Change in food security status and change in weight are not associated in urban women with preschool children

Cross-sectional studies have suggested that food insecurity leads to obesity in women. The objective of this longitudinal study was to determine whether changes in women's food security status were associated with changes in their body weight. In 20 large U.S. cities, 1707 mothers of preschool children were followed for 2 y. At baseline (2001-2003) and follow-up (2003-2005), women's height and weight were measured and food security status was assessed with the US Household Food Security Survey Module. Those with no positive responses on the food security items were considered fully food secure and those with any positive responses were considered not fully food secure. Seventy-one percent were unmarried and 45% had incomes below the U.S. poverty threshold. At baseline, 41% were obese (BMI > or = 30 kg/m(2)) and 31% were not food secure. After adjusting for sociodemographic characteristics and baseline BMI, there were no significant differences in 2-y weight increases between 4 groups that differed in food security status: food secure at both time points (n = 1000), 1.7 kg (95% CI = 1.1-2.3); food secure at baseline, but not at follow-up (n = 183), 2.1 kg (95% CI = 0.7-3.5); not food secure at either time point (n = 257), 1.7 kg (95% CI = 0.5-2.9); and not food secure at baseline but food secure at follow-up (n = 267), 1.9 kg (95% CI = 0.7-3.0). In this population of urban women, changes in food security status over 2 y were not significantly associated with changes in weight. These findings do not support a causal association between food insecurity and obesity.     

8 The Observed Teaching Encounter: Providing Residents Feedback on Their Teaching Skills

Introduction:  Emergency medicine residents spend a significant portion of their time teaching junior residents and medical students in the clinical setting. Feedback is an integral component of any teaching curriculum, and therefore, feedback on residents' skill in teaching abilities is an essential part of their learning to teach. We have developed a structured method of providing feedback to senior residents on their teaching competence.
Methods:  Upcoming senior residents receive an 8-hour course on clinical teaching during their useful conference time. In our ED, attending faculty and senior "teaching" residents are matched with medical student learners. The Observed Teaching Encounter (OTE) is used during usual clinical ED shifts to reinforce concepts in teaching. During the OTE, the teaching resident is directly observed by a faculty physician while teaching a student learner. A checklist is completed by both the faculty member and the student learner in order to provide feedback to the teaching resident. Assessed skills correlate with teaching theory provided to residents in their didactic curriculum. Written formative comments are provided to the resident from faculty, as well.
Results:  Attending faculty, senior residents, and student learners have all provided positive feedback on the OTE. Assessment of residents' retention of knowledge on methodology of teaching is presently in progress as a tool to evaluate the efficacy of the OTE.     

Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction

Background

Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited.

Foundations of medical decision-making for older adults with cardiovascu-lar disease

In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical examples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.     

Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques

We have described a new technique of using ultra-thin silicon sheet (0.2 mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15 years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2 years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5 mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2 cm. The mouth opening was about more than 2.7 cm in all our cases at 2 years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.     

Extracorporeal management of poisonings

Extracorporeal methods have been an integral part in the management of poisonings. The elimination of a drug or toxin by extracorporeal techniques (ECT) is governed by the properties of the toxin and the chosen extracorporeal therapy. The various ECT include hemodialysis, hemoperfusion, hemofiltration, continuous renal replacement therapy and peritoneal dialysis, all of which have been used some time or another for the management of poisonings. This review highlights the concepts forming the basis for selecting one modality over the others.