Todd Gress

Personal growth during internship: A qualitative analysis of interns' responses to key questions

BACKGROUND: During clinical training, house officers frequently encounter intense experiences that may affect their personal growth. The purpose of this study was to explore processes related to personal growth during internship.DESIGN: Prospective qualitative study conducted over the course of internship.PARTICIPANTS: Thirty-two postgraduate year (PGY)-1 residents from 9 U.S. internal medicine training programs.APPROACH: Every 8 weeks, interns responded by e-mail to an open-ended question related to personal growth. Content analysis methods were used to analyze the interns’ writings to identify triggers, facilitators, and barriers related to personal growth.RESULTS: Triggers for personal growth included caring for critically ill or dying patients, receiving feedback, witnessing unprofessional behavior, experiencing personal problems, and dealing with the increased responsibility of internship. Facilitators of personal growth included supportive relationships, reflection, and commitment to core values. Fatigue, lack of personal time, and overwhelming work were barriers to personal growth. The balance between facilitators and barriers may dictate the extent to which personal growth occurs.CONCLUSIONS: Efforts to support personal growth during residency training include fostering supportive relationships, encouraging reflection, and recognizing interns’ core values especially in association with powerful triggers.

Personal Growth and its Correlates During Residency Training

Objectives  To explore the characteristics of and factors associated with personal growth during residency training.

Pancreatic cancer survival in elderly patients treated with chemotherapy.

Objectives Pancreatic cancer is a lethal disease mostly affecting elderly people. Clinical trials on treatment contain disproportionately fewer elderly patients compared with everyday practice. This retrospective study evaluates differences in the rates of chemotherapy delivered and associated survival in different age groups. Methods Data were collected from the Cancer Information Resource Files on patients diagnosed with pancreatic cancer from 1993 to 2008. Patients were divided into 3 age groups, namely, A with younger than 50 years, B with 50 to 70 years old, and C with older than 70 years. Results Complete data were available on 16,694 patients. Forty-four percent were in group C. Chemotherapy was given to 38% of patients in group C versus 69% of patients in group A. A multivariate analysis revealed a similar chemotherapy benefit in all groups, as follows: group C (hazard ratio [HR], 0.51), group A (HR, 0.74), and group B (HR, 0.55). Conclusions We found that elderly patients with pancreatic cancer receive treatment less frequently compared with younger patients. However, elderly patients receiving chemotherapy derive similar benefits. Randomized clinical trials are needed to evaluate pancreatic cancer treatment in the elderly patients, particularly given the increasing occurrence of pancreatic cancer in later life.

Infection With Streptococcus Pneumoniae Moderately Resistant to Penicillin Does Not Alter Clinical Outcome

Increasingly, drug-resistant Streptococcus pneumoniae is an identified pathogen causing pneumonia, sepsis, and meningitis. Our study evaluated outcome variables of patients infected with strains of S. pneumoniae moderately resistant to penicillin. We retrospectively analyzed the data on 110 Huntington, West Virginia, community patients who had types 6, 9, 14, 19, and 23 pneumococcal infections between 1982 and 1994. These strains are most likely to demonstrate resistance. Comparing patients infected with sensitive vs. moderately resistant pneumococcal strains, we found no significant difference in days in the hospital (10.9 vs. 11.1, P =.96), days of fever (2.4 vs. 2.8, P =.74), or mortality (21% vs. 19%, P =.15). Antibiotic selection did not significantly affect case fatality rates in the two groups—treated with penicillin or ampicillin alone, 16% vs. 11%, Odds Ratio = 1.50 ± 1.73; P =.38; treated with an antibiotic other than penicillin, 24% vs. 28%, Odds Ratio = 0.77 ± 0.69; P =.27). No significant differences occurred between groups regarding type of infectious process (P =.94). We conclude that infection with pneumococcal strains of moderate resistance to penicillin does not affect clinical outcome.

Effects of a Brief Physical Activity Program on Young Students’ Physical Fitness

Background. Our objective was to test whether brief daily activity could increase young students’ physical fitness and compare different forms of intervention delivery. Methods. Two intervention groups were instructed to increase children’s activity by 6 minutes daily. The principal was responsible for the intervention in the first group while classroom teachers were responsible in the second. The third group was a control. Success was defined by changes in student fitness. Results. The principal-led group had a significant increase in the number of 75-foot laps completed after intervention (+0.61 laps) and a significant decrease in after-exercise heart rate (−37.4 beats per minute) as compared with the control group. The teacher-led group experienced no change in either outcome. Conclusions. Our findings demonstrate that a 6-minute increase in activity can produce a significant improvement in student fitness. Administrative support of school-based interventions can have a positive impact on program completion.

Metabolic disease and shift work: Is there an association? An analysis of NHANES data for 2007–2008

Previous epidemiological studies have shown that shift work is associated with higher levels of obesity and diabetes, possibly related to physiological maladaptation as a direct result of sleