Implementation and faculty perception of outpatient medical student workplace-based assessments

BACKGROUND

There is growing interest in use of entrustable professional activity (EPA)-grounded workplace-based assessments (WBAs) to assess medical students through direct observation in the clinical setting. However, there has been very little reflection on how these tools are received by the faculty using them to deliver feedback. Faculty acceptance of WBAs is fundamentally important to sustained utilisation in the clinical setting, and understanding faculty perceptions of the WBA as an adjunct for giving targeted feedback is necessary to guide future faculty development in this area.

APPROACH

Use of a formative EPA-grounded WBA was implemented in the ambulatory setting during the paediatrics clerkship following performance-driven training and frame-of-reference training with faculty. Surveys and semi-structured interviews with faculty members explored how faculty perceived the tool and its impact on feedback delivery.

EVALUATION

Faculty reported providing more specific, task-oriented feedback following implementation of the WBA, as well as greater timeliness of feedback and greater satisfaction with opportunities to provide feedback, although these later two findings did not reach significance. Themes from the interviews reflected the benefits of WBAs, persistent barriers to the provision of feedback and suggestions for improvement of the WBA.

IMPLICATIONS

EPA-grounded WBAs are feasible to implement in the outpatient primary care setting and improve feedback delivery around core EPAs. The WBAs positively impacted the way faculty conceptualise feedback and provide learners with more actionable, behaviour-based feedback. Findings will inform modifications to the WBA and future faculty development and training to allow for sustainable WBA utilisation in the core clerkship.

A qualitative assessment of adolescent perspectives on patient education in the outpatient setting

Objective

To explore adolescent perspectives on the content and delivery of anticipatory guidance (AG), both during and after outpatient visits, in order to develop targeted resources and educational material for adolescent patients.

Methods

Semi-structured phone interviews among patients ages 12 to 21 seen between May-July 2021 at four outpatient sites of NewYork Presbyterian Hospital were recorded, transcribed and analyzed using thematic analysis. Content domains included attitudes toward and preferences around AG, discharge instructions and patient education resources.

Results

Twenty-eight of 156 recruited patients completed interviews; 52% received an After Visit Summary (AVS); of the 48% who did not receive it, half of them expressed interest in receiving one. Themes included positive perceptions of the AVS, patient-physician communication, multimodal delivery of educational materials, and critical discussion topics such as mental health and nutrition.

Conclusion

Adolescents value the AVS and prefer multimodal materials and topics that are specifically geared towards them, rather than their caregivers.

Innovation

This study is the first to explore adolescent perspectives on AG and after-visit informational materials. These findings may help more effectively reach, educate and engage adolescent patients in the primary care setting by guiding the focused development of patient-centered instructions and resources.

Where Do We Go from here? Post-pandemic Planning and the Future of Graduate Medical Education

Background

As the pandemic wanes, there is an opportunity to reevaluate resultant changes in graduate medical education (GME), particularly from the viewpoints of those affected most. We aimed to assess both trainee and faculty perceptions on the educational changes and innovations resulting from the pandemic to inform future educational planning.

Methods

We surveyed trainees and core education faculty at three New York City children's hospitals. Surveys assessed perceived changes to educational activities, skills, scholarship, effectiveness of virtual teaching, future desirability, and qualitative themes.

Results

The survey was completed by 194 participants, including 88 (45.4%) faculty and 106 (54.6%) trainees. Trainees were more likely to report a negative impact of the pandemic compared with faculty (75.5% vs. 50%, p < 0.01). Most respondents reported a decrease in formal educational activities (69.8%), inpatient (77.7%) and outpatient (77.8%) clinical teaching. Despite this, most perceived clinical and teaching skills to have stayed the same. Most (93.4%) participated in virtual education; however, only 36.5% of faculty taught virtually. Only 4.2% of faculty had extensive training in virtual teaching and 28.9% felt very comfortable teaching virtually. In the future, most (87.5%) prefer a hybrid approach, particularly virtual didactic conferences and virtual grand rounds. Faculty themes included challenges to workflows and increased empathy for trainees, while trainee themes included increased work/life balance and support, but increased burnout.

Conclusion

Many changes and innovations resulted from the pandemic. Hospital systems and GME programs should consider this data and incorporate viewpoints from trainees and faculty when adapting educational strategies in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01737-8.

Re-visiting the 'mysterious myth of attention deficit': A systematic review of the recent evidence

Based on the inclusive and methodologically rigorous framework provided by Ed Zigler's developmental approach, we previously challenged what we called, 'the mysterious myth of attention deficit', the fallacy of attention as a universal deficit among persons with intellectual disability (ID). In this latest update, we conducted a systematic review of studies of essential components of attention among persons with ID published in the interim since the last iteration of the mysterious myth narrative was submitted for publication approximately a decade ago. We searched the databases PubMed and PsycINFO for English-language peer-reviewed studies published from 1 January 2011 through 5 February 2021. In keeping with the developmental approach, the two essential methodological criteria were that the groups of persons with ID were aetiologically homogeneous and that the comparisons with persons with average IQs (or with available norms) were based on an appropriate index of developmental level, or mental age. Stringent use of these criteria for inclusion served to control for bias in article selection. Articles were then categorised based on aetiological group studied and component of visual attention. Based on these criteria, 18 articles were selected for inclusion out of the 2837 that were identified. The included studies involved 547 participants: 201 participants with Down syndrome, 214 participants with Williams syndrome and 132 participants with fragile X syndrome. The findings from these articles call attention to the complexities and nuances in understanding attentional functioning across homogeneous aetiological groups and highlight that functioning must be considered in relation to aetiology; factors associated with the individual, such as developmental level, motivation, styles and biases; and factors associated with both the task, such as context, focus, social and emotional implications, and levels of environmental complexity.

Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer

BACKGROUND

The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety.

PATIENTS AND METHODS

One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015.

RESULTS

With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome.

CONCLUSION

With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.

