The Impact of Stimulant Medications on Blood Pressure and Body Mass Index in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE

To describe changes in blood pressure (BP) and body mass index (BMI) associated with stimulant medication fills in children.

METHODS

Observational, retrospective matched cohort study of children 6-17.9 years initiating stimulant medication between 7/1/2010-6/30/2017 matched 1:3 by age, race, ethnicity, and sex to children with no stimulant use during this period. All BPs and BMIs recorded during ambulatory visits were identified. Generalized linear models were used to estimate differences in change in systolic BP (SBP), diastolic BP (DBP), and BMI over time.

RESULTS

The 686 children with stimulant prescription fills and 2048 matched controls did not differ by baseline SBP or BMI. The matched control group (30.5% female, mean age 11.2 ± 3.4 years 79.7% white) was more likely to be publicly insured (35% vs. 21%, P < .01). After adjusting for baseline values, over a mean follow-up of 144 days change in SBP or DBP did not differ significantly between patients with stimulant medication fills and matched controls. Stimulant use was associated with a 4.7 percentile decrease in BMI percentile compared to matched controls (95% CI: 3.69, 5.71; P < .01).

CONCLUSIONS

In a pediatric primary care cohort, stimulant prescription fills were associated with marked decreases in BMI but no significant changes in BP over time.

Outcomes of Adopting Endoscopic Tympanoplasty in an Academic Teaching Hospital

Objectives:

To compare the outcomes of endoscopic versus microscopic tympanoplasty during the initial period of a surgeon adopting the new endoscopic technique and teaching the surgical approach to residents assisting in surgery.

Methods:

Retrospective medical chart review of 60 consecutive operations for repair of isolated tympanic membrane perforations from 2011 to 2016 performed by a single surgeon assisted by residents in an academic teaching hospital. The outcomes of 20 ears repaired microscopically before the senior author adopted endoscopic ear surgery (Group A) were compared with the outcomes of the first 20 ears that were attempted with endoscopic surgery (Group B) and the next 20 ears performed endoscopically (Group C). Sixty ear operations were performed on 52 patients as 8 patients had bilateral ear surgery.

Results:

The tympanic membrane closure rate was 80% for Group A, 80% for Group B, and 95% for Group C. Mean air-bone gap improvement was 12.8 dB in Group A, 8.3 dB in Group B, and 12.1 dB in Group C. Mean duration of surgery was 99.2 minutes in Group A, 91.3 minutes in Group B, and 90.5 minutes in Group C. In Group B, 20% of the ears (4/20) were converted to a microscopic approach; in Group C, none required conversion.

Conclusions:

Maintenance of good outcomes and similar results can be maintained during a surgeon’s transition to adopting endoscopic tympanoplasty and teaching it to residents.

Using simulation technology to teach diabetes care management skills to resident physicians

BACKGROUND

Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management.

METHODS

A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters. Primary care residents in 10 U.S. residency programs received the educational activity. Satisfaction and changes in knowledge and confidence in managing diabetes were analyzed with mixed quantitative and qualitative methods.

RESULTS

Pre- and post-education surveys were completed by 92/142 (65%) of residents. Likert scale (five-point) responses were favorably higher than neutral for general satisfaction (94%), recommending to colleagues (91%), training adequacy (91%), and navigation ease (92%). Finding time to complete cases was difficult for 50% of residents. Mean ratings of knowledge (on a five-point scale) posteducational activity improved by +0.5 (p < .01) for use of all available drug classes, +0.9 (p < .01) for how to start and adjust insulin, +0.8 (p < .01) for interpreting blood glucose values, +0.8 (p < .01) for individualizing treatment goals, and +0.7 (p < .01) for confidence in managing diabetes patients.

CONCLUSIONS

A virtual diabetes educational activity to teach cognitive skills to manage diabetes to primary care residents was successfully developed, implemented, and well liked. It significantly improved self-assessed knowledge and confidence in diabetes management.

Statin use is associated with a reduced risk of colon cancer recurrence

4114

Background: A significant body of data suggests that statin use reduces the risk of developing colon and other cancers, although other data have not confirmed these findings. We examined whether statin use helps prevent recurrence of colon cancer in patients with resected disease. Methods: We conducted a retrospective analysis of patients treated for stage I, II, and III colon cancer in a Minneapolis/St. Paul health system. Incident cases of colon cancer between 1995 and the present were identified through a hospital tumor registry. All identified cases were then cross-checked against an HMO membership database. Data regarding statin use was pulled from the HMO outpatient pharmacy database. For each patient all available data from a 5-year window prior to first diagnosis of cancer until either recurrence or most recent data available was obtained. Demographic data and survival data from the tumor registry were then combined with pharmacy data regarding statin use in a single database for analysis. Recurrence and time to recurrent disease were compared in statin users and non-users. Results: A total of 358 colon cancer cases were available for analysis. Median follow up of patients after diagnosis of colon cancer was 49 months. 89 patients (24.9%) used statin drugs for some period of time with a median of 780 days of use. Median age of all patients enrolled was 69 (range 24–95). Statin use was higher in patients ages 61–75 (33%) than in those aged 24–60 (22%) or those aged 76–95 (19%) (p=0.02). There was no association between statin use and stage at diagnosis. 6 of 89 patients (6.7%) with any statin use relapsed as opposed to 43 of 269 (16%) of patients with no statin use (Fisher’s exact p=0.03). Kaplan-Meier analysis of relapse curves found a significant difference in relapse between groups with a two year recurrence rate of 3.7% among statin users and 10.1% among non users (Log Rank p=0.03, using age stratification). Conclusions: Statin use was associated with a decreased risk of recurrence in patients diagnosed with stages I-III colon cancer in this study. Further study of statin use in the prevention of colon cancer recurrence is warranted.

No significant financial relationships to disclose.