3-year Program Research Articles

Improvement in Symptoms of Depression and Anxiety and Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity Following the Implementation of a Multidisciplinary Personalized Lifestyle Intervention Program

Background/Objectives: Childhood obesity is one of the most challenging contemporary public health problems. Children and adolescents with obesity experience multiple psychosocial difficulties, such as low self-esteem, depression, anxiety, and behavioral problems, which persist for a long time. The aim of the study was to assess the effect of a multidisciplinary personalized lifestyle intervention for depressive and anxiety symptoms, as evaluated by psychometric questionnaires, and their effect and association with cardiometabolic parameters in children and adolescents with overweight and obesity conditions before and after the intervention. Methods: Six hundred and eleven (n = 611) children and adolescents (mean age ± SE: 10.39 ± 0.10 years; 51.5% females, 46.6% pubertal) were studied prospectively. Subjects were classified as being obese (50.2%), overweight (33.5%), or having a normal BMI (16.2%) according to IOTF criteria. All participants entered a 1-year lifestyle intervention program; laboratory investigations were obtained at the beginning and end of the study and two psychometric questionnaires were completed, the CDI and SCARED, which evaluate symptoms of depression and anxiety, respectively. Results: Following the lifestyle intervention, a significant decrease was noted in anxiety scores in all subjects and in depression scores in youth with obesity, as well as in adolescents with obesity, while females presented a reduced response to the intervention. Insulin resistance and metabolic syndrome parameters, cortisol, PRL, and LH concentrations were positive predictors for depressive and anxiety symptoms. Conclusions: The implementation of a multidisciplinary personalized lifestyle intervention program in the management of childhood obesity is associated with a significant decrease in cardiometabolic and psychosocial comorbidities in children with and without excess adiposity. The improvement in mental health is speculated to be mediated by an improvement in energy metabolism with subsequent improvement in neuroinflammation owing to lifestyle changes.

Experiences from the initial 3 years of introducing the British Pharmacological Society and UK Medical Schools Council Prescribing Safety Assessment for Danish junior doctors.

The British Pharmacological Society and UK Medical Schools Council Prescription Safety Assessment (BPS/MSC PSA) is an electronic platform developed for assessing the prescription skills of medical students. Our aim was to investigate the feasibility of the BPS/MSC PSA in addressing prescribing competencies among junior doctors in a hospital setting. The Department of Clinical Pharmacology at Odense University Hospital established a Danish translated programme using the BPS/MSC PSA platform. We launched a formal 3-year programme in 2021, potentially assessing all first-year doctors at Odense University Hospital and Esbjerg Regional Hospital. Participation was followed by a survey. During the period of 2021 to 2023 n =364 doctors were invited, from which n =246 participated. The compliance rate increased from 38% in 2021 to 88% in 2023. The mean assessment score (points normalized to percentage) across n =246 participants was 71%, and 94% achieved a score of at least 50%. A subset of participants responded to the survey, with the majority of those completing the questionnaire indicating that the purpose of the assessment was clear. The items related to difficulty and number of questions received comparable evaluations, and most respondents found the questions clinically relevant. It is feasible to translate and implement the BPS/MSC PSA in a Danish hospital setting. The programme provides insight into the prescribing competencies of junior doctors and the participants are generally positive.

Perspectives on program duration and research: A survey of graduates of a 3-year medical physics residency program.

The goal of this manuscript is to evaluate strengths and weaknesses of a 3-year medical physics residency program with the first year dedicated to research and the remaining 2 years dedicated to clinical training. An anonymous survey was distributed to graduates of a 3-year medical physics residency program with a dedicated year of research. Questions focused on several categories: (1) in retrospect, factors graduates considered at the time of application, (2) aspects of respondents' career and life after graduating from residency, (3) respondents' opinions on the residency duration, and (4) research productivity during residency. Of 22 graduates who were contacted, 17 filled out the survey. In retrospect, the most impactful consideration at the time of application was quality of clinical training. Extra time for research was reported as the factor with the most positive career impact and financial considerations as the most negative impact of completing a 3-year residency. Preference for a 3-year residency at the time of application and in retrospect was expressed by 47% and 88% of respondents, respectively. 71% of respondents would recommend applying to a 3-year program to current residency candidates, and 29% respondents said their recommendation on entering a 3-year program would depend on the candidate's interests. 76% of respondents preferred dedicated time for research during residency. The optimal duration of medical physics residency depends on the goals and career objectives of the incoming residents. Two years may be an optimal duration for clinical training. For candidates interested in a career with a substantial research component, a 3-year program may be a good option, and graduates express favorable opinions after completing such a program. A 4-year residency duration is not viewed favorably by the graduates.

Impact of advanced endoscopy training on colonoscopy quality and efficiency.

Few reports have detailed improvements in the quality of colonoscopies with continuous training post-fellowship completion. We examined the changes in colonoscopy performance among trainees during our advanced endoscopy training program. Screening or surveillance colonoscopies performed by 11 trainees who participated in our 3-year advanced endoscopy training program between April 2015 and March 2020 were retrospectively analyzed. Quality and efficiency metrics of colonoscopies were evaluated annually. Altogether, 297, 385, and 438 colonoscopies were enrolled in the first, second, and third training years, respectively. The mean insertion times were 8.6, 7.6, and 6.9 min in the first, second, and third training years, respectively, with significant improvement from the first to second year (p = 0.03) and from the first to third year (p < 0.01). The adenoma detection rate, proximal adenoma detection rate, and mean number of adenomas per patient exhibited a tendency to improve annually; however, the difference was not significant. Polypectomy efficiency was 10.5%, 11.2%, and 13.0%, with significant improvements from the first to third year (p < 0.01) and from the second to third year (p = 0.02). Insertion time and polypectomy efficiency showed significant improvements, especially among trainees experienced with <500 colonoscopies. Through our advanced endoscopy training program, there has been an improvement in the quality and efficiency of colonoscopy for trainees who have completed their fellowships, particularly those with <500 colonoscopies.

Building the clinical workforce of pediatric infectious diseases in Bolivia for better care of children with cancer

Abstract Background Infections in children with cancer can be fatal if not appropriately managed. Access to trained and competent professionals in infection care and prevention (IC&amp;P) improve care outcomes. Bolivia expects about 1700 new pediatric cancer cases annually. In 2023, 2371 hematological neoplasms were reported in children, cared mainly at 4 public hospitals where, until 2016, 5 pediatric infectious disease (PID) specialists were working in 2 of these 4 hospitals. For better PID clinical workforce for critically ill children, we built a PID medical residency training. In 2017, the training accepted its first trainees at Hospital del Niño “Dr. Ovidio Aliaga Uría” (Hospital del Niño), a public hospital in La Paz. Here, we describe the program, how we built it, and its outcomes. Methods The PID training goal is to train leaders in PID for clinical observations, PID literature interpretation, and to transform them into concepts that can be applied to ID pathogenesis or treatment. At the end of the 2-year PID training program, we expect trainees will gain expertise in PID clinical practice and clinical or translational science research. Our PID program was based on other PID specialty training programs from Mexico, Spain, and the USA of which, we adapted standard topics and formats of training. The content has routine and prevalent PIDs of Bolivia and the region, including on immunocompromised patients. We expected that the trainee dedicate full time to the PID training program plus caring for assigned patients and those requested consultations in the wards and clinics of Hospital del Niño; review articles; participate in clinical discussions; attend the Infection Control Course of St. Jude Children’s Research Hospital; attend and / or present in the PID case-based learning international sessions; visit the virology, bacteriology, parasitology and immunology laboratories of the national reference laboratory; and attend international rotations at participating hospitals. Results Since 2017, 5 new PID pediatricians graduated from our program, 3 work in public hospitals that care for children with cancer and 2 work in government insurance hospitals. They are working in hospitals in La Paz (n=2), Cochabamba (n=1), Santa Cruz (n=1), and Tarija (n=1). These graduates are leaders in ICP, antimicrobial stewardships, and education of hospital staffs. As per December 2023, they produced 5 articles for local journals, 2 for international journals, 7 abstracts for scientific meetings. Currently, 2 pediatricians participate in the PID training program, and post-graduation, they plan to work in departments of Potosí and Sucre where there are no PID specialists. Challenges to establish PID specialists in Bolivia are lack of value attributed to PID and its role in care quality. Conclusion Creating local expertise in PID are essential to improve and sustain the optimum care for children with cancer in Bolivia especially in places where these personnel did not exist before. However, for best investment return of PID trained professionals, having PID job descriptions and paid positions in hospitals will absorb PID specialists to benefit the largest population of children with cancer in Bolivia.