Improving Utilization of an After-Hours Phone Triage Service: A Resident Quality Improvement Initiative

BACKGROUND/OBJECTIVE

Phone triage systems are increasingly used by primary care clinics to improve patient satisfaction and direct low-acuity patients to appropriate care settings. Despite the prevalence of telephone triage, the majority of pediatric training programs do not include this practice in their curricula. Our aim was to increase the volume of after-hours patient phone calls per week by 25% and to secondarily reduce "treat and release" emergency department (ED) visits by 5% over the course of a 9-month quality improvement (QI) study.

METHODS

A resident-led QI project was conducted from 2017 to 2019 at a mixed faculty-resident pediatric primary care practice providing care for an urban, primarily immigrant, underserved population. Eight Plan-Do-Study-Act cycles were developed on the basis of identified key drivers and included efforts to increase the visibility of the call service to patient families. After-hours calls were tracked and compared with similar practices, and ED visits for the first week of each month were reviewed using the electronic medical record system.

RESULTS

After promoting the service via various modalities, the number of after-hours calls increased by 30%, from an average of 6.5 calls per week to 8.5. Treat and release ED visits decreased by 6%, from a baseline of 64.3 to 60.3 visits per week.

CONCLUSIONS

The increased patient awareness of and availability of a reliable after-hours call service in pediatric practices are promising tools for reducing unnecessary ED visits, leveraging resident direction and implementation to promote the service through varying modalities.

OP0038 VITAMIN D AND MARINE n-3 FATTY ACID SUPPLEMENTATION FOR PREVENTION OF AUTOIMMUNE DISEASE IN THE VITAL RANDOMIZED CONTROLLED TRIAL: OUTCOMES OVER 7 YEARS

Background

Strong biologic rationale supports both vitamin D and marine omega-3 (n-3) fatty acids for prevention of autoimmune disease (AD). Within the randomized, double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL), we tested the effects of these supplements on AD incidence. We previously reported results after 5.3 years of randomized follow-up showing overall protective effects for vitamin D on AD incidence (HR 0.78, 95% CI 0.61-0.99) and suggestive results for n-3 fatty acids (HR 0.85, 95%CI 0.67-1.08)1.

Objectives

We aimed to test effects of these supplements with two more years of post-intervention follow-up in VITAL.

Methods

VITAL enrolled and randomized men and women (age ≥50 and ≥55 years, respectively) in a 2-by-2 factorial design to vitamin D3 (2000 IU/d) and/or n-3 fatty acids (1000 mg/d) or placebo and followed for median 5.3 years. Here, we followed participants for another 2 years of observation to assess for sustained effects. Incident AD diagnoses were reported by participants annually and confirmed by medical record review by expert physicians using existing classification criteria. The primary endpoint was total incident AD, including rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), autoimmune thyroid disease (AITD), psoriasis, and all others. Pre-specified secondary endpoints included individual common AD; and probable AD. Cox models calcuated hazard ratios (HR) for incident ADs.

Results

Of 25,871 participants randomized, 71% self-reported non-Hispanic Whites, 20% Black, 9% other racial/ethnic groups, 51% women, mean age was 67.1 years. During 7.5 years median follow-up, confirmed AD was diagnosed in 156 participants in vitamin D arm vs 198 in vitamin D placebo arm, HR 0.79 (0.64-0.97). Incident AD was confirmed in 167 participants in n-3 fatty acid arm and 187 in n-3 fatty acid placebo arm, HR 0.89 (0.72-1.10). For vitamin D, HRs trended toward reduction for RA 0.67 (0.37- 1.21), PMR 0.69 (0.46-1.03) and psoriasis 0.57 (0.33-0.99). For n-3 fatty acids, HRs trended toward reduction for RA 0.55 (0.30-1.10) and AITD 0.61 (0.33-1.12). Vitamin D’s effect on AD incidence was stronger in those with body mass index (BMI) < 25 (HR 0.65, 0.44-0.96) than ≥ 25 kg/m2 (p interaction 0.01).

Conclusion

Supplementation for 5.3 years with 2000 IU/day vitamin D (compared to placebo), followed by 2 years of observational follow-up, significantly reduced overall incident AD by 21% in older adults. HRs for RA, PMR and psoriasis trended toward reduction with vitamin D, with stronger effect in those with normal BMI. Supplementation with 1000 mg/day n-3 fatty acids did not significantly reduce total AD.

References

[1]Hahn J et al, BMJ, 2022 Jan 26;376: e066452.

Table 1.

Hazard Ratios for Primary and Secondary Endpoints, by Randomized Assignment to Vitamin D/Placebo (Left), N-3 Fatty Acids/Placebo (Right)a

EndpointVitamin D3(N=12,927)Placebo (N=12,944)Hazard Ratio (95% CI)pN-3 Fatty Acids (N=12,933)Placebo (N=12,938)Hazard Ratio (95% CI)pPrimary: Confirmed AD1561980.79 (0.64-0.97)0.031671870.89 (0.72-1.10)0.27Secondary:Confirmed + probable AD2653210.83 (0.70-0.97)0.022713150.86 (0.73-1.01)0.06Excluding subjects with any pre-randomization AD Confirmed AD1271620. 79 (0.62-0.99)0.041411480.95 (0.75-1.20)0.66 Confirmed + probable AD2112700. 78 (0.65-0.94)0.0072322490.93 (0.78-1.11)0.41Excluding first 2 years follow-up Confirmed AD861300.66 (0.50-0.87)0.0031041120.92 (0.71-1.21)0.56 Confirmed + probable AD1472050.72 (0.58-0.89)0.0021721800.95 (0.77-1.17)0.63Individual ADb RA18270.67 (0.37-1.21)0.1816290.55 (0.30-1.01)0.06 PMR39570.69 (0.46-1.03)0.0746500.92 (0.61-1.37)0.67 AITD27181.50 (0.82-2.71)0.1917280.61 (0.33-1.12)0.11 Psoriasis20350.57 (0.33-0.99)0.0534211.62 (0.94-2.79)0.08

aAnalyses from Cox regression models controlled for age, sex, race, and other (n-3 fatty acid or vitamin D) randomization group bConfirmed AD.

Figure 1.

