1
|
Dinardo PB, Rome ES, Taub IB, Liu W, Zahka K, Aziz PF. Electrocardiographic QTc as a Surrogate Measure of Cardiac Risk in Children, Adolescents, and Young Adults With Eating Disorders. Clin Pediatr (Phila) 2023; 62:576-583. [PMID: 36451274 DOI: 10.1177/00099228221134441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The study goal was to investigate electrocardiographic findings, including corrected QT interval (QTc), in patients aged 8 to 23 with eating disorders (EDs) at presentation, compared with an age-and sex-matched control population. We retrospectively reviewed 200 ED patients, and 200 controls. Blinded electrocardiograms (ECGs) were interpreted by an expert reader, and QT intervals corrected using the Bazett formula. Eating disorder patients were 89.5% female, with mean age 16.4 years and median percent median body mass index (BMI)-for-age (%mBMI)a of 91.1%. In ED patients, QTc was significantly shorter than controls (399.6 vs 415.0msec, P < .001). After adjusting for height, %mBMI, sex, magnesium level, and bradycardia, mean QTc duration in patients with anorexia nervosa-restricting subtype (AN-R) was significantly shorter than other ED patients (P = .010). Higher %mBMI was associated with shorter QTc duration (P = .041) after adjusting for height, magnesium, bradycardia, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis. Within the ED group, no significant association was identified between QTc and medications, electrolytes, or inpatient status.
Collapse
Affiliation(s)
- Perry B Dinardo
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Ira B Taub
- Department of Pediatric Cardiology, Akron Children's Hospital, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kenneth Zahka
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
2
|
Tzeng A, Bruno B, Cooperrider J, Dinardo PB, Baird R, Swetlik C, Goldstein BN, Rastogi R, Roth AJ, Gilligan TD, Rish JM. A Structured Peer Assessment Method with Regular Reinforcement Promotes Longitudinal Self-Perceived Development of Medical Students' Feedback Skills. Med Sci Educ 2021; 31:655-663. [PMID: 34457918 PMCID: PMC8368272 DOI: 10.1007/s40670-021-01242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Given that training is integral to providing constructive peer feedback, we examined the impact of a regularly reinforced, structured peer assessment method on student-reported feedback abilities throughout a two-year preclinical Communication Skills course. METHODS Three consecutive 32-student medical school classes were introduced to the Observation-Reaction-Feedback method for providing verbal assessment during Year 1 Communication Skills orientation. In biweekly small-group sessions, students received worksheets reiterating the method and practiced giving verbal feedback to peers. Periodic questionnaires evaluated student perceptions of feedback delivery and the Observation-Reaction-Feedback method. RESULTS Biweekly reinforcement of the Observation-Reaction-Feedback method encouraged its uptake, which correlated with reports of more constructive, specific feedback. Compared to non-users, students who used the method noted greater improvement in comfort with assessing peers in Year 1 and continued growth of feedback abilities in Year 2. Comfort with providing modifying feedback and verbal feedback increased over the two-year course, while comfort with providing reinforcing feedback and written feedback remained similarly high. Concurrently, student preference for feedback anonymity decreased. CONCLUSIONS Regular reinforcement of a peer assessment framework can increase student usage of the method, which promotes the expansion of self-reported peer feedback skills over time. These findings support investigation of analogous strategies in other medical education settings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01242-w.
Collapse
Affiliation(s)
- Alice Tzeng
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Bethany Bruno
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jessica Cooperrider
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Perry B. Dinardo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Rachael Baird
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - Carol Swetlik
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Brittany N. Goldstein
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Department of Psychiatry & Behavioral Sciences, McGaw Medical Center of Northwestern University, Chicago, Chicago, IL USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, PA USA
| | - Alicia J. Roth
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH USA
| | - Timothy D. Gilligan
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH USA
| | - Julie M. Rish
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
- Center for Behavioral Health, Cleveland Clinic, Cleveland, OH USA
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH USA
| |
Collapse
|
3
|
Abstract
The COVID-19 pandemic has dramatically affected every aspect of daily life. Parents of adolescents, in particular, may be facing unique challenges in helping them navigate unexpected changes to their daily routine. This article discusses how adolescents may respond to stressful and traumatic situations and provides recommendations for clinicians who may be advising parents of adolescents or parenting their own children.