Scotland's internal medicine simulation strategy: A 5-year journey

In 2019, the internal medicine (IM) stage 1 curriculum was implemented in the UK. This introduced a revised 3-year training programme for physicians in training. The new IM stage 1 curriculum emphasised simulation-based education, triggering the integration of simulation training on a national scale in Scotland. Bespoke training courses were developed for IM trainees in Scotland, spanning all 3 years of their training programme. Each course was meticulously designed with input from key stakeholders and trainees, aligning learning objectives with curriculum outcomes. The Scottish IM simulation strategy encompasses a 3-day bootcamp in IM year 1, a 1-day skills day in IM year 2, and a 2-day ‘registrar ready’ course in IM year 3. These courses, delivered at central locations, focus on immersive simulation, communication workshops, and simulation-based mastery learning of procedural skills. Evaluation of the programme includes pre- and post-course questionnaires, data tracking over the training programme, interviews with trainees and faculty, and annual review days to gather feedback and make necessary adaptations. The impact of the programme for trainees includes transfer to clinical practice of communication skills, improved non-technical skills, and increased confidence in procedural skills. Alignment with the IM stage 1 curriculum supports trainees’ annual reviews of competence progression. The IM simulation training also offers valuable social benefits and remains crucial, especially with increased pressure in the NHS. It is our belief that ongoing delivery of this training is invaluable to the IM stage 1 programme in Scotland.

The Leaders in Informatics, Quality, and Systems (LInQS) Fellowship.

Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership. This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians. From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education. Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields.

National health and economic impact of a lifestyle program to prevent type 2 diabetes mellitus in Germany: a simulation study

IntroductionTo examine the long-term health and economic impact of a lifestyle diabetes prevention program in people with high risk of developing type 2 diabetes in Germany.Research design and methodsWe assessed...

University Students' Satisfaction and its Effect on Positive Youth Development: A Gender-Based Comparison from Pakistan

This study investigates university students’ satisfaction and its implications for positive youth development (PYD), focusing on gender-based comparisons. Through a comprehensive analysis of survey data gathered from a diverse sample of university students, this research explores how various aspects of university students’ satisfaction, including reliability, responsiveness, tangibles, assurance, and empathy influence PYD attributes. The students of 06 public sector general category universities studying in the 1st year (1st and 2nd semester) and the last year (7th and 8th semester) of the BS 4-year program were the target population. By examining potential gender differences in the satisfaction-PYD relationship, this study sheds light on the unique challenges and opportunities faced by male and female students in Pakistan’s higher education institutions. The results indicated a significant, and positive relationship between university students’ satisfaction and their positive youth development. The findings also affirmed the significant effect on university students’ satisfaction with PYD.

Reducing the incidence of overweight and obesity by a healthy lifestyle intervention program for schoolchildren in Hanoi, Vietnam: a randomized controlled trial