Disclosure of Interests

Karen Costenbader Consultant of: Astra Zeneca, Glaxo Smith Kline, Neutrolis, Grant/research support from: Merck, Exagen, Gilead, Nancy Cook: None declared, I-min Lee: None declared, Jill Hahn: None declared, Joseph Walter: None declared, Vadim Bubes: None declared, Gregory Kotler: None declared, Nicole Yang: None declared, Sonia Friedman: None declared, Erik Alexander: None declared, JoAnn Manson: None declared.

A Pediatric Resident Curriculum for the Use of Health Literacy Communication Tools

Background:

Objective:

Methods:

Key Results:

Conclusions:

Plain Language Summary:

Design and implementation of an interactive, competency-based pilot pediatric telemedicine curriculum

During the height of the COVID-19 pandemic, telemedicine visits surged to increase access and maintain continuity of care, while reducing transmission of disease. However, few curricula exist for training residents on how to care for patients via telemedicine, especially in pediatrics. We aimed to create and evaluate an interactive, competency-based pilot curriculum, to meet the urgent need to train residents in telemedicine. The curriculum was developed in 2020 and includes a didactic, cased-based discussions, and direct observation exercise. A model for precepting residents, adhering to new ACGME guidelines, was also created to further engage residents in telemedicine in the outpatient general pediatrics settings. To evaluate the curriculum, we assessed feasibility of a direct observation to provide feedback and we conducted pre and post surveys to assess for changes in residents' self-reported skills in performing telemedicine visits following implementation of the curriculum. 16 residents participated in the curriculum and 15 completed both the pre and post surveys (93%). Residents' self-reported efficacy in performing key components of telemedicine visits, including completion of telemedicine visit (p = 0.023), initiation of visits (p = 0.01), and documentation (p = 0.001) all improved significantly following implementation. Residents' perception of patient satisfaction with telemedicine and personal perception of ease of use of the telemedicine system increased, though neither were statistically significant. Uptake of the direct observation exercise was nearly universal, with all but one resident having a direct observation completed during their ambulatory month. This novel, interactive telemedicine pilot curriculum for residents addresses ACGME competencies and provides residents with a toolkit for engaging in telemedicine.

Transition-to-residency: pilot innovative, online case-based curriculum for medical students preparing for pediatric internships

Background: There is increasing recognition in medical education that greater emphasis must be placed on preparing graduating medical students for their new roles as interns. Few publications in the literature have described transition-to-residency curricula specifically for students interested in pediatrics or pediatric-related fieldsApproach: We developed novel online pediatric cases, embedded within an innovative, hybrid transition-to-residency course, to address high yield, multi-disciplinary topics within the context of several of the AAMC's identified Entrustable Professional ActivitiesEvaluation: The pilot cases were evaluated over two academic years (2018, 2019) at a single academic medical center as part of routine student course evaluation (N = 18/35) with the 2019 evaluation containing additional retrospective pre-post survey questions (N = 9/18) assessing self-reported changes in knowledge. Almost all students were very satisfied or satisfied with the modules overall (94%), the quality of the resources provided (100%), and the structure and clarity of the presentation of the material (100%). Among the students who completed the retrospective pre-post survey after participation in the online modules, significant self-reported improvements were noted in writing orders to the pediatrics floor (Z = -2.07, p = 0.04), providing anticipatory guidance (Z = -2.0,p = 0.046), formulating a differential diagnosis for common pediatric conditions (Z = -2.24, P = 0.03), and preparedness for managing common pediatric floor emergencies (Z = -2.33, P = 0.02).Reflection: We demonstrated feasibility of implementation of an interactive, online case-based curriculum, medical student satisfaction with content and delivery, and increased self-reported knowledge after completion of the pilot pediatric cases on the online, asynchronous learning platform.

Bridging the Gap in Graduate Medical Education: A Longitudinal Pediatric Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Health Curriculum

OBJECTIVE

Despite known health disparities, there is limited training in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) health, particularly in pediatric graduate medical education (GME). We aimed to develop a longitudinal LGBTQ curriculum for a pediatrics residency program tailored to the needs and interests of our trainees.

METHODS

We developed a year-long curriculum based on a formal needs assessment and evaluated changes in provider knowledge, comfort, and self-reported clinical impact through pre- and postsurveys.

RESULTS

The needs assessment was completed by 78 out of 110 providers (70.9% response rate); 60 (54.5%) and 70 (63.6%) completed the pre- and postcurriculum surveys, respectively. Postcurriculum implementation, there was an increase in mean comfort level asking about sexual orientation (4.1-4.5, P < .01), gender identity (3.5-3.8, P = .02), and sexual practices (3.4-3.8, P < .01), psychosocial screening (3.2-4.2, P < .01), applying medical/preventive screening guidelines (2.4-3.6, P < .01), and medically managing transgender patients (1.9-3.1, P < .01). Knowledge-based assessments increased from 25.2% correct to 38.5% (P = .01). Faculty felt significantly more comfortable teaching this material to trainees (21.7-70.0%, P < .01). Providers reported high scores regarding impact on clinical practice (4.0 of 5), intent to change practice (4.5 of 5), importance of (4.8 of 5) and satisfaction with (4.5 of 5) the curriculum.

CONCLUSIONS

There is a need to incorporate formal LGBTQ health training in GME. Our curriculum improved provider knowledge, comfort, self-reported clinical practice, and faculty preparedness to teach this material. It can serve as a framework for other pediatric programs to develop their own curricula.

Aramchol in patients with nonalcoholic steatohepatitis: a randomized, double-blind, placebo-controlled phase 2b trial

Nonalcoholic steatohepatitis (NASH), a chronic liver disease without an approved therapy, is associated with lipotoxicity and insulin resistance and is a major cause of cirrhosis and hepatocellular carcinoma. Aramchol, a partial inhibitor of hepatic stearoyl-CoA desaturase (SCD1) improved steatohepatitis and fibrosis in rodents and reduced steatosis in an early clinical trial. ARREST, a 52-week, double-blind, placebo-controlled, phase 2b trial randomized 247 patients with NASH (n = 101, n = 98 and n = 48 in the Aramchol 400 mg, 600 mg and placebo arms, respectively; NCT02279524 ). The primary end point was a decrease in hepatic triglycerides by magnetic resonance spectroscopy at 52 weeks with a dose of 600 mg of Aramchol. Key secondary end points included liver histology and alanine aminotransferase (ALT). Aramchol 600 mg produced a placebo-corrected decrease in liver triglycerides without meeting the prespecified significance (-3.1, 95% confidence interval (CI) -6.4 to 0.2, P = 0.066), precluding further formal statistical analysis. NASH resolution without worsening fibrosis was achieved in 16.7% (13 out of 78) of Aramchol 600 mg versus 5% (2 out of 40) of the placebo arm (odds ratio (OR) = 4.74, 95% CI = 0.99 to 22.7) and fibrosis improvement by ≥1 stage without worsening NASH in 29.5% versus 17.5% (OR = 1.88, 95% CI = 0.7 to 5.0), respectively. The placebo-corrected decrease in ALT for 600 mg was -29.1 IU l^-1 (95% CI = -41.6 to -16.5). Early termination due to adverse events (AEs) was <5%, and Aramchol 600 and 400 mg were safe, well tolerated and without imbalance in serious or severe AEs between arms. Although the primary end point of a reduction in liver fat did not meet the prespecified significance level with Aramchol 600 mg, the observed safety and changes in liver histology and enzymes provide a rationale for SCD1 modulation as a promising therapy for NASH and fibrosis and are being evaluated in an ongoing phase 3 program.

Who to Test? A Retrospective Study of Lead Testing in High-Risk Children

BACKGROUND

Nearly all pediatric patients in our setting meet high-risk criteria for lead exposure based on screening recommendations and guidelines. Implementation of screening and testing has been inconsistent.

OBJECTIVE

To assess the utility and efficacy of performing universal lead testing between ages 1 and 5 at an urban academic pediatric practice.

METHODS

Retrospective review of patients with routine lead testing between 2010 and 2015. Key variables included demographics, serum lead level, and behavioral diagnoses.

RESULTS

A total of 6597 serum lead levels from 3274 patients were reviewed. Forty-seven samples (0.7%) from 24 patients (0.7%) were elevated. Of the 24 patients with elevated lead, 75% were identified at age 1 or 2. Sixty-seven percent of patients with first elevated lead level at age 3 or older had a diagnosis of developmental delay.

CONCLUSION

Routine testing of high-risk patients yielded minimal specificity in identifying elevated lead levels, especially in patients older than 3 years and without developmental delay.

Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study

OBJECTIVES

Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care.

METHODS

Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information.

RESULTS

One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic.

CONCLUSIONS FOR PRACTICE

Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.

Incorporating Near Peers for Teaching and Fast Feedback in a Rapidly Developed Virtual Pediatric Clerkship Curriculum in Response to the COVID Pandemic

As COVID-19 necessitated student removal from clinical environments, a virtual curriculum involving existing and novel clerkship elements was developed that utilized near peers for both teaching and feedback. Shelf scores, engagement, and satisfaction demonstrated success of these new curricular elements, many of which will be incorporated for future students.

Rainbows and "Ready for Residency": Integrating LGBTQ Health Into Medical Education

INTRODUCTION

To provide appropriate and sensitive care for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, providers must learn specific skills and guidelines. Most medical schools lack formal education on LGBTQ health, particularly for adolescent patients.

METHODS

We developed an Introduction to LGBTQ Health course for fourth-year medical students as part of a monthlong Ready for Residency curriculum in March and April of their graduating year. The course addressed guidelines recommended in the care of LGBTQ individuals utilizing problem-based learning methodology. Through learner-led discussion, students worked in small groups to research case-based scenarios and reported their findings to the larger group, followed by teaching points from a facilitator. The course was evaluated on curricular perception using a 5-point Likert scale and open-ended feedback.

RESULTS

One hundred forty-six students participated in the curriculum; 103 completed the session evaluation. Mean total scores were 4.6 out of 5 in March and 4.7 out of 5 in April after changes were made based on student feedback, namely, increasing the session from 50 to 80 minutes and decreasing session size from 72 students to 36. Students felt the session was well planned and run, engaging, and relevant; appropriately integrated evidence-based medicine; and taught them what they hoped to learn.

DISCUSSION

Many medical schools lack curricula dedicated to LGBTQ health care. Implementing this mandatory LGBTQ health course was well received and highly rated by almost all students regardless of anticipated specialty. The session could be easily replicated at medical schools across the country.

A Curriculum to Improve Pediatric Residents' Telephone Triage Skills

INTRODUCTION

Telephone triage systems are frequently used due to their success in decreasing emergency department utilization, reduction of health care costs, and high levels of satisfaction among patients and providers. Despite phone triage's prevalence, few residency programs have designated curricula for residents to learn this vital skill.

METHODS

We designed a phone triage curriculum initially piloted with senior residents at one of our continuity clinics. The curriculum consisted of a didactic session, a just-in-time simulation training session, and an experiential component of being on call during the ambulatory rotation. Retrospective pre-post self-assessments evaluated resident perceptions of their skills in taking histories and triaging care over the phone in addition to obtaining qualitative feedback from faculty and residents immediately after the curriculum and 1-2 years postgraduation.

RESULTS

Of 11 eligible residents, 10 (91%) chose to participate in the pilot curriculum. Residents reported that their skills in history taking over the phone improved from 20% to 90% and their ability to triage patients over the phone improved from 0% to 80%. This led to a quality improvement initiative to increase patient calls and has continued for 5 years, with continued positive feedback from residents and attendings.

DISCUSSION

Phone triage skills are a necessity for pediatric providers, but few residency programs have training curricula in place. Through an experience-based phone triage program, residents significantly improved their self-reported skills at history taking and triaging. Similar curricula could easily be adopted at other institutions.

A-20 Do Children With LD and/or ADHD Differ at Baseline on a Pediatric Measure Used to Assess Concussion?

