Impact of cuddler service-learning program in medical student education of opioid use disorder in pregnancy and neonatal opioid withdrawal syndrome.

Background: Given the increasing incidence of neonatal opioid withdrawal syndrome (NOWS), medical student training on substance use disorders (SUDs) and opioid use disorder (OUD) in pregnancy must be augmented. Through the Cuddling Assists in Lowering Maternal and Infant Stress (CALM) service-learning program, medical students attend SUD-related didactics and provide monthly cuddling services to infants with NOWS. Objective: This study examines the impact of CALM on medical students' attitudes toward individuals with SUDs and self-reported comfort with clinical skills related to caring for this population. Methods: Self-reported pre- and post-survey data was collected at the beginning and end of an academic year from the intervention group, CALM cuddlers, and the control group, non-cuddlers for 2 years. Mean total survey scores and individual survey questions using a 3-point Likert scale were compared before and after 1 year of participation for cuddlers and for non-cuddlers using paired t-tests and two sample t-tests. Results: The mean total score increased for cuddlers after participation in the intervention (MD 0.13, SD 0.26, p = 0.03). Mean scores for the comfort-related subset of questions also increased significantly for cuddlers after participation in the intervention (MD 0.22, SD 0.41, p = 0.01). Cuddlers felt more comfortable discussing substance use with appropriate language (72.0% vs 51.5%, p = 0.03), talking with patients about substance use (72.0% vs 36.0%, p = 0.01), and asking about substance use or recovery (80.0% vs 48.0%, p = 0.01). Conclusion: OUD- and NOWS-related service-learning positively impacts student attitudes and self-reported comfort with skills related to caring for individuals with SUDs, such as communicating about substance use.

Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation.

BACKGROUND AND AIMS: Only scant data describe the practice of canceling colonoscopies before colonoscope insertion for presumed inadequate bowel preparation (PIBP). We sought to better understand the ramifications of such cancellations and to characterize the nationwide practice of cancellations for PIBP. METHODS: We determined the frequency of colonoscopies canceled for PIBP at our institution, assessing practice variation and whether patients who were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. We also surveyed gastroenterology program directors to determine whether canceling colonoscopies for PIBP is commonly permitted and if such cancellations are included in calculations of bowel preparation adequacy rates. RESULTS: Three percent of patients were canceled because of PIBP at our institution, with significant provider practice variability in cancellation rates. Only 67% of patients whose cases were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. The ability of an endoscopist to cancel a colonoscopy for PIBP was reported by 97% of survey respondents. Such cases are frequently not included in calculations of bowel preparation adequacy rates. CONCLUSIONS: The ability to cancel colonoscopies because of PIBP is near ubiquitous, but such cases are not uniformly included in calculations of bowel preparation adequacy rates. Variation in provider practice, and resulting impact on patient care, suggests a need for standardized protocols. Colonoscopies canceled for PIBP should be included in calculations of bowel preparation adequacy rates.

Relationship of Medical Student Lecture Attendance with Course, Clerkship, and Licensing Exam Scores.

OBJECTIVE: We sought to determine whether viewing versus attending lecture impacted medical student course and licensing examination performance, grades on clinical rotations, perceptions of school-life balance, and comfort with clinical skills. METHODS: Optional anonymous questionnaires were emailed to all first-year medical students (class of 2020) at Boston University School of Medicine at the end of their first academic year and again to this same class after their first clinical rotation. A separate questionnaire was emailed to fourth-year medical students (class of 2019) midway through their final year. RESULTS: One hundred five (55.5%) and 69 (36.5%) students from the class of 2020 completed the first and second questionnaires respectively. Eighty-one (45%) students from the class of 2019 completed the third questionnaire. Students who attended 75% or more and viewed fewer than 50% of lectures were classified as attenders. Those who viewed 75% or more and attended fewer than 50% of lectures were classified as viewers. The others were grouped as mixed users. There were no significant differences between the groups in preclinical grades, United States Medical Licensing Examination scores, satisfaction with perception of school-life balance, and student-reported comfort with clinical skills. Viewers achieved a lower percentage of honors overall in core clerkships (p = 0.0001) with the greatest difference noted in the Internal Medicine clerkship. CONCLUSION: Despite similar preclinical test scores and perceived comfort with clinical skills, the percentage of students earning honors grades in clinical clerkships was lowest in first-year lecture viewers.

Neuronal CTGF/CCN2 negatively regulates myelination in a mouse model of tuberous sclerosis complex.

Disruption of myelination during development has been implicated in a range of neurodevelopmental disorders including tuberous sclerosis complex (TSC). TSC patients with autism display impairments in white matter integrity. Similarly, mice lacking neuronal Tsc1 have a hypomyelination phenotype. However, the mechanisms that underlie these phenotypes remain unknown. In this study, we demonstrate that neuronal TSC1/2 orchestrates a program of oligodendrocyte maturation through the regulated secretion of connective tissue growth factor (CTGF). We characterize oligodendrocyte maturation both in vitro and in vivo. We find that neuron-specific Tsc1 deletion results in an increase in CTGF secretion that non-cell autonomously stunts oligodendrocyte development and decreases the total number of oligodendrocytes. Genetic deletion of CTGF from neurons, in turn, mitigates the TSC-dependent hypomyelination phenotype. These results show that the mechanistic target of rapamycin (mTOR) pathway in neurons regulates CTGF production and secretion, revealing a paracrine mechanism by which neuronal signaling regulates oligodendrocyte maturation and myelination in TSC. This study highlights the role of mTOR-dependent signaling between neuronal and nonneuronal cells in the regulation of myelin and identifies an additional therapeutic avenue for this disease.