BackgroundThe increasing incidence and prevalence of childhood overweight (OW) and obesity (OB) are major global health challenges. This study aimed to evaluate the effectiveness of a 2-year healthy lifestyle intervention program in reducing the incidence of OW and OB among schoolchildren aged 11–12 years in Vietnam.MethodsStudy design: Randomized controlled trial.Participants and interventions: In total, 733 students participated in this study. Participants were included from four schools in Hanoi based on a random cluster sampling method. Students’ health outcomes were assessed at baseline and after 2 years.Main outcomes: The primary outcomes were the incidence of OW and OB, and the secondary outcomes were the prevalence and remission of OW and OB. Generalized estimating equations (GEEs) were used to determine the outcomes and risk factors.ResultsAfter the intervention, the prevalence of OW decreased by 9.24% in the intervention group and 3.01% in the control group.After adjustment for age and sex, the odds of overweight were 36.7% lower in the intervention group than in the control group (OR = 0.633; 95% CI: 0.434–0.925; P = 0.018). The incidence of OW was 1.31% in the intervention group compared with 5.33% in the control group. After adjustment for age and sex, the odds of incident overweight in the intervention group were 77.4% lower than in the control group (OR = 0.226; 95% CI: 0.063–0.813; P = 0.023). The proportion of patients who achieved OW remission was 41.22% in the intervention group and 28.68% in the control group. After adjustment for age and sex, the odds of OW remission of overweight were 2.219 times greater in the intervention group than in the control group (OR = 2.219; 95% CI: 1.220–4.036; P = 0.009). For most OB-related factors, there were no significant differences between the intervention and control groups.ConclusionA multicomponent healthy lifestyle intervention was effective in reducing the incidence of OW; however, it had no significant effect on OB among children aged 11–12 years in Hanoi, Vietnam.Trial registrationRetrospectively registered number: UMIN000014992, 20/08/2023.

The TeLeo Program: Tele-education in pediatric oncology as a tool to support training programs in Latin America.

The TeLeo Program offers a free-access 2-year online learning program to support fellowship programs in pediatric oncology, enhance networking opportunities, and facilitate the exchange of context-specific, educational content within the pediatric oncology community in training in Latin America. In its first edition beginning in 2021, 185 fellows from 40 centers in 12 Latin American countries were enrolled. Additional courses for other healthcare professionals related to oncology in the region were produced to further support the program. A digital platform was created to allow users to easily access learning activities after registration, with 7075 professionals currently registered.

Strategic Learning Strategies of Doctor of Physical Therapy Students

Introduction. The use of strategic learning strategies has been positively associated with academic performance in several graduate health profession programs. This finding suggests that it may be an important construct to explore in Doctor of Physical Therapy (DPT) education. The Learning and Study Strategies Inventory (LASSI) summarizes a student's perception and use of 10 learning and study strategies. Review of Literature. Although the LASSI has limited reporting in DPT education, other health care education programs have shown correlation with academic performance. The purpose of this study was to examine DPT students' early perceptions of strategic learning with descriptive summaries of LASSI data and examine correlations between demographic and admissions-related data. Subjects. Matriculated DPT students (n = 294) at a 2-year hybrid program who completed the LASSI at orientation in 2020 and 2021. Methods. This was a descriptive study that retrospectively analyzed LASSI scores in entry-level DPT students. LASSI score differences among demographic groups and Spearman's rho correlations between the LASSI, Graduate Record Examination (GRE) scores, grade point averages, grit, and emotional intelligence (EI) were explored. Results. LASSI score means were in the 50th–75th percentile (moderate category) suggesting a need for further development in strategic learning. Group differences in LASSI scores were noted for gender identity (male higher Anxiety management, P &lt; .001; female higher Attitude, P &lt; .001, Time Management, P = .003, and Use of Academic Resources, P = .003), racial–ethnic minoritized group (higher Self-regulation, P = .013), first-generation college students (higher Attitude, P = .047), physical therapy assistants (higher Information Processing, P = .047), students with a primary language other than English (higher Time Management, P = .046), and older students (higher Anxiety management, P = .026). Weak but significant correlations were identified between LASSI scale and component scores and several admissions variables. Highest correlations were with grit (Will, ρ = 0.319, P &lt; .001; Concentration, ρ = 0.312, P &lt; .001), EI (Will, ρ = 0.328, P &lt; .001; Attitude, ρ = 0.302, P &lt; .001; Self-regulation, ρ = 0.382, P &lt; .001; Use of Academic Resources ρ = 0.331, P &lt; .001), and quantitative GRE scores (Anxiety management, ρ = 0.341, P &lt; .001). Discussion/Conclusion. All LASSI scale scores and components were in the moderate category, potentially indicating a need to coach and develop strategic learning strategies. Group differences in LASSI scores may represent varied student needs. The weak relationship between LASSI scores and admissions variables could suggest that the constructs measured by LASSI are not currently captured through typical DPT admissions practices.

The Role of Secreted Frizzled-Related Protein 5 (Sfrp5) in Overweight and Obesity in Childhood and Adolescence.