Objective

To examine differences at baseline between children with ADHD and/or LD vs. children with neither ADHD/LD on 1) neurocognitive scores and 2) child- and parent-reported concussion symptoms.

Method

Retrospective data was obtained for 1856 children ages 5–11 who were assessed at baseline using ImPACT Pediatric. Groups were determined based on parent-reported diagnosis of their child at baseline (ADHD and/or LD vs. neither ADHD/LD), and groups were compared on the four factor scores: Sequential Memory, Word Memory, Visual Memory, and Rapid Processing and on child- and parent-reported concussion symptoms using a series of ANOVAs.

Results

ANOVAs revealed that children with ADHD and/or LD performed significantly worse than children without ADHD/LD on Sequential Memory (F(1,1845) = 69.86, p &lt; .001)) and Word Memory (F(1,1853) = 10.36, p = .001)). In contrast, children with ADHD and/or LD performed significantly better on the neurocognitive measures of Visual Memory [(F(1,1845) = 4.94, p = .026)] and Rapid Processing [(F(1,1853) = 20.35, p &lt; .001). Symptom reporting was significantly greater in the ADHD and/or LD group for both child (F(1,1853) = 30.21, p &lt; .001) and parent (F(1,1853) = 34.64, p &lt; .001) reported symptoms.

Conclusions

The current study demonstrated differences at baseline in children on neurocognitive performance and concussion symptom reporting based on diagnostic group. Analysis of symptom reporting suggested that children with pre-existing diagnoses of ADHD and/or LD and their parents may report concussion-like symptoms at baseline, prior to ever experiencing a concussion. This finding has clinical implications for interpretation of post-concussion symptoms without a baseline comparison in children with pre-existing diagnoses such as ADHD and/or LD.

Esterases affect the physical properties of materials used to seal the endodontic space

Materials used to seal the endodontic space are subjected to enzymatic degradative activities of body fluids and bacteria.

OBJECTIVES

To assess effects of simulated human salivary, blood and bacterial esterases (SHSE) on physical properties of typical restorative material and root canal sealers.

METHODS

Specimens of set methacrylate-based resin composite (BisfilTM2B; RC), calcium-silicate sealer (EndoSequence®; BC) or epoxy-resin sealer (AH-Plus®; ER) were tested after up to 28Days exposure to phosphate buffered saline (PBS) or SHSE, using ANSI/ADA-57:2000 and ISO-6876:2012.

RESULTS

Regardless of media, microhardness increased with time for BC remained unchanged for ER and decreased for RC (p < 0.05). SHSE moderated the increase for BC compared to PBS (28.0 ± 4.8 vs. 38.1 ± 7.9 KHN) at 7Days, and enhanced the decrease for RC at 7Days (55.6 ± 7.1 vs. 66.3 ± 6.5 KHN) and 28Days (52.3 ± 9.2 vs. 62.6 ± 8.5 KHN). Compressive strength was enhanced only for BC by either media. BC expanded with time for both incubation conditions; SHSE moderated the expansion compared to PBS at 7Days (0.026 ± 0.01% vs. 0.049 ± 0.007%). Shrinkage of ER was similar for both incubation media and was lower than that for RC (p < 0.05). Shrinkage of RC was enhanced by SHSE compared to PBS at 7Days (0.5 ± 0.07% vs. 0.38 ± 0.08%). Weight loss was lowest for ER and highest for BC (p < 0.05). It was enhanced by SHSE compared to PBS for BC at 28Days (2.40 ± 0.2 vs. 2.96 ± 0.19 W L%), and for RC at 7Days (0.54 ± 0.09 vs. 0.80 ± 0.1 W L%).

SIGNIFICANCE

Simulated body fluids and bacterial esterases affected the physical properties of test materials, suggesting potential impacts on sealing ability and resistance to bacterial ingress, and tooth strength ultimately affecting their clinical performance.

Preseason Pediatrics: an Interactive Preclinical Curriculum Enhances Knowledge and Skills in Medical Students

INTRODUCTION

Medical students have limited preclinical exposure to pediatrics. We created an optional preclinical curriculum for first-year medical students called "Preseason Pediatrics" (PSP). This 6-month curriculum teaches pediatric-specific knowledge and clinical skills, consisting of monthly resident-led didactic sessions followed by complementary resident-mentored clinical experiences.

METHODS

Participants completed a survey before and after completion of PSP. Knowledge was assessed with multiple-choice questions pertaining to each topic covered in PSP and perceived skills, with a 5-point Likert scale ranging from not at all (1) to extremely (5) for skills taught. Skill maintenance was assessed with a newborn objective structured clinical exam (OSCE) 6 months after PSP completion in 2016. Students beginning their pediatric clerkship also completed a survey, comparing students who did and did not complete PSP.

RESULTS

From 2014 to 2017, 135 first-year medical students participated. Percent correct scores on pediatric knowledge increased in 4/5 topics covered, and students perceived increases in their pediatric skills in all course domains. 86.8% (n = 92/106) of students reported feeling more prepared for the pediatric clerkship. 94.3% (n = 100/106) would recommend the PSP experience to other students. Third-year students who participated in PSP reported higher comfort with pediatric patients prior to their clerkship.

CONCLUSIONS

PSP is a successful novel preclinical program introducing students to pediatrics. We demonstrated that didactics paired with resident-mentored clinical experiences improved pediatric knowledge, clinical-based skills, and perceived clerkship preparedness. Students may academically and professionally benefit from such earlier exposure to pediatrics.

Does an Eczema Action Plan Improve Atopic Dermatitis? A Single-Site Randomized Controlled Trial

The multitude of treatment options for atopic dermatitis (AD) makes management frustrating for providers and patients. Eczema action plans (EAPs) have been proposed to improve parental and provider management. We developed a single-site randomized controlled trial to evaluate the impact of an EAP on quality of life (QOL), provider knowledge, and comfort with AD management. Providers were randomized into an EAP-use group and a traditional care group. All patients completed validated AD QOL surveys, and those with AD were verbally administered the survey 1 month later. Providers' perceptions on managing AD were compared in the EAP and usual use groups. Parents in the EAP group demonstrated a significantly increased understanding of AD treatment, and providers in the EAP group had a significantly increased understanding and management of AD. The EAP is a feasible tool that can be integrated into a busy clinic practice with a positive impact on physicians and patients.

Increased Use of Medications for Erectile Dysfunction in Men With Ulcerative Colitis and Crohn's Disease Compared to Men Without Inflammatory Bowel Disease: A Nationwide Cohort Study

BACKGROUND

Men with inflammatory bowel disease (IBD) may have decreased sexual function due to factors related to the underlying disease, medication, and/or surgery. We aimed to examine the use of erectile dysfunction (ED) medications in men with IBD.

METHODS

This is a nationwide cohort study based on the Danish registries, comprising all men >18 years old with IBD during 1 January 1995 through December 2016. The cohorts included 31,498 men with IBD and 314,980 age-matched men without IBD. Our main outcome was a first prescription of an ED medication. Cox regression analyses were used to estimate the hazard rate (HR) for use of ED medications, controlled for multiple time-varying covariates.

RESULTS

Overall, 21,966 (69.7%) men had ulcerative colitis (UC) while 9532 (30.3%) had Crohn's disease (CD). Men with a first ED prescription numbered 3749 (11.9%) (men with IBD) and 30,635 (9.7%) (men without IBD). Adjusting for central nervous system and intestinal anti-inflammatory medications, systemic corticosteroids and co-morbidities, the HR was 1.19 (95% CI: 1.13-1.26) (IBD and no prior IBD operation), and 1.31 (95% CI: 1.20-1.43) (IBD and prior IBD operation). The adjusted HR for UC was 1.17 (95% CI: 1.10-1.24) (no operation) and 1.43 (95% CI: 1.27-1.61) (prior operation), and for CD 1.26 (95% CI: 1.15-1.38) (no operation) and 1.20 (95% CI: 1.06-1.35) (prior operation).

DISCUSSION

Men with IBD are more likely to fill an ED prescription than men without IBD. This result is significant regardless of a history of IBD surgery.

Abstract P6-10-05: UPTAKE study - Uptake of preventive surgeries among Latinas with BRCA1/2 mutations

Introduction: Germline testing for BRCA1/2 genes provides an opportunity to reduce mortality and morbidity by adopting appropriate risk reduction and screening options, in particular with risk-reducing bilateral salpingo-oophorectomy (BSO).There is a paucity of data on Latinas and prophylactic measures among BRCA1/2 carriers.Existing studies are limited either by the small number of Latinas, or limited to a specific geographic location.Factors related to decision making have also not been evaluated.

Methods: The UPTAKE study is an observational study of Latinas with germline BRCA1/2 mutations.Subjects were recruited nationally and, by telephone interviews, reported uptake of prophylactic surgeries (BSO, bilateral mastectomy in unaffected women, and contralateral mastectomy in carriers with breast cancer (BC)). Women with ovarian cancer were ineligible. All women had to have been informed that they carried a deleterious BRCA1/2 mutation at least 1 year prior to completing the interview. The objectives of this study are: 1)to examine the rate of uptake of prophylactic surgeries; 2)identify acculturation and attitudinal factors related to decisions made and 3)examine relationships between primary language, receipt of genetic counseling (GC) and in which language it was provided and uptake of prophylactic surgeries. We plan to enroll 100 participants.

Results: As of 6/11/2017, 86 telephone interviews have been conducted. We anticipate that all 100 interviews will be completed by July 2017. 51.2% (44/86) of participants completed the interview in Spanish. Our population was diverse in terms of country of origin: 50.0% (43/86) were born in the US, 22.1% (19/86) in Mexico, 11.6% (10/86) in Puerto Rico, 4.6% (4/86) in El Salvador, 3.5% (3/86) in Ecuador and 8.1% (7/86) in other countries of Latin America. 30% (26/86) of the participants reported an annual household income inferior to $50.000. Only 26.7% (23/86) of women reported having a graduate degree. Approximately one quarter of participants were unemployed at the time of study participation (26.7%, 23/86). 34.9% (30/86) were unaffected and 62.8% (54/86) were affected with BC. 73.3% (63/86) of participants reported having received formal GC, of which only 28.6% (18/63) was conducted in Spanish. 66.3% (57/86) of women opted to undergo BSO and 58.1% (50/86) underwent prophylactic mastectomy. Being born outside the US and currently working were associated with higher uptake of BSO. Multivariate analysis will be performed once all interviews have been completed.

Conclusions: To our knowledge this is the largest study that evaluates uptake of prophylactic measures in Latinas known to be BRCA1/2 carriers. Our study included a heterogeneous group of participants in terms of country of origin, income and level of education including English knowledge. It was conducted across various academic and community centers in the country. The uptake of prophylactic surgeries among Latinas with germline BRCA mutations seems to be slightly lower than what has been reported in non-Hispanic whites (71-74%) but higher than in African Americans (32-50%). Results and factors associated with decision making will be updated once the total number of participants is enrolled.

Citation Format: Lynce F, Serrano A, Friedman S, Nahleh Z, Dutil J, Campos C, Ricker C, Rodriguez P, Duron Y, Isaacs C, Graves K. UPTAKE study - Uptake of preventive surgeries among Latinas with BRCA1/2 mutations [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-05.

Reassuring results on birth outcomes in children fathered by men treated with azathioprine/6-mercaptopurine within 3 months before conception: a nationwide cohort study

OBJECTIVE

Information on the safety of paternal use of azathioprine (AZA) and 6-mercaptopurine (6-MP) prior to conception is limited. Based on nationwide data from the Danish health registries, we examined the association between paternal use of AZA/6-MP within 3 months before conception and adverse birth outcomes.

DESIGN

This nationwide cohort study is based on data from all singletons born in Denmark from 1 January 1997 through 2013. Children fathered by men who used AZA/6-MP within 3 months before conception constituted the exposed cohort (N=699), and children fathered by men who did not use AZA/6-MP 3 months prior to conception constituted the unexposed cohort (N=1 012 624). The outcomes were congenital abnormalities (CAs), preterm birth and small for gestational age (SGA). We adjusted for multiple covariates and performed a restricted analysis of men with IBD.

