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1.
Acad Pediatr ; 2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38609014

RESUMO

PROBLEM: Workplace mistreatment is a contributor to resident burnout; understanding and intervening against mistreatment is one key tool in mitigating burnout. While Accreditation Council for Graduate Medical Education (ACGME) survey data alerts programs to general mistreatment trends, those data are not detailed enough to inform local interventions. Our team designed and implemented a Challenging Interactions Reporting Tool (CIRT) to characterize the experiences of our trainees at a granular level and to inform targeted interventions for improvement. APPROACH: Our CIRT was offered to 158 residents in August 2020 via REDCap. Residents submit electronic reports that are reviewed weekly by program leaders who develop action plans for each report. Reporters can identify themselves or can choose to remain anonymous. When "hot spots" for mistreatment are identified in our hospital, we implement a targeted systems-level intervention. OUTCOMES: Residents filed 275 reports between August 2020 and December 2022. Reports represented all training environments and involved all interprofessional members of clinical teams. Residents reported awareness of, use of, and satisfaction with the tool. NEXT STEPS: Our program created the CIRT as a tool to inform local interventions for improving the safety of our clinical learning environment. We continue to disseminate our tool across our hospital's GME programs and are now measuring the impact of our interventions.

2.
J Adolesc Health ; 72(6): 964-971, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36907801

RESUMO

PURPOSE: Although pediatricians are primary care providers for most adolescents, pediatric residents receive limited training on long-acting reversible contraceptive (LARC) methods. This study aimed to characterize pediatric resident comfort with placing contraceptive implants and intrauterine devices (IUDs) and assess pediatric resident interest in obtaining this training. METHODS: Pediatric residents in the United States were invited to participate in a survey assessing comfort with LARC methods and interest in LARC training during pediatric residency. Bivariate comparisons used Chi-square and Wilcoxon rank sum testing. Multivariate logistic regression was used to assess associations between primary outcomes and covariates including geographic region, training level, and career plans. RESULTS: Six hundred twenty seven pediatric residents across the United States completed the survey. Participants were predominantly female (68.4%, n = 429), self-identified their race as White (66.1%, n = 412), and anticipated a career in a subspecialty other than Adolescent Medicine (53.0%, n = 326). Most residents were confident counseling patients on the risks and benefits, side effects, and effective use of contraceptive implants (55.6%, n = 344) and both hormonal and nonhormonal IUDs (53.0%, n = 324). Few residents reported comfort with inserting contraceptive implants (13.6%, n = 84) or IUDs (6.3%, n = 39), with most of these respondents having learned these skills as a medical student. Most participants believed that residents should receive training on insertion of contraceptive implants (72.3%, n = 447) and IUDs (62.5%, n = 374). DISCUSSION: Although most pediatric residents believe LARC training should be a component of pediatric residency training, few pediatric residents are comfortable with provision of this care.


Assuntos
Dispositivos Intrauterinos , Contracepção Reversível de Longo Prazo , Adolescente , Humanos , Feminino , Estados Unidos , Criança , Masculino , Estudos Transversais , Educação de Pós-Graduação em Medicina , Anticoncepção , Anticoncepcionais
3.
Eat Weight Disord ; 27(2): 831-837, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34021903

RESUMO

PURPOSE: This study sought to examine associations between meat-restricted diets and disordered eating cognitions and behaviors in a large sample of university students and assess the relationships between motivations for choosing a vegetarian or semi-vegetarian diet and eating patterns. METHODS: University students (n = 1585; 60%F, 40%M, mean age 20.9) completed an online survey; students were categorized into vegetarians, semi-vegetarians, and non-vegetarians. Vegetarians and semi-vegetarians were sub-categorized into groups: those who cited weight or health among their reasons for adopting the diet and those who reported other reasons (e.g., religion). Outcomes were Eating Disorder Examination Questionnaire (EDE-Q) scores and rates of disordered eating behaviors. RESULTS: Vegetarians comprised 8.6% (32M, 104F) and semi-vegetarians comprised 3.2% (6M, 45F) of the sample; 25% of vegetarians (n = 34) and 65% of semi-vegetarians (n = 33) chose the diet for weight or health-related reasons. Semi-vegetarians scored the highest on measures of eating disorder cognitions and were the most likely to report engaging in disordered eating behaviors, with vegetarians at intermediate risk and non-vegetarians the least likely to report disordered cognitions or behaviors. Semi-vegetarians adopting the diet for reasons of weight or health were at especially high risk compared to other semi-vegetarians, while no associations were found between motivations for adopting a vegetarian diet and disordered eating patterns. CONCLUSION: Semi-vegetarians, especially those adopting the diet for reasons of weight or health, are more likely to exhibit disordered eating cognitions and behaviors compared to vegetarians and non-vegetarians. LEVEL OF EVIDENCE: Level III, cohort study.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Vegetarianos , Adulto , Estudos de Coortes , Dieta Vegetariana , Humanos , Carne , Estudantes , Universidades , Adulto Jovem
4.
J Pediatr Adolesc Gynecol ; 33(2): 133-138, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31715368

RESUMO

STUDY OBJECTIVE: Adolescents with eating disorders and a history of overweight present with higher weights, longer duration of disease, but equally severe symptomatology compared with previously normal weight patients. To better delineate treatment goals for this understudied population, we compared weight at menses resumption with premorbid maximum weight among previously overweight and normal weight patients. DESIGN: Retrospective cohort study. SETTING: Outpatient adolescent medicine clinic at an eating disorder referral center. PARTICIPANTS: Postmenarchal patients meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorders. History of overweight was defined as a body mass index (BMI) greater than or equal to the 85th percentile or 25 or more. INTERVENTIONS AND MAIN OUTCOME MEASURES: Weight characteristics at presentation and menses resumption (BMI, BMI z-score, change from maximum weight to presentation weight) RESULTS: Previously overweight patients presented with greater mean weight, longer duration of disease, and higher BMI than previously normal weight patients. No difference was found in rates of amenorrhea at presentation or menses resumption. Previously overweight patients resumed menses at a younger age and higher BMI z-scores. The difference between weight at menses resumption and premorbid maximum weight was greater for previously overweight patients. CONCLUSION: Previously overweight patients with eating disorders present differently than their normal-weight peers, so reliance on weight status as a screening criterion might result in underdiagnosis. Although BMI z-scores associated with menses resumption are higher for previously overweight patients, there is no difference in weight gain between presentation and menses resumption and time to menses resumption compared with previously normal-weight patients. Moreover, menses resumption occurred at weights significantly lower than premorbid maximum weight for previously overweight patients, so restoration to highest premorbid weight is not necessary.


Assuntos
Amenorreia/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Menstruação/fisiologia , Sobrepeso/complicações , Adolescente , Amenorreia/terapia , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Aumento de Peso/fisiologia
5.
Curr Opin Obstet Gynecol ; 28(5): 381-92, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27551880

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to discuss the diagnosis, medical complications, and treatment of eating disorders as defined by the newly released Diagnostic and Statistical Manual, 5th edition. RECENT FINDINGS: With the introduction of the Diagnostic and Statistical Manual, 5th edition, the diagnostic criteria for anorexia nervosa and bulimia nervosa have been revised to better capture the varied presentations of patients with eating disorders. In addition, new eating disorder diagnoses including binge-eating disorder, characterized by recurrent bingeing without associated compensatory behaviors, and avoidant/restrictive food intake disorder, characterized by a restrictive eating pattern without associated body dysmorphism, allow for increased recognition, diagnosis, and treatment of disordered eating patterns. In addition to a high mortality rate, eating disorders are associated with serious medical sequelae secondary to malnutrition and disordered behaviors, including disturbances of the cardiovascular, neurologic, gastrointestinal, reproductive, and skeletal systems. Early diagnosis and family-based treatment are associated with improved outcomes in children and adolescents. SUMMARY: Eating disorders are illnesses with biological, psychological, and social implications that commonly present in childhood and adolescence. Gynecologists are on the front line for the screening and diagnosis of eating disorders in adolescent women.


Assuntos
Anorexia Nervosa/diagnóstico , Transtorno da Compulsão Alimentar/diagnóstico , Bulimia Nervosa/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Amenorreia/complicações , Anorexia Nervosa/terapia , Transtorno da Compulsão Alimentar/terapia , Bulimia Nervosa/terapia , Criança , Anticoncepção , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Ginecologia , Humanos
6.
Eat Weight Disord ; 21(3): 403-410, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26597679

RESUMO

PURPOSE: Nutritional insufficiency (NI) is a potential consequence of restrictive eating disorders. NI patients often require hospitalization for refeeding to restore medical stability and prevent complications such as refeeding syndrome. Limited information is available on the optimal approach to refeeding. In this study, we describe an inpatient NI care path and compare treatment outcomes at an academic medical center and a community hospital. METHODS: A retrospective chart review was conducted on inpatients treated using a standardized NI care path at either the academic site, from August 2012 to July 2013 (n = 51), or the community site, from August 2013 to July 2014 (n = 39). Demographic information, eating disorder history, and treatment variables were recorded for each patient. Data were compared using the Kruskal-Wallis test and Fisher's exact test. RESULTS: Patients admitted to the community site had shorter hospital stays than patients admitted to the academic site (IQR 2-4 vs. 2-7 days, p = 0.03). All patients were discharged in <14 days with a median stay of 3 days. The median initial calorie prescription was 2200 calories for both groups. No clinical cases of refeeding syndrome occurred, with only one patient developing hypophosphatemia during refeeding. CONCLUSIONS: A standardized care path with a higher-calorie intervention allows for short-term hospitalization of NI patients without increasing the risk of refeeding syndrome, regardless of treatment site. This study demonstrates the efficiency and safety of treating NI patients on a regular medical floor at a community hospital.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Hospitalização , Desnutrição/terapia , Adolescente , Criança , Humanos , Tempo de Internação , Desnutrição/etiologia , Estado Nutricional , Estudos Retrospectivos , Aumento de Peso , Adulto Jovem
7.
J Adolesc Health ; 57(6): 673-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26422290

RESUMO

PURPOSE: Avoidant/restrictive food intake disorder (ARFID), a recently defined Diagnostic and Statistical Manual of Mental Disorders-5 eating disorder diagnosis, has not been extensively studied in the inpatient population. This study compares hospitalized ARFID and anorexia nervosa (AN) patients, including differences in presentation, treatment response, and 1-year outcomes. METHODS: We conducted a retrospective chart review of ARFID and AN patients hospitalized between 2008 and 2014 for acute medical stabilization at an academic medical center. Data, including characteristics on admission, during hospitalization, and 1 year after discharge, were recorded for each patient and compared between ARFID and AN patients. RESULTS: On presentation, ARFID patients (n = 41) were younger with fewer traditional eating disorder behaviors and less weight loss, comorbidity, and bradycardia than AN patients (n = 203). During hospitalization, although ARFID and AN patients had similar caloric intake, ARFID patients relied on more enteral nutrition and required longer hospitalizations than AN patients (8 vs. 5 days; p = .0006). One year after discharge, around half of ARFID and AN patients met criteria for remission (62% vs. 46%; p = .18), and less than one-quarter required readmission (21% vs. 24%; p = .65). CONCLUSIONS: The findings from this study reveal several differences in hospitalized eating disorder patients and emphasize the need for further research on ARFID patients, including research on markers of illness severity and optimal approaches to refeeding. Similar remission and readmission rates among ARFID and AN patients highlight both the success and the continued need for improvement in eating disorder treatment regardless of diagnosis.


Assuntos
Comportamento Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos , Hospitalização , Centros Médicos Acadêmicos , Adolescente , Anorexia Nervosa/diagnóstico , Criança , Pré-Escolar , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Masculino , Auditoria Médica , Estudos Retrospectivos , Adulto Jovem
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