analysis was performed using survival duration as a dependent variable. RESULTS: In all, 113 patients with epithelial ovarian cancer were reviewed. Patients had increased hospitalizations (P < .001) and SCE (P < .001) as they approached the end of life. There was no difference in the pattern of hospitalizations and SCE between the top and bottom survival quartiles. Patients with a shorter survival time had a trend toward increased chemotherapy during their last 3 months of life (P = .057) and had increased overall aggressiveness of care (P = .013). In patients with a disease remission, the length of initial remission time was found to be significant in predicting survival (P < .01). Time to second disease recurrence was also significant in predicting survival time (P < 0.01). CONCLUSIONS: Patients who received aggressive care did not have improvement in survival. Short disease remissions and increasing hospitalizations with SCE should be indicators of the appropriateness of reducing cure-oriented therapies and increasing palliative interventions.