Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension.

PURPOSE OF REVIEW: Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. RECENT FINDINGS: DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

"Zoom"ing to the Kitchen: A Novel Approach to Virtual Nutrition Education for Medical Trainees.

While nutritional interventions are first-line therapy for many chronic diseases, most medical trainees receive minimal nutrition education, leaving them unprepared to address nutritional issues with patients. An interactive, single-session, virtual nutrition curriculum was taught online to 80 physician assistant (PA) students. Topics included plant-based nutrition, dietary history-taking and counseling, and culinary medicine. Students were surveyed before, immediately after, and four weeks after the curriculum to assess changes to nutrition-related knowledge, attitudes, confidence, and personal dietary behaviors. Seventy-three PA students (91%) completed the pre-survey, 76 (95%) completed the post-survey, and 42 (52.5%) completed the delayed post-survey. Knowledge scores increased immediately post-intervention (48.9% to 78.9%; p < 0.001) and persisted four weeks later (78.9% to 75.8%; p = 0.54). Post-intervention, students felt more confident in dietary history-taking (55% vs. 95%; p = 0.001) and nutrition counseling (53% vs. 84%; p = 0.003) and agreed that dietary changes alone could reverse type 2 diabetes (74% vs. 97%; p = 0.027) and coronary artery disease (66% vs. 92%; p = 0.039). Curricula using virtual teaching kitchens may be a scalable approach to nutrition education for medical trainees.

Are We What We Eat? The Moral Imperative of the Medical Profession to Promote Plant-Based Nutrition.

The typical Western diet, high in processed and animal-based foods, is nutritionally and ethically problematic. Beyond the well-documented cruelty to animals that characterizes the practices of the factory-farming industry, current patterns of meat consumption contribute to medical and moral harm in humans on both an individual level and a public health scale. We aim to deconstruct, by highlighting their fallacies, the common positive and normative arguments that are used to defend current nutritional patterns. Animal-based foods promote the mechanisms that underlie chronic cardiometabolic disease, whereas whole-food plant-based nutrition can reverse them. Factory farming of animals also contributes to climate change, antibiotic resistance, and the spread of infectious diseases. Finally, the current allocation of nutritional resources in the United States is unjust. A societal shift toward more whole-food plant-based patterns of eating stands to provide significant health benefits and ethical advantages, and the medical profession has a duty to advocate accordingly. Although it remains important for individuals to make better food choices to promote their own health, personal responsibility is predicated on sound advice and on resource equity, including the availability of healthy options. Nutrition equity is a moral imperative and should be a top priority in the promotion of public health.

Profiles of GPs with high and low self-reported physician empathy-personal, professional, and antibiotic prescribing characteristics.

BACKGROUND: General Practitioners' (GPs) professional empathy has been hypothesized to have substantial impact on their healthcare delivery and medication prescribing patterns. This study compares profiles of personal, professional, and antibiotic prescribing characteristics of GPs with high and low empathy. METHODS: We apply an extreme group approach to a unique combined set of survey and drug register data. The survey included questions about demographic, professional, and antibiotic prescribing characteristics, as well as the Jefferson Scale of Empathy for Health Professionals (JSE-HP) to assess self-reported physician empathy. It was sent to a stratified sample of 1,196 GPs comprising 30% of the Danish GP population of whom 464 (38.8%) GPs responded. GPs in the top and bottom decile of empathy levels were identified. All intra- and inter-profile descriptive statistics and differences were bootstrapped to estimate the variability and related confidence intervals.  RESULTS: 61% of GPs in the top decile of the empathy score were female. GPs in this decile reported the following person-centered factors as more important for their job satisfaction than the bottom decile: The Patient-physician relationship, interaction with colleagues, and intellectual stimulation. High-empathy scoring GPs prescribed significantly less penicillin than the low-empathy GPs. This was true for most penicillin subcategories. There were no significant differences in age, practice setting (urban vs. rural), practice type (partnership vs. single-handed), overall job satisfaction, or GP's value of prestige and economic profit for their job satisfaction. The intra profile variation index and confidence intervals show less prescribing uncertainty among GPs with high empathy. CONCLUSIONS: This study reveals that high empathy GPs may have different personal, professional, and antibiotic prescribing characteristics than low empathy GPs and have less variable empathy levels as a group. Furthermore, person-centered high empathy GPs on average seem to prescribe less penicillins than low empathy GPs.

Empathy Variation in General Practice: A Survey among General Practitioners in Denmark.

Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45-54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds of having a high empathy score. Conclusions: Albeit generally high, we observed substantial variation in physician empathy levels among this population of Danish GPs. This variation is positively associated with values of interpersonal relationships and interaction with colleagues, and negatively associated with middle age (45-54 years) and lack of outside employment. There is room to increase GP physician empathy via educational and organizational interventions, and consequently, to improve healthcare quality and outcomes.

Conducting Elite Performance Training.

Training to excellence in the conduct of surgical procedures has many similarities to the acquisition and mastery of technical skills in elite-level music and sports. By using coaching techniques and strategies gleaned from analysis of professional music ensembles and athletic training, surgical educators can set conditions that increase the success rate of training to elite performance. This article describes techniques and strategies used in both music and athletic coaching, and it discusses how they can be applied and integrated into surgical simulation and education.

Visual illusions based on single-field contrast asynchronies.

A single-field contrast asynchrony refers to a stimulus configuration in which there is a single temporally modulated field and multiple sources of contrast information; the sources of contrast information modulate at different temporal phases or at different temporal frequencies. In this paper we show how single-field contrast asynchronies can lead to a wide variety of visual illusions. We investigate, in depth, the window shade/rocking disk configuration, in which a temporally modulated disk is surrounded by a split annulus (i.e., the top half is dark, and the bottom half is light). When the annulus is thick, the disk appears spatially inhomogeneous (shading); when the annulus is thin, the disk appears to rock back and forth (shifting). We measure the proportion of trials that a disk appears to shade or, on separate trials, appears to shift as a function of modulation amplitude, surround thickness, temporal frequency, and disk size. We account for the shading effects by postulating a combination of separate first- and second-order responses and/or a multi-scale spatial filtering process. We account for the shifting effects by examining four elemental motion conditions. For luminance modulation, the direction of the shift follows the same pattern as that produced by the rectified output of an array of spatial center-surround filters applied to the X, t plot. For equiluminant modulation, the direction of the shifts is consistent with a sequence-tracking (or third-order) motion response.

Induced contrast asynchronies may be useful for luminance photometry.

Shapiro et al. (2004) introduced a new visual effect (the induced contrast asynchrony) that demonstrates a perceptual separation between the response to a modulated light and the response to contrast of the light relative to background. The effect is composed of two physically identical disks, one surrounded by a dark annulus and the other by a light annulus. The luminance levels of both central disks were modulated in time, producing a stimulus with in-phase luminance modulation and antiphase contrast modulation. Observers primarily perceived the disks to be modulating asynchronously (i.e. they perceived the contrast), but at low temporal frequencies could also track the luminance level. Here we document that the induced contrast asynchrony disappears when the surrounds are achromatic and the center lights are modulated near the equiluminant axis. Observers viewed 1-deg-diameter disks embedded 2-deg-diameter achromatic surrounds. The chromaticity of the disks was modulated in time (1 Hz) along lines in an S versus Luminance cardinal color plane and an L-M versus Luminance cardinal color plane; observers responded as to whether the modulation appeared in phase. For all observers and both color planes, the lights appeared in phase most frequently at angles near the standard observer's equiluminant line and out of phase at angles further away from that line. Observers differed in the range of angles that produce the appearance of in-phase modulation. The results suggest that induced contrast asynchronies may be useful as a technique for equating luminance of disparate lights.

Induced contrast asynchronies.

We document a new type of perceptual effect in which asynchronous contrast signals are presented simultaneously with synchronous luminance signals. The template for the basic effect consists of two physically identical disks (.75-deg diameter, 40 cd/m2), one surrounded by a dark annulus (1.5 deg, 20 cd/m2) and the other by a light annulus (1.5 deg, 60 cd/m2). The center disks are modulated in time, with a maximum luminance of 55 cd/m2 and a minimum luminance of 25 cd/m2. With this stimulus configuration, the luminance signals of the disks modulate in phase with each other while the contrast signals relative to the surrounds modulate in anti-phase. Observers can track the contrast and luminance signals when the luminance is modulated at 1 Hz but perceive primarily the contrast signal at 2-6 Hz. We show that the asynchrony can be perceived with a thin annular surround, that the appearance of the asynchrony is dependent on the modulation amplitude, and that a decrease in the relative strength of the asynchrony at 1 Hz corresponds to the band-pass shape of the temporal contrast sensitivity function in the presence of light and dark edges. We also introduce variations of the induced contrast asynchrony principle in which a single modulated disk is surrounded by a half-light and half-dark split annulus; we refer to these configurations as the window-shade and rocking-disk illusions.