Resident training to optimize patient-focused menopause management: a multispecialty menopause curriculum to enhance knowledge and preparedness.

OBJECTIVE: Surveys of residents in obstetrics and gynecology, internal medicine, and family medicine have demonstrated low levels of knowledge and comfort in treating patients with menopausal symptoms, suggesting a need for improved training during residency. To address this problem, we used a flipped classroom design to deliver a novel menopause curriculum for medical residents. The curriculum included six podcast episodes followed by an interactive case-based classroom session. We then assessed effects of the curriculum on the residents' knowledge and preparedness to manage menopause symptoms. METHODS: We targeted 200 residents (43 obstetrics and gynecology, 86 internal medicine, and 71 family medicine) from six residency programs from 2019 to 2020. Of these, 115 (58%) completed both pre- and postcurriculum assessments, including a 15-item knowledge test and self-ratings of their knowledge, comfort, and preparedness to manage menopause. RESULTS: Following the curriculum, the proportion of correctly answered knowledge questions rose from 60.8% to 79.1% (+18.3%; 95% confidence interval, 15.4-21.2; Cohen's d = 1.2). Improvement did not significantly differ by specialty or year of residency. There were higher gains for residents who listened to the entirety of all six podcast episodes ( b = 11.4, P < 0.001) and who attended the classroom session ( b = 11.6, P = 0.003). Residents' self-ratings of knowledge, comfort, and preparedness also improved following the curriculum across all medical specialties (Cohen's d = 0.47-1.2). Residents rated the podcast format as convenient (73%) and effective (65%) compared with an equivalent amount of reading. CONCLUSIONS: Pairing a podcast with a classroom discussion was found to be an effective combination for improving menopause knowledge.

The association of bowel function, participation in life activities, and quality of life in rectal cancer survivors.

PURPOSE: To evaluate whether limited participation in life activities is associated with quality of life (QOL) in rectal cancer survivors, and if so, whether this association is independent of bowel function difficulties. METHODS: We surveyed rectal cancer survivors from four healthcare systems about their QOL, bowel function, and participation in life activities. Additional demographic and clinical variables were extracted from the electronic health record. We examined independent associations between bowel function, participation in life activities, and QOL, controlling for potential confounders. We also identified factors, including ostomy status, that correlate with participation in life activities. RESULTS: Of the 527 respondents, 52% were male, 80% were non-Hispanic white, and the mean age was 63. In fully adjusted models for all rectal cancer survivors, participation in life activities was positively associated with QOL, while bowel function was not. Bowel function retained an independent association with QOL for those who previously had an ostomy and were therefore more likely to have a low rectal anastomosis. Lower participation in life activities was correlated with lower self-reported physical and cognitive function, younger age, financial difficulty, and being non-Hispanic white. CONCLUSIONS: Rectal cancer survivors' participation in life activities was strongly associated with QOL, even when controlling for numerous confounders, including bowel function. Identifying ways to improve participation in life activities may be critical to developing rehabilitative and other supportive interventions that optimize QOL among rectal cancer survivors.

Positive predictive value and sensitivity of ICD-9-CM codes for identifying pediatric leukemia.

BACKGROUND: To facilitate community-based epidemiologic studies of pediatric leukemia, we validated use of ICD-9-CM diagnosis codes to identify pediatric leukemia cases in electronic medical records of six U.S. integrated health plans from 1996-2015 and evaluated the additional contributions of procedure codes for diagnosis/treatment. PROCEDURES: Subjects (N = 408) were children and adolescents born in the health systems and enrolled for at least 120 days after the date of the first leukemia ICD-9-CM code or tumor registry diagnosis. The gold standard was the health system tumor registry and/or medical record review. We calculated positive predictive value (PPV) and sensitivity by number of ICD-9-CM codes received in the 120-day period following and including the first code. We evaluated whether adding chemotherapy and/or bone marrow biopsy/aspiration procedure codes improved PPV and/or sensitivity. RESULTS: Requiring receipt of one or more codes resulted in 99% sensitivity (95% confidence interval [CI]: 98-100%) but poor PPV (70%; 95% CI: 66-75%). Receipt of two or more codes improved PPV to 90% (95% CI: 86-93%) with 96% sensitivity (95% CI: 93-98%). Requiring at least four codes maximized PPV (95%; 95% CI: 92-98%) without sacrificing sensitivity (93%; 95% CI: 89-95%). Across health plans, PPV for four codes ranged from 84-100% and sensitivity ranged from 83-95%. Including at least one code for a bone marrow procedure or chemotherapy treatment had minimal impact on PPV or sensitivity. CONCLUSIONS: The use of diagnosis codes from the electronic health record has high PPV and sensitivity for identifying leukemia in children and adolescents if more than one code is required.

Referring Hospitalized Smokers to Outpatient Quit Services: A Randomized Trial.

INTRODUCTION: Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals. DESIGN: A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers. SETTING/PARTICIPANTS: Over 24 months (November 2011-November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon, area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81). INTERVENTION: Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system. MAIN OUTCOME MEASURES: The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015. RESULTS: A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site. CONCLUSIONS: Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.

Lattice-matched transition metal disulfide intergrowths: the metallic conductors Ag2Te(MS2)3 (M = V, Nb).