Background/Objective: Secreted frizzled-related protein 5 (Sfrp5) is an anti-inflammatory adipokine that has been implicated in the pathophysiology of obesity and its metabolic complications. Despite the fact that numerous studies have been carried out in adults, limited data on Sfrp5 exist for youth, especially in relation to overweight and obesity. Methods: In our study, we assessed the concentrations of Sfrp5, total oxidative (TOS) and antioxidative (TAS) status, high-sensitivity C-reactive protein (hs-CRP), and several cytokines (IL-1α, IL-1β, IL-2, IL-6, IL-8, IL-12, TNF-α) in 120 children and adolescents (mean age ± SE: 11.48 ± 0.25 years; 48 prepubertal, 72 pubertal; 74 males and 46 females) before and 1 year after the implementation of a personalized, structured, lifestyle intervention program of healthy diet, sleep, and physical exercise. Results: Based on the body mass index (BMI), participants were categorized as having morbid obesity (n = 63, 52.5%), obesity (n = 21, 17.5%), overweight (n = 22, 18.33%), or normal BMIs (n = 14, 11.67%), based on the International Obesity Task Force (IOTF) cut-off points. Following the 1-year lifestyle intervention program, a significant improvement in anthropometric measurements (BMI, BMI-z score, diastolic blood pressure, WHR, and WHtR), body-composition parameters, hepatic enzymes, lipid profile, inflammation markers, and the insulin-sensitivity profile (HbA1C, HOMA index) was observed in all subjects. Sfrp5 decreased in subjects with obesity (p < 0.01); however, it increased significantly (p < 0.05) in patients with morbid obesity. Linear regression analysis indicates that TNF-α and systolic blood pressure were the best positive predictors and hs-CRP was the best negative predictor for Sfpr5 concentration at initial assessment and glucose concentration for ΔSfrp5, while TNF-α and TAS were the best positive predictors for Sfpr5 concentration at annual assessment. Conclusions: These results indicate that Sfrp5 is associated with severe obesity and is increased following weight loss in children and adolescents with morbid obesity. It is also related to metabolic homeostasis, as well as inflammation and oxidative status.

Community Outreach, Engagement, and Mentoring Program for Underrepresented Scholars in Cancer Health Disparities.

Racial/ethnic minorities and women are affected by cancer and cancer risk factors at higher rates; however, they are largely underrepresented in scientific professions focused on health disparities. One way to reduce disparities is to increase diversity within the workforce by planning training activities for minority scholars and paying close attention to community outreach. This paper describes the outcomes of a robust community outreach plan engaging communities in education, research, and clinical trials to increase the number of underrepresented student scholars in cancer disparities research through research training, mentorship, and service-learning activities provided within local organizations. The program provided two cohorts of scholars from underrepresented communities with opportunities to attend seminars, present their research to community representatives, and connect with the local community. Cohort 1 consisting of ten scholars participated in a 2-year program that started in the summer of 2018. Cohort 2, consisting of seven scholars, participated in a 1-year program starting in June 2020. Overall, scholars provided positive feedback on all service-learning program activities and the effectiveness of the program in shaping career interests. New procedures developed in response to the COVID-19 pandemic continued the effective management of all components of the program and helped increase engagement with the community outreach staff. The outreach program evaluated here can prepare diverse scholars to enter the workforce with interdisciplinary training for mitigating cancer disparities and serve as a model for planning and implementing similar programs at other institutions.

Changes in therapists’ knowledge of symptom management and stabilization following program co-participation with dissociative patients

Few professionals in the mental health field receive systematic training in treating trauma-related symptoms and disorders, including dissociative disorders (DD). Experts in the field of treating DDs recommend building stabilization skills early in treatment to improve emotion regulation and safety, yet research on DD therapists’ actual practices suggest that they are engaging in these practices less than recommended. DD patients may benefit from therapists learning more about emotion regulation and trauma symptom management towards stabilizing difficult experiences and risky, unhealthy, or unsafe behaviors. The current study considered whether an international group of therapists who participated alongside their DD patients in a 2-year Internet-based psychoeducational program demonstrated changes in knowledge related to symptom management and stabilization techniques. Therapists answered five free-form text questions related to DD symptom management and stabilization at baseline, mid-point, and end of the study. Results showed that significant changes in therapist knowledge were evident between baseline and mid-point, as well as between the baseline and the end of the study, with effect sizes ranging from small to large. Compared to when they began the study, therapists were better able to understand their DD patients’ reasons for self-injury, recognize warning signs of unsafe behaviors, identify coping skills, and identify skills to manage overwhelming feelings and intrusive traumatic content. Implications and opportunities for future research are discussed.

Towards more sustainable and inclusive development corridors in Africa

Abstract Development corridors are linear programmes of infrastructure and agriculture aiming to facilitate rapid socio-economic development. In Africa, they are a major development activity, with 88 underway or planned corridors. Drawing from extensive literature and insights gleaned from a 4 year research programme, this review scrutinizes the impacts of development corridors on people, wildlife and ecosystems in Kenya and Tanzania, proposing solutions to achieve better outcomes. The overarching goal was to discern the principle challenges emerging from the practical execution of the prevailing corridor model. The holistic approach taken, assessing the development corridors paradigm through an integrated ecological, social, and economic lens, provides novel insights that have not been possible using more traditional—siloed—research approaches. Eight key challenge areas are identified: impact assessments processes; coherence across international, national and local planning; governance; inclusivity; equality; impacts on biodiversity and ecosystem services; incorporation of future climate risks; and integrated water resource management. Poorly planned and implemented corridors detrimentally impact livelihoods and ecosystems. They lack a sustainable development vision, detailed social, environmental or climate risk assessments, and develop incrementally in policy and corporate spaces. There is also often a disconnect between investors and recipient governments, with some investors funding what governments request without applying internationally-recognised safeguards, and governments lacking capacity and resources to enforce regulations. We make recommendations for addressing these challenge areas. These aim to enhance impact assessment efficacy; integrate local perspectives into effective and inclusive corridor planning; overcome siloed project development and implementation; anticipate future development projections; and prioritise landscape preservation for enhanced ecosystem services and climate resilience.

Economic Evaluation of Fasting Mimicking Diet vs Standard Care in Diabetic Patients on Dual or Triple Medications at Baseline in the United States: A Cost-Utility Analysis

ObjectivesAccording to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the fasting in diabetes treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD) in patients with type 2 diabetes mellitus. Their results showed that FMD cycles improve glycemic management and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality-of-life effects, cost implications, and cost-effectiveness of adding a 3-year FMD program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer. MethodsWe constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD effectiveness outcomes and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%. ResultsThis cost-utility analysis showed that the FMD program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 quality-adjusted life year and net monetary benefit of 41 613 USD per simulated patient. Thus, the FMD program is cost saving. ConclusionsThese results indicate that the FMD program is a beneficial first-line strategy in T2DM management.

Quantifying Radiology Residents' Learning Curves in Report Writing Performance Through Report Comparison and Jaccard Similarity.

Background Report writing skills are a core competency to be acquired during residency, yet objective tools for tracking performance are lacking. Purpose To investigate whether the Jaccard index, derived from report comparison, can objectively illustrate learning curves in report writing performance throughout radiology residency. Materials and Methods Retrospective data from 246 984 radiology reports written from September 2017 to November 2022 in a tertiary care radiology department were included. Reports were scored using the Jaccard similarity coefficient (ie, a quantitative expression of the amount of edits performed; range, 0-1) of residents' draft (unsupervised initial attempt at a complete report) or preliminary reports (following joint readout with attending physicians) and faculty-reviewed final reports. Weighted mean Jaccard similarity was compared between years of experience using Welch analysis of variance with post hoc testing overall, per imaging division, and per modality. Relationships with years and quarters of resident experience were assessed using Spearman correlation. Results This study included 53 residents (mean report count, 4660 ± 3546; 1-5 years of experience). Mean Jaccard similarity of preliminary reports increased by 6% from 1st-year to 5th-year residents (0.86 ± 0.22 to 0.92 ± 0.15; P < .001). Spearman correlation demonstrated a strong relationship between residents' experience and higher report similarity when aggregated for years (rs = 0.99 [95% CI: 0.85, 1.00]; P < .001) or quarters of experience (rs = 0.90 [95% CI: 0.73, 0.96]; P < .001). For residents' draft reports, Jaccard similarity increased by 14% over the course of the 5-year residency program (0.68 ± 0.27 to 0.82 ± 0.23; P < .001). Subgroup analysis confirmed similar trends for all imaging divisions and modalities (eg, in musculoskeletal imaging, from 0.77 ± 0.31 to 0.91 ± 0.16 [P < .001]; rs = 0.98 [95% CI: 0.72, 1.00] [P < .001]). Conclusion Residents' report writing performance increases with experience. Trends can be quantified with the Jaccard index, with a 6% improvement from 1st- to 5th-year residents, indicating its effectiveness as a tool for evaluating training progress and guiding education over the course of residency. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Bruno in this issue.