Collapse
Affiliation(s)
- Ellen S Rome
- Head, Center for Adolescent Medicine, Center for Pediatric Endocrinology, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Perry B Dinardo
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Veronica E Issac
- Center for Adolescent Medicine, Department of Pediatric Endocrinology, Cleveland Clinic
| |
Collapse
|
4
|
Abstract
PURPOSE There is concern among physicians that the rising use of technology in medicine may have a negative impact on compassionate patient-centered care. This study explores medical student attitudes and ideas about technology in medicine in order to consider ways to achieve symbiosis between technology use and the delivery of humanistic, patient-centered care. METHODS This qualitative study uses data from 138 essays written by medical students in the United States and Canada responding to the prompt "Using a real life experience, describe how technology played a role, either negatively or positively, in the delivery of humanistic patient care." Data were analyzed for themes about technology and the impact on humanistic patient care. RESULTS Seven themes emerged from the medical students' essays: Patient Perspective; Life-Giving versus Life-Prolonging; Boundaries between Human and Technology; Distancing versus Presence; Adapting to Change; Tools to Enhance Care; and Definitions of Technology. CONCLUSION Listening to medical students lends insight into ways to integrate technology into the healthcare environment, to ensure that physicians' ability to deliver compassionate care is enhanced, not hindered. Utilizing perceptions of the next generation of physicians, educational and developmental strategies are proposed to ensure the successful integration of technology with humanistic patient-centered care.
Collapse
Affiliation(s)
- Arabella L Simpkin
- a Massachusetts General Hospital , Boston , MA , USA
- b Harvard Medical School , Boston , MA , USA
| | | | | | - Elizabeth Gaufberg
- b Harvard Medical School , Boston , MA , USA
- c Cambridge Health Alliance , Cambridge , MA , USA
| |
Collapse
|
5
|
Danese A, Moffitt TE, Arseneault L, Bleiberg BA, Dinardo PB, Gandelman SB, Houts R, Ambler A, Fisher H, Poulton R, Caspi A. The Origins of Cognitive Deficits in Victimized Children: Implications for Neuroscientists and Clinicians. Am J Psychiatry 2017; 174:349-361. [PMID: 27794691 PMCID: PMC5378606 DOI: 10.1176/appi.ajp.2016.16030333] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals reporting a history of childhood violence victimization have impaired brain function. However, the clinical significance, reproducibility, and causality of these findings are disputed. The authors used data from two large cohort studies to address these research questions directly. METHOD The authors tested the association between prospectively collected measures of childhood violence victimization and cognitive functions in childhood, adolescence, and adulthood among 2,232 members of the U.K. E-Risk Study and 1,037 members of the New Zealand Dunedin Study who were followed up from birth until ages 18 and 38 years, respectively. Multiple measures of victimization and cognition were used, and comparisons were made of cognitive scores for twins discordant for victimization. RESULTS Individuals exposed to childhood victimization had pervasive impairments in clinically relevant cognitive functions, including general intelligence, executive function, processing speed, memory, perceptual reasoning, and verbal comprehension in adolescence and adulthood. However, the observed cognitive deficits in victimized individuals were largely explained by cognitive deficits that predated childhood victimization and by confounding genetic and environmental risks. CONCLUSIONS Findings from two population-representative birth cohorts totaling more than 3,000 individuals and born 20 years and 20,000 km apart suggest that the association between childhood violence victimization and later cognition is largely noncausal, in contrast to conventional interpretations. These findings support the adoption of a more circumspect approach to causal inference in the neuroscience of stress. Clinically, cognitive deficits should be conceptualized as individual risk factors for victimization as well as potential complicating features during treatment.
Collapse
Affiliation(s)
- Andrea Danese
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK,Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK,National & Specialist Clinic for Child Traumatic Stress and Anxiety Disorders, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK,Address correspondence to Dr. Andrea Danese, P080 SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK,
| | - Terrie E Moffitt
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK,Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Louise Arseneault
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Ben A Bleiberg
- Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Perry B Dinardo
- Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Stephanie B Gandelman
- Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Renate Houts
- Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Antony Ambler
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Helen Fisher
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Richie Poulton
- Department of Psychology, University of Otago, Dunedin 9015, New Zealand
| | - Avshalom Caspi
- MRC Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK,Departments of Psychology and Neuroscience & Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| |
Collapse
|