Health Professions Students' Knowledge, Skills, and Attitudes Toward Transgender Healthcare.

Most graduate medical education programs dedicate almost no time in their curricula to the topic of transgender health. This study aimed to assess medical (MD), physician assistant (PA), and clinical nutrition (CN) students' self-reported knowledge, skills, and attitudes toward healthcare for transgender patients and identify differences between groups. This cross-sectional study was conducted at a single United States academic health center. Students were surveyed using a questionnaire with 16 Likert-type items. A total of 178 MD, 96 PA, and 28 CN students completed the survey. Most (67%) respondents reported a "high" level of personal comfort in caring for a transgender patient, with no difference between groups (p = .57). MD students were more likely than PA or CN students to report greater knowledge of gender dysphoria management (p < .001) and transgender care guidelines (p < .001), as well as a greater skill level in caring for patients with gender dysphoria (p = .009) and inquiring about gender identity (p < .001). All three groups, however, reported overall "low" or "intermediate" levels of knowledge and skills. Our research demonstrates that MD, PA, and CN students exhibit an equally high degree of personal comfort in caring for transgender patients but lack the knowledge and skills to confidently care for them.

Sandwiches, 6 Feet Apart: Reflections on Community (and Medical School) During COVID-19.

During the COVID-19 pandemic, medical students were removed from clinical clerkships. During this time of uncertainty, 4 clinical medical students at the University of Michigan returned to the community to support their neighbors experiencing homelessness. They did so by making brown bag lunches for people sleeping on the streets and acting as community volunteers in temporary shelters. Though formal education was stalled, they reconnected with the initial desire that led them to pursue medical education in the first place and developed key skills in communication, relating to others, and compassion that they believe will enable them to become better physicians in the future.

Allergies and Adaptations: A Perspective on the Need for Culturally Responsive Care to Medically Indicated Dietary Restrictions.

In medicine, we tend to think of food as being equivalent to nutrition, and food allergies are understood primarily as a biomedical process. In this piece, I explore how my experience with food allergies intersects with my cultural identity as a second-generation Indian-American. I also offer insights from my experiences in medical training and practice and reflect on the responsibility of health providers to understand the social and cultural context of food allergies.

Abortion Is a Right: Perspectives of Family Medicine Physician Residents.

Abortion is healthcare. Bodily autonomy is a fundamental human right. As chief resident physicians representing family medicine residency programs in the Greater Bay Area and Central California in the University of California San Francisco Family Medicine Alliance, we share a deep commitment to promoting health equity, advancing social justice, and eliminating health disparities. The 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization to overturn Roe v. Wade contradicts the inherent rights of patients to make their own reproductive healthcare decisions. This is a clarion call for all people to engage in activities to raise awareness and prompt discussion about abortion, reproductive rights, and maternal mortality.

Developing a Curriculum on Transgender Health Care for Physician Assistant Students.

PURPOSE: Our goal was to (1) evaluate physician assistant (PA) students' knowledge, skills, and attitudes toward transgender patients, (2) develop and deliver a lecture on transgender health care, and (3) determine changes in knowledge, skills, and attitudes postlecture. METHODS: A 32-item survey was developed and emailed to PA students. Students were then invited to a 2-hour lecture on transgender-specific psychosocial topics and clinical skills plus medical treatment for gender dysphoria. Lecture attendees retook the survey after 2 weeks. RESULTS: Initial mean self-assessment scores regarding clinical knowledge and skills were below 3 on a 7-point Likert scale. All measures improved following the lecture (p < .001 for all). Overall, 86.7% of students were interested in the addition of transgender health into their didactic curriculum. CONCLUSIONS: Our results illustrate insufficient student competence in transgender medicine. Our proposed transgender curriculum may be a useful guide for educators wanting to integrate this topic into their instruction.

Metformin: a potential therapeutic agent for recurrent colon cancer.

Accumulating evidence suggests that metformin, a biguanide class of anti-diabetic drugs, possesses anti-cancer properties. However, most of the studies to evaluate therapeutic efficacy of metformin have been on primary cancer. No information is available whether metformin could be effectively used for recurrent cancer, specifically colorectal cancer (CRC) that affects up to 50% of patients treated by conventional chemotherapies. Although the reasons for recurrence are not fully understood, it is thought to be due to re-emergence of chemotherapy-resistant cancer stem/stem-like cells (CSCs/CSLCs). Therefore, development of non-toxic treatment strategies targeting CSCs would be of significant therapeutic benefit. In the current investigation, we have examined the effectiveness of metformin, in combination with 5-fluorouracil and oxaliplatin (FuOx), the mainstay of colon cancer therapeutics, on survival of chemo-resistant colon cancer cells that are highly enriched in CSCs/CSLCs. Our data show that metformin acts synergistically with FuOx to (a) induce cell death in chemo resistant (CR) HT-29 and HCT-116 colon cancer cells, (b) inhibit colonospheres formation and (c) enhance colonospheres disintegration. In vitro cell culture studies have further demonstrated that the combinatorial treatment inhibits migration of CR colon cancer cells. These changes were associated with increased miRNA 145 and reduction in miRNA 21. Wnt/ß-catenin signaling pathway was also down-regulated indicating its pivotal role in regulating the growth of CR colon cancer cells. Data from SCID mice xenograft model of CR HCT-116 and CR HT-29 cells show that the combination of metformin and FuOX is highly effective in inhibiting the growth of colon tumors as evidenced by ∼ 50% inhibition in growth following 5 weeks of combination treatment, when compared with the vehicle treated controls. Our current data suggest that metformin together with conventional chemotherapy could be an effective treatment regimen for recurring colorectal cancer (CRC).

Omega-3 fatty acid is a potential preventive agent for recurrent colon cancer.

Increasing evidence supports the contention that many malignancies, including sporadic colorectal cancer, are driven by the self-renewing, chemotherapy-resistant cancer stem/stem-like cells (CSC/CSLC), underscoring the need for improved preventive and therapeutic strategies targeting CSCs/CSLCs. Omega-3 polyunsaturated fatty acids (ω-3 PUFA), have been reported to inhibit the growth of primary tumors, but their potential as a preventive agent for recurring cancers is unexplored. The primary objectives of this investigation are (i) to examine whether eicosapentaenoic acid (EPA; one of the ω-3 PUFA) synergizes with FuOx (5-FU+Oxaliplatin), the backbone of colon cancer chemotherapy, and (ii) whether EPA by itself or in combination with conventional chemotherapy prevents the recurrence of colon cancer via eliminating/suppressing CSCs/CSLCs. FuOx-resistant (chemoresistant; CR) colon cancer cells, highly enriched in CSCs, were used for this study. Although EPA alone was effective, combination of EPA and FuOx was more potent in (i) inhibiting cell growth, colonosphere formation, and sphere-forming frequency, (ii) increasing sphere disintegration, (iii) suppressing the growth of SCID mice xenografts of CR colon cancer cells, and (iv) decreasing proinflammatory metabolites in mice. In addition, EPA + FuOx caused a reduction in CSC/CSLC population. The growth reduction by this regimen is the result of increased apoptosis as evidenced by PARP cleavage. Furthermore, increased pPTEN, decreased pAkt, normalization of ß-catenin expression, localization, and transcriptional activity by EPA suggests a role for the PTEN-Akt axis and Wnt signaling in regulating this process. Our data suggest that EPA by itself or in combination with FuOx could be an effective preventive strategy for recurring colorectal cancer.