RESULTS

There were no significantly increased risks of CAs, preterm birth or SGA in exposed versus unexposed cohorts of children. The adjusted ORs were 0.82 (95% CI 0.53 to 1.28) for CAs, 1.17 (95% CI 0.72 to 1.92) for preterm birth and 1.38 (95% CI 0.76 to 2.51) for SGA. Restricting our analysis to fathers with IBD showed similar results with no significantly increased risk of adverse birth outcomes.

CONCLUSIONS

This nationwide study is the largest to date, examining the effect of preconceptual paternal use of AZA/6-MP on birth outcomes in live born singletons. The results of no significantly increased risks of adverse birth outcomes are reassuring and support the continuation of paternal AZA/6-MP treatment during conception.

Abstract P3-08-08: Preferences for breast cancer risk reduction among BRCA1 and BRCA2 mutation carriers: A discrete choice experiment

This abstract was withdrawn by the authors.

Supplementation with n-3, n-6, n-9 fatty acids in an insulin-resistance animal model: does it improve VLDL quality?

Could supplementation with n-3, n-6 and n-9 fatty acids prevent atherogenic alterations of VLDL produced in insulin-resistance?

Postpartum Depression in a General Pediatric Practice: Practical Methods for Improving Screening and Referrals

Postpartum depression (PPD) is a common problem in new mothers. Untreated PPD is associated with behavioral and developmental problems in children. We examined the effects of an educational session about PPD and modification of the electronic medical record (EMR) on providers' screening for PPD. An education session was given to the physicians and pre and post surveys compared comfort and self-reported screening. Following the EMR change, a retrospective chart review was conducted from three time periods: group 1-before the conference, group 2-after the conference but before EMR change, and group 3-after screening in the EMR. Documented screening increased from 0% in group 1, to 2% in group 2, to 74% in group 3 (P < .001). Ten percent screened positive, but only 14% had documented referrals to a provider for treatment. The combination of provider education and screening questions integrated into the EMR enhanced PPD screening rates among physicians in a busy practice.

Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction: a 20-year nationwide cohort study

OBJECTIVE

To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments.

METHODS

This was a nationwide cohort study based on Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 2013. The cohorts comprised 1360 ART treatments in 432 women with UC, 554 ART treatments in 182 women with CD and 148,540 treatments in 52,489 women without IBD. Our primary outcome was live births per ART treatment cycle. We controlled for multiple covariates in the analyses. Our secondary outcomes were adverse birth outcomes.

RESULTS

The chance of a live birth for each embryo transfer was significantly reduced in ART treatments in women with UC (OR=0.73, 95% CI 0.58 to 0.92), but not significantly reduced in the full model of ART treatments in women with CD (OR=0.77, 95% CI 0.52 to 1.14). Surgery for CD before ART treatment significantly reduced the chance of live birth for each embryo transfer (OR=0.51, 95% CI 0.29 to 0.91). In children conceived through ART treatment by women with UC, the OR of preterm birth was 5.29 (95% CI 2.41 to 11.63) in analyses including singletons and multiple births; restricted to singletons the OR was 1.80, 95% CI 0.49 to 6.62.

CONCLUSIONS

Our results suggest that women with UC and CD receiving ART treatments cannot expect the same success for each embryo transfer as other infertile women. Women with CD may seek to initiate ART treatment before needing CD surgery. Increased prenatal observation in UC pregnancies after ART should be considered.

Abstract P5-10-03: XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer

Women age 45 or under with breast cancer, or who are at high risk for breast cancer, have distinct health risks and needs when compared to their older counterparts. Young women with breast cancer or at high risk for breast cancer need evidence-based, high-quality information to help them make informed decisions about their specific health needs. Interpreting media reports on research findings, including determining the study implications for younger women is often challenging. To help women better understand media coverage of new research, Facing Our Risk of Cancer Empowered (FORCE) developed the CDC-funded XRAYS (eXamining Relevance of Articles to Young Survivors) program. To assure that the XRAYS program is responsive to the community's needs, FORCE launched a survey to assess where young women turn for information about breast cancer and to identify their information needs. The survey examines: how frequently women visit various media sources and health- or cancer-related websites for information on breast cancer screening, treatment, surgery, prevention, genetics, or survivorship; how much the women trust these information sources; whether they have ever tried to share media articles with their health care team and how the team received the information; and at what point(s) during the process of screening, diagnosis, treatment, survivorship and/or risk management respondents actively seek out information from the media. FORCE launched the survey nationally through its network of 50 outreach groups, partner organizations that serve young breast cancer survivors, and via a social media campaign targeting women age 45 and under with, or at high risk for breast cancer. The survey was open March 15 - June 30, 2015. We will report results from over 800 women, age 45 or younger, including those with breast cancer, who have previously had breast cancer, or who are at high risk for breast cancer. Analysis will determine response frequencies and whether information needs and utilization correlate with key demographic variables such as race/ethnicity, education, and income level. We will use correlation and multiple regression analysis to assess patterns in the types of information needed and channels where information is sought. These results will ensure XRAYS materials and dissemination efforts are efficient and responsive to the young breast cancer population's needs, and will inform the broader medical, media and patient advocacy communities about the distinct information needs of this group.

Citation Format: Rezende LF, Huynh J, Kramer K, Cranmer M, Schlager L, Pugh-Yi R, Friedman S. XRAYS (eXamining Relevance of Articles to Young Survivors) program survey of information needs and media use by young breast cancer survivors and young women at high risk for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-10-03.

Abstract P2-09-09: Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers

Background: Distress levels among female BRCA1 and BRCA2 mutation carriers can be similar to levels reported among breast cancer patients. However, there is a lack of data on long-term psychosocial functioning, and it is not known if uptake of risk-reducing surgery influences long-term cancer related distress in women with a BRCA mutation who are unaffected with cancer. The objective of this study was to evaluate long-term cancer-related distress in women with a BRCA mutation, and to evaluate predictors of distress, including uptake of cancer risk reducing surgery.

