Improved provider preparedness through an 8-part genetics and genomic education program

PurposeLarge-scale genetics education appropriate for general practice providers is a growing priority. We describe the content and impact of a mandatory system-wide program implemented at Sanford Health.MethodsThe Imagenetics Initiative at Sanford Health developed a 2-year genetics education program with quarterly web-based modules that were mandatory for all physicians and advanced practice providers. Scores of 0 to 5 were calculated for each module on the basis of the number of objectives that the participants reported as fulfilled. In addition, the participants completed surveys before starting and after finishing the education program, which included a 7-item measure scored 7 to 28 on the perceived preparedness to practice genetics.ResultsBetween 2252 and 2822 Sanford Health employees completed each of the 8 quarterly education modules. The ratings were highest for the module about using genomics to improve patient management (mean score = 4.3) and lowest for the module about different types of genetic tests and specialists. The mean perceived preparedness scores increased from 15.7 at pre-education to 19.1 at post-education (P < .001).ConclusionWeb-based genetics education was highly effective in increasing health care providers’ confidence about using genetics. Both comfort with personal knowledge and confidence regarding access to the system’s genomic medicine experts increased significantly. The results demonstrate how scalable approaches can improve provider preparedness.     

Clinical Problems in Atrial Synchronous Ventricular Inhibited Pacing: A Long-term Follow-up of 54 Patients

Fifty-four VDD-paced patients were followed for more than 12 months; they were studied retrospectively in order to assess possible clinical problems and their management. The patients were between 19 and 84 years of age (mean, 66 +/- 11). Twenty-four of the 54 received a VDD pacemaker as a primary implant and 30 had had VVI pacemakers which were changed to VDD mainly because of limited exercise tolerance or symptoms of AV asynchrony. The follow-up time was between 12 and 69 months (mean, 39 +/- 17). Pacemaker and lead problems were neither frequent nor serious. Six patients had spontaneous paroxysmal supraventricular tachyarrhythmias, four had pacemaker-mediated supraventricular tachycardias and six had ventricular tachyarrhythmias. Treatment of tachyarrhythmias included drugs, DC conversion, reprogramming, or combinations of these measures. Frequency of hospitalization was not greater than expected. In conclusion, VDD pacing appears safe and reliable, with problems mainly associated with the underlying cardiac disease rather than to the pacing mode itself.     

A New Lead for Transvenous Atrial Pacing and Sensing Clinical and Electrophysiological Experiences

The Medtronic 6961 lead has been used in 14 patients for transvenous atrial sensing and/or pacing. This lead is furnished with small tines of silicone rubber at the distal end. The conductor coil material is space wound for flexibility. Thus, the lead lacks intrinsic elasticity and can be fastened within the right atrial appendage without a preformed J-shape. The clinical experiences with the lead are encouraging. The lead is easier to introduce and position in the right atrial appendage than the previously used tined J-shaped leads (Medtronic 6991). The small size of the new lead makes the choice of vein less critical and a normally-sized external jugular or cephalic vein permits the use of the same vessel for a second ventricular lead. By means of a lead extension wire, consecutive determinations of the P-wave amplitude, stimulation threshold of the right atrium, electrode resistance, and P/QRS-ratio were made for four weeks following electrode insertion. The mean P-wave amplitude at insertion was 4.9 +/- 1.5 mV (mean +/- SD). There was a significant decrease to a lowest mean level of 309 +/- 1.1 mV after one week. From that time there were only small variations. In the supine position and with normal breathing there was a spontaneous variation of the P-wave amplitude of +/- 12%. The P-wave amplitude was influenced by body position and maximal breathing movements to a minor extent. The threshold of stimulation was 0.9 +/- 0.4 V after one week. Later there was a small decrease in the threshold which, however, still remained significantly higher than at the time of insertion. The total resistance of the electrode system was about 700 ohms and P/QRS-ratio about 4 +/- 3. During an observation time ranging from 4 to 11 months there were no electrode dislocations. The electrodes were connected to the intended pacemakers without complications. In conclusion, the transvenous endocardial atrial lead, Medtronic 6961, shows attractive and promising qualities. The electrophysiological data recorded are suitable for the pacemakers in use. The electrode definitely deserves further evaluation.     

Opposing influences of prenatal and postnatal weight gain on adrenarche in normal boys and girls

Associations between low birth weight and higher adrenal androgen secretion before puberty have yet only been reported in case-control studies in girls. We examined the influence of birth weight and early postnatal weight gain on overnight-fasting adrenal androgen and cortisol levels in 770 children from a large normal United Kingdom birth cohort at age 8 yr. In univariate analyses, adrenal androgen levels were inversely related to birth weight sd score in each sex [dehydroepiandrosterone sulfate in boys: regression coefficient (B) = -2.5 microg/dl/SD; 95% confidence interval (CI), -4.7 to -0.2; in girls: B = -3.8 microg/dl/SD; 95% CI, -6.2 to -1.4; androstenedione in boys: B = -0.15 nmol/liter/sd, 95% CI, -0.25 to -0.6; in girls: B = -0.13 nmol/liter/SD; 95% CI, -0.24 to -0.02). In multivariate analyses, both lower birth weight and larger current body weight predicted higher adrenal androgen levels (P < 0.005 for all comparisons). Allowing for current weight, children who showed rapid postnatal weight gain between 0 and 3 yr had higher dehydroepiandrosterone sulfate (P = 0.002) and androstenedione (P = 0.004) levels at 8 yr. In contrast, cortisol levels were unrelated to birth weight or current body size. In summary, the relationship between lower birth weight and higher childhood adrenal androgen levels was continuous throughout the range of normal birth weights, and was similar in boys and girls. Adrenal androgen levels were highest in small infants who gained weight rapidly during early childhood. We suggest that higher adrenal androgen secretion could contribute to links between early growth and adult disease risks, possibly by enhancing insulin resistance and central fat deposition.     

