Perspectives on inadequate preparation and training priorities for physicians working with sexual minority youth.

OBJECTIVES: To understand pediatric and family medicine residents' and practitioners' perceived ability to work with lesbian, gay, bisexual, and queer (LGBQ) youth, assessment of their prior educational experiences, and recommendations for medical training to better prepare physicians to provide quality care to this population. METHODS: We conducted semi-structured individual interviews with 24 pediatric/family medicine residents (n=20) and practicing physicians (n=4) in the U.S. Recorded interviews were professionally transcribed. Data were analyzed using Grounded Theory and qualitative content analysis approaches. RESULTS: Most physicians did not feel adequately prepared to provide quality care to LGBQ youth, and many who felt knowledgeable obtained their knowledge from on-the-job experiences of caring for LGBQ patients. Findings regarding physicians' recommendations for implementing a formal training program revealed three themes: (I) medical school training (implemented earlier in medical school within a structured program as part of the normal curriculum), (II) training content (LGBQ-specific health needs, self-awareness of implicit biases, interviewing techniques, and resources), and (III) training strategies (panels of LGBQ patients, role-playing/standardized patients, and online modules). CONCLUSIONS: Understanding physicians' assessment of abilities and recommendations for training improvements based on their experiences is important for advancing the quality of healthcare for LGBQ youth. Guidance came mostly from residents who recently completed medical school. Thus, their perspectives are especially useful to improve medical education and, ultimately, the care provided to LGBQ youth. Findings suggest a multi-pronged approach that offers several training modalities encompassing individual, intrapersonal, and institutional/systemic/community levels can improve medical school curricula on caring for LGBQ youth.

The Impact of Frailty on Post-Acute Rehabilitation Outcomes in Older Adults.

UNLABELLED: Objective, Design, Measurements: We assessed the correlations of the Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI on admission: non-frail, pre-frail, frail) with the outcomes of a Short-term Post-Acute Rehabilitative Care programme (N=172 admissions over one-year period, 95 of which were frail). RESULTS: SHARE-FI correlated with age (non-frail: mean 79.2 years; frail: 83.6; P<0.001). Adjusting for age, SHARE-FI correlated with longer length of stay (non-frail: median 30 days; frail: 42; P=0.047), higher rate of emergency transfer to acute hospital (non-frail: 2.4%; frail: 21.1%; P=0.004), and lower home discharge rate (non-frail: 97.6%; frail: 81.9%; P=0.009). While frailty correlated with more disability on admission and discharge, there was no statistically significant difference in Barthel Index (BI) improvement across frailty categories (all groups had median BI improvement of ≥2 points, P=0.247). CONCLUSION: The post-acute rehabilitation of the frail is worthwhile but requires more time and access to acute hospital facilities.

Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial.

Infants at risk for neuromotor delay (NMD) are associated with premature birth and low birth weight. These infants frequently exhibit tone, posture, and movement abnormalities. Therefore, it is important to identify potential interventions to facilitate early motor development within this population. The purpose of this study was to examine the potential benefits of treadmill (TM) training in infants at risk for NMD. Furthermore, relationships between TM stepping performance and onset of walking have been suggested, and therefore, were also explored. Twenty-eight infants at moderate risk for NMD were randomly assigned to one of two groups: (1) TM training (experimental) (N=15) or (2) control (N=13). Infants in the experimental group were trained for 8 min/day, five days/week from study entry until walking onset. Monthly, 5 min of TM stepping performance were videotaped and analysed for infants in both groups to obtain frequency and quality of TM stepping. Groups were different in terms of TM stepping performance with experimental group displaying better stepping. However, they did not differ in age of walking onset (experimental=15.1 months, control=14.6 months). In both groups, frequency of TM stepping was significantly related to onset of walking. Findings suggest that TM training as implemented impact the quality of TM stepping, but did not significantly improve walking onset. Given the significant relationship between stepping and walking onset, the moderate affection of the population, the relative low intensity and lack of individualisation of the training, we suggest future research should further explore the impact of TM training on gait-related variables and include individualised, more intense, and prolonged training.

Hereditary metabolic diseases (HMDs) in adult practice in Ireland: a preliminary assessment.

BACKGROUND: Hereditary metabolic diseases (HMDs) are almost all rare diseases, many of which, if ascertained are treatable and preventable causes of intellectual and general disability. The improved detection and treatment of HMDs in paediatric practice has resulted in increased survival into adult life. The identification of adult patients with HMDs who may benefit from new emerging treatments is challenging. As for many rare diseases, there are difficulties tracing patients for many of these conditions in current Irish coding systems and lack of established patient Registries. METHODS: In this study, we describe the efforts made to trace Irish adult patients with potentially treatable HMDs using (1) a mailed questionnaire sent to all currently registered adult Medical Specialists practising in Ireland requesting details of all cases seen over the 4-year period 2007-2010, (2) the analysis of HIPE in-patient data during this time and (3) analysis of the database held at NCIMD. CONCLUSIONS: The current systems in place for identification and coding of potentially treatable HMDs are very deficient. This emphasizes the need to prioritize the development of a National HMD Registry.

Maternal uniparental isodisomy for chromosome 14 detected prenatally.

Maternal uniparental disomy (UPD) for chromosome 14 (upd(14)mat) has been associated with a distinct phenotype. We describe the first case of maternal uniparental isodisomy for chromosome 14 detected prenatally, in a pregnancy with mosaicism for trisomy 14 observed in both a chorionic villus sample (CVS) and in amniocytes. Detailed analysis of polymorphic microsatellites showed that the fetus was essentially isodisomic for one of the mother's chromosomes 14 and that recombination had introduced a mid-long arm region of heterodisomy. The fetus, which died in utero at 18 weeks, showed no apparent pathological features. The case demonstrates for the first time a maternal meiosis II non-disjunction of chromosome 14 leading to a trisomic conception which has been incompletely corrected by 'rescue' in the early embryo.

Splenic crisis at high altitude in 2 white men with sickle cell trait.

This article describes 2 white male patients with probable splenic crisis caused by sickle cell trait after travel from sea level to a moderately high altitude. Both did well with return to lower altitude and conservative treatment. Although rare, this entity should be considered in patients presenting to the emergency department with left-sided chest or abdominal pain after travel to moderate or high altitude.

Utilization-focused evaluation of acute care nurse practitioner role.

Using nurse practitioners in acute care is a relatively new phenomenon with little existing data on related expectations and effectiveness. This article describes one organization's program evaluation of the Advanced Practice Registered Nurse (APRN) role. It includes a conceptual model as well as pragmatic data on: perception of the performance of agreed-upon role expectations, influence on targeted aspects of care, retention of a focus on nursing, and factors facilitating or hindering APRN effectiveness.

Blood volume displacement with inflation of antishock trousers.

Eleven healthy male volunteers were studied to determine the amount of blood displaced by the inflation of the antishock trousers (AST) at pressures of 40 and 100 mm Hg. Radioisotope scans were used to determine the blood volume distribution and the change in the volume of distribution with inflation of the AST. The volunteers were then phlebotomized approximately one liter of blood and the study was repeated. Less than 5% of the total blood volume was displaced with inflation of the AST. It is unlikely that the clinical improvement seen with inflation of the AST in hypovolemic shock is due to autotransfusion of blood alone.