We present new chalcogenide compounds, Ag2Te(MS2)3 (M = V, Nb), built up of alternating planes of [MS2] and [Ag2Te]. The Ag and Te atoms are linearly coordinated by S atoms in the [MS2] layers and held in place by covalent interactions. Structural polymorphism was found by single crystal X-ray diffraction studies, where long-range ordering or disorder of the Ag and Te atoms within the hexagonal planar [Ag2Te] layer yielded two distinct crystal forms. When the Ag and Te atoms are ordered, the two isostructural compounds crystallize in the non-centrosymmetric P62m space group, with a = 5.5347(8) Å, c = 8.0248(16) Å, and V = 212.89(6) Å(3) for α-Ag2Te(VS2)3 and a = 5.7195(8) Å, c = 8.2230(16) Å, and V = 232.96(6) Å(3) for α-Ag2Te(NbS2)3. For the occupationally disordered Ag/Te arrangement, a subcell of the ordered phase that crystallizes in the non-centrosymmetric P6m2 space group, with a = 3.2956(6) Å (=a(a)/(3)(1/2)), c = 8.220(2) Å, and V = 77.31(3) Å(3) for ß-Ag2Te(VS2)3, was identified. Furthermore, pair distribution function analysis revealed local distortions in the [Ag2Te] layer. Band structure calculations at the density functional theory level were carried out to investigate the electronic structure of Ag2Te(MS2)3. Electronic transport measurements on Ag2Te(MS2)3 show that they exhibit p-type metallic behavior. Thermal analyses and temperature-dependent powder X-ray diffraction studies were focused on the stability and transformation/decomposition of the Ag2Te(MS2)3 phases. Magnetic susceptibility data are also reported. The new intercalated Ag2Te(MS2)3 system features a unique hypervalent Te with a three-center, four-electron bonding environment isoelectronic to that found in I3(-).

Structures and phase transitions of CePd3+xGa8-x: new variants of the BaHg11 structure type.

New distorted variants of the cubic BaHg11 structure type have been synthesized in Ga flux. Multiple phases of CePd3+xGa8-x, which include an orthorhombic Pmmn structure (x = 3.21(2)), a rhombohedral R3m structure (x = 3.13(4)), and a cubic Fm3m superstructure (x = 2.69(6)), form preferentially depending on reaction cooling rate and isolation temperature. Differential thermal analysis and in situ temperature-dependent powder X-ray diffraction patterns show a reversible phase transition at approximately 640 °C between the low temperature orthorhombic and rhombohedral structures and the high temperature cubic superstructure. Single crystal X-ray diffraction experiments indicate that the general structure of BaHg11, including the intersecting planes of a kagomé-type arrangement of Ce atoms, is only slightly distorted in the low temperature phases. A combination of Kondo, crystal electric field, and magnetic frustration effects may be present, resulting in low temperature anomalies in magnetic susceptibility, electrical resistivity, and heat capacity measurements. In addition to CePd3+xGa8-x, the rare earth analogues REPd3+xGa8-x, RE = La, Nd, Sm, Tm, and Yb, were successfully synthesized and also crystallize in one of the lower symmetry space groups.

Development and loss of ferromagnetism controlled by the interplay of Ge concentration and Mn vacancies in structurally modulated Y4Mn(1-x)Ga(12-y)Ge(y).

The cubic intermetallic phase Y(4)Mn(1-x)Ga(12-y)Ge(y) (x = 0-0.26, y = 0-4.0) has been isolated from a molten gallium flux reaction. It presents a rare example of a system where ferromagnetism can be induced by controlling the vacancies of the magnetic centers. The Y(4)PdGa(12) type crystal structure is made up of a corner-sharing octahedral network of Ga and Ge atoms with Mn atoms at the centers of half the octahedra and Y atoms in the voids. At the highest Ge concentration, y = 4.0, the Mn site is nearly fully occupied, x = 0.05, and the samples are paramagnetic. At a lower Ge concentration, y = 1.0, Mn deficiency develops with x = 0.10. Surprisingly, strong ferromagnetism is observed with T(c) = 223 K. When Ge is excluded, y = 0, Mn is substantially deficient at x = 0.26 and ferromagnetism is maintained with a T(c) of approximately 160 K. In addition, a 6-fold modulated superstructure appears owing to an ordered slab-like segregation of Mn atoms and vacancies. Corresponding bond distortions propagate throughout the octahedral Ga network. Structure-property relationships are examined with X-ray and neutron diffraction, magnetic susceptibility, and electrical resistivity measurements.

Distortion and charge density wave in the Ga square net coupled to the site occupancy wave in YCo0.88Ga3Ge.

YCo 0.88Ga 3Ge has an incommensurately modulated structure that was solved with (3 + 1)D superspace techniques. YCo 0.88Ga 3Ge crystallizes in the orthorhombic superspace group Immm(alpha00)00 s with unit cell constants of a = 4.1639(4), b = 4.1639(4), c = 23.541(2) A and a modulation vector of q = 0.3200(4) a* at 293 K. The incommensurate modulation, which creates a very large supercell ( approximately 25 fold), arises from a charge density wave (CDW) in the square net of Ga atoms that is coupled with a site occupancy wave (SOW) of Co atoms. The distorted Ga net features polygallide ribbons, chains, as well as single atoms. Temperature dependent crystallographic studies of the structure from 100-500 K indicate that the CDW is "locked in". Electrical conductivity and thermopower measurements in the temperature range of 300-500 K show that YCo 0.88Ga 3Ge is a poor metal.