Methods: Female BRCA1 or BRCA2 mutation carriers, ages 25-55, and without cancer were eligible to complete the survey online. A validated instrument, Impact of Events Scale (IES)-Revised (Horowitz 1979, Weis & Marmar 1995; 0-80 overall scale), was used to assess current levels of cancer risk-related psychological distress. Respondents were recruited through the Facing Our Risk of Cancer Empowered (FORCE) advocacy organization, which includes women at high risk of breast cancer. This interim analysis is part of a larger multi-center patient preference study of BRCA mutation carriers designed to assess women's willingness to adopt hypothetical treatments to prevent breast cancer. Linear regression was used to evaluate predictors of IES distress levels.

Results: Between January and April 2015, 259 women completed the survey. The mean age of the participants was 41 years, and the mean time since receipt of genetic test results was 3.5 years (range 0-16; median 2 years). One hundred thirty-six (52%) women elected for prophylactic bilateral mastectomy (PBM), 139 (54%) elected for bilateral salpingo oophorectomy (BSO) (93 [36%] women had both surgeries), and 77 (30%) had not undergone risk-reducing surgery. The mean total IES score was 15.1 (range 0-72; median 11). Overall, 54 (21%) women reported moderate or severe cancer-related distress, and those who had undergone risk-reducing surgery reported lower perceived risk of developing breast cancer. Results to date indicate that shorter time since notification of mutation status, not having PBM (with or without BSO) (table), and not completing post-secondary education were independent predictors of higher IES distress scores.

IES severityNo prophylactic surgeryPBM onlyBSO onlyPBM and BSOn (%)77434693Subclinical27 (35)23 (54)16 (35)44 (47)Mild26 (34)13 (30)21 (46)35 (38)Moderate18 (23)5 (12)6 (13)11 (12)Severe6 (8)2 (5)3 (6)3 (3)

Conclusions: This study measured cancer-related distress in a large population of women with BRCA mutations who participate in the FORCE online support community. Higher levels of distress were associated with not having PBM and more recent genetic test disclosure. These findings are specific to a more informed community of women with high levels of understanding of cancer risk than may be seen in the clinical setting.

Citation Format: Liede A, Fairchild A, Friedman S, Amelio J, Hallett DC, Mansfield CA, Metcalfe KA. Risk-reducing surgery and cancer-related distress among female BRCA1 and BRCA2 mutation carriers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-09.

Review article: the psychosexual impact of inflammatory bowel disease in male patients

BACKGROUND

Knowledge of the extent and the impact of sexual dysfunction and interpersonal relationships in men with inflammatory bowel disease is scarce.

AIMS

The aim of this review article was to summarise the current literature on sexual function in male patients with IBD and to provide a critical review of the IBD-related medical, surgical and psychological complications that can result in impaired quality of sexual health.

METHODS

To collect relevant articles, PubMed/Medline and Embase searches were performed using Boolean search phrases.

RESULTS

Reported rates of sexual dysfunction in male IBD patients range from 10% to 50%. Thirty-three to fifty per cent of patients report that sexual desire and satisfaction deteriorated after IBD diagnosis. Of those patients who were sexually inactive, half of these attributed lack of intercourse to underlying IBD. A striking finding reproduced in numerous studies is that disease activity relates strongly to impaired psychological function, and the most consistently reported risk factor for sexual problems in IBD patients is co-existing mood disorders. Hypogonadism is a complication of IBD and its therapies, the role of testosterone deficiency should be further explored as a potentially treatable and reversible factor in sexual dysfunction.

CONCLUSIONS

By understanding what factors contribute to poor sexual functioning in our patients, we can strive to minimise adverse psychosocial events. Further insight into this complex relationship requires an IBD-specific measure of sexual function in male patients. We recommend screening for and treating co-morbid depression, testosterone deficiency and striving for clinical remission to prevent psychosexual dysfunction in male patients with inflammatory bowel disease.

Effect of insulin-resistance on circulating and adipose tissue MMP-2 and MMP-9 activity in rats fed a sucrose-rich diet

BACKGROUND AND AIM

Adipose tissue produces different metalloproteinases (MMPs), involved in adipogenesis and angiogenesis. Different studies have shown that in obesity the behavior of different MMPs may be altered. However there are scarce data about the effect of insulin-resistance (IR) on MMP-2 and MMP-9 activity in adipose tissue. Our aim was to determine whether sucrose induced IR modifies MMP-2 and MMP-9 behavior in expanded visceral adipose tissue and the contribution of this tissue to circulating activity of these gelatinases.

METHODS AND RESULTS

Male Wistar rats were fed with standard diet (Control) or standard diet plus 30% sucrose in the drinking water throughout 12 weeks (SRD). In epididymal adipose tissue vascular density, size and adipocyte density, PPARγ expression and MMP-2 and -9 were measured. Adipose tissue from SRD presented higher adipocyte size (6.32 ± 8.71 vs 4.33 ± 2.17 × 10(3) μm(2), p = 0.001) lower adipocyte density (164 (130-173) vs 190 (170-225) number/mm(2), p = 0.046) and lower vascular density (16.2 (12.8-23.5) vs 28.1 (22.3-46.5) blood vessels/mm(2), p = 0.002) than Control. MMP-2 and MMP-9 activity was decreased in SRD (1.93 ± 0.7 vs 3.92 ± 0.9 relative units, p = 0.048 and 1.80 ± 0.8 vs 5.13 ± 1.7 relative units, p = 0.004 respectively) in accordance with lower protein expression (0.35 ± 0.20 vs 2.71 ± 0.48 relative units, p = 0.004 and 1.12 ± 0.21 vs 1.52 ± 0.05 relative units, p = 0.036 respectively). There were no differences in PPARγ expression between groups.

CONCLUSION

Insulin resistance induced by SRD decreases MMP-2 and MMP-9 activity in adipose tissue which would not represent an important source for circulating MMP-2 and -9. In this state of IR, PPARγ would not be involved in the negative regulation of adipose tissue gelatinases.