Moderating effects of race in clinical trial participation and outcomes among marijuana-dependent young adults

Background

Few studies have examined clinical trial participation rates and treatment outcomes among underserved young adults who are dependent on marijuana, the most commonly abused illicit drug.

Method

The present study was a secondary analysis of a trial of court-referred marijuana-dependent young adults (ages 18–25) randomized to one of four treatment conditions: Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), MET/CBT + Contingency Management (CM), Drug Counseling (DC) or DC + CM. African American (N = 81) participants were compared to White (N = 31) participants with respect to rates of participation in phases of treatment and substance use outcomes. In addition, the interaction of race and treatment condition was examined to ascertain if the interventions yielded different effects based on race.

Results

Among those who started treatment, African American young adults were significantly less likely to complete the treatment and posttreatment phases of the clinical trial than their White counterparts. Irrespective of treatment type, substance use outcomes (i.e., percentage of marijuana-negative specimens and longest duration of continuous abstinence) did not vary by race. However, there was a significant interaction effect between treatment type and race; African American young adults did not benefit differentially from any specific type of treatment, but CM was effective in reducing proportion of marijuana positive samples among White young adults.

Conclusions

Findings suggest that clinical trial treatment and posttreatment completion rates vary by race in this population, as does response to specific treatment types. More treatment research focusing specifically on African American marijuana-dependent young adults is warranted.     

Efficacy of Procox® oral suspension for dogs (0.1% emodepside and 2% toltrazuril) against experimental nematode (Toxocara cati and Ancylostoma tubaeforme) infections in cats

Two exploratory studies were performed to determine the optimum therapeutic dose of Procox(?) for the removal of experimental infection with mature adult Toxocara (T.) cati and Ancylostoma (A.) tubaeforme in kittens. Procox(?) is a new oral suspension containing a combination of the nematocidal and coccidiocidal active principles emodepside (0.1 %) and toltrazuril (2 %).In the first study, 18 eight-weeks-old kittens were inoculated with 450 L3 larvae of T. cati. 56 days after infection, the kittens were allocated to three treatment groups and were treated with 0.5 mg emodepside/kg body weight (group 1), 0.25 mg emodepside/kg body weight (group 2) and 0.1 mg emodepside/kg body weight (group 3), respectively. In the second study, 10 eight-weeks-old kittens were inoculated with 350 L3 larvae of A. tubaeforme. Four weeks after infection, the kittens were allocated to two treatment groups and were treated with 0.1 mg emodepside/kg body weight (group 1) or 0.25 mg emodepside/kg body weight (group 2). In both studies, all kittens received a reference treatment with Drontal(?) (230 mg pyrantel embonate and 20 mg praziquantel per tablet) at the recommended dose of one tablet/4 kg body weight 5 days after treatment with Procox(?). Anthelmintic efficacy was calculated by reduction in worm numbers expelled with the faeces following treatment with Procox(?) as compared with faecal worm numbers after reference treatment with Drontal(?), by thus avoiding necropsy of the animals.In the T. cati study, emodepside was at 99.9 %, 100 % and 96.5 % effective at a dosage of 0.5 mg, 0.25 mg and 0.1 mg per kg body weight, respectively. Against A. tubaeforme emodepside was at 95.7 % and 100 % effective at a dosage of 0.1 mg and 0.25 mg per kg body weight. No adverse events were seen during either study.It can be concluded that Procox(?) is efficacious for the control of mature adult T. cati and A. tubaeforme infections in cats at a single-dose rate of 0.25 mg emodepside/kg body weight.     

Internet gambling is common in college students and associated with poor mental health

This study evaluated prevalence of Internet gambling and its association with pathological gambling and mental health status in college students. The South Oaks Gambling Screen and General Health Questionnaire were administered to 1356 undergraduates, and 23% reported ever gambling on the Internet, with 6.3% reporting Internet gambling weekly. Almost two-thirds (61.6%) of regular Internet gamblers were pathological gamblers, compared with 23.9% of infrequent Internet gamblers and 5.0% of non-Internet gamblers. Internet gambling frequency was significantly associated with poor mental health, after controlling for demographics and pathological gambling. These data call for prevention and treatment efforts of Internet gambling in students.     

Psychometric properties of the inventory of gambling situations with a focus on gender and age differences

Environmental, interpersonal, and psychological factors contribute to gambling, but no standardized instrument for assessing high-risk gambling situations exists. This study evaluates the factor structure of the Inventory of Gambling Situations (IGS), a newly developed measure to examine situations that precipitate gambling. Pathological gamblers (n = 233) beginning a treatment study completed the IGS. Principal component analysis revealed that a 5-factor solution best fit the data, representing items related to Negative Affect, Luck and Control, Positive Affect, Social Situations, and Gambling Cues. Overall, Cronbach alpha was 0.960, ranging from 0.820 to 0.935 for the 5 factors. IGS scores correlated with other indices of gambling problems. Women scored higher on the Gambling Cues factor than men, and younger respondents, regardless of gender, scored higher on the Luck and Control factor than older respondents. The IGS may assist in better understanding situations in which pathological gamblers wager, and individual differences with respect to these situations.