Comparison of clustering and phenotyping approaches for subclassification of type 2 diabetes and its association with remission in Indian population

Identification of novel subgroups of type 2 diabetes (T2D) has helped improve its management. Most classification techniques focus on clustering or subphenotyping but not on both. This study aimed to compare both these methods and examine the rate of T2D remission in these subgroups in the Indian population. K-means clustering (using age at onset, HbA1C, BMI, HOMA2 IR and HOMA2%B) and subphenotyping (using homeostatic model assessment (HOMA) estimates) analysis was done on the baseline data of 281 patients with recently diagnosed T2D who participated in a 1-year online diabetes management program. Cluster analysis revealed three distinct clusters: severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), and mild obesity-related diabetes (MOD) while subphenotyping showed four distinct categories: hyperinsulinemic, insulinopenic, classical, and nascent T2D. Comparison of the two approaches revealed that the clusters aligned with phenotypes based on shared characteristics of insulin sensitivity (IS) and beta cell function (BCF). Clustering correctly identified individuals in nascent group (high IS and BCF) as having mild obesity related diabetes which subphenotyping did not. Post-one-year intervention, higher remission rates were observed in the MOD cluster (p = 0.383) and the nascent phenotype showing high IS and BCF (p = 0.061, Chi-Square test). In conclusion, clustering based on a comprehensive set of parameters appears to be a superior method for classifying T2D compared with pathophysiological subphenotyping. Personalized interventions may be highly effective for newly diagnosed individuals with high IS and BCF and may result in higher remission rates in these individuals. Further large-scale studies are required to validate these findings.

Coagulation factors VIII and factors IX testing practices in China: Results of the 5-year external quality assessment program

Background and aimsTesting for coagulation factors VIII (FVIII) and IX (FIX) plays significant importance in the diagnostic and treatment of hemophilia A and B. External quality assessment (EQA) scheme aimed to assess the participants’ performance of testing for coagulation factors and identify shortcomings in clinical practice. This study aimed to investigate the performance trends of the participating laboratories in China national external quality assessment Scheme (China NEQAS) for FVIII and FIX over a five-year period (2019–2023). Materials and methodsA total of ten external quality assessment (EQA) rounds were conducted from 2019 to 2023 in the China NEQAS for FVIII and FIX. The distribution of method, reagent and instrument were calculated. The trends of method- specific inter-laboratory coefficient of variation (CV) and pass rates were analyzed over 5 years. The dilutions for coagulation factor testing were also investigated. ResultsAll laboratories use one-stage assays to detect FVIII and FIX activity. The inter-laboratory overall CV decreased year by year (10.9 % to 9.3 % for FVIII and 13.5 % to 10.2 % for FIX), and the laboratory pass rate steadily increased (88.0 % to 93.4 % for FVIII and 81.3 % to 92.7 % for FIX). The majority of laboratories employed a single dilution methodology for the assessment of FVIII and FIX activity. The interlaboratory CV was elevated for the Siemens reagent (Actin FSL) during analysis of moderately abnormal FIX concentrations of EQA samples in most batches. ConclusionsThe implementation of the external quality assessment has contributed to facilitate the enhancement of testing quality. Chromogenic assay is a supplement to accurate determination when necessary. Laboratories may choose to perform dilution tests or direct assays to identify the presence of inhibitors, particularly when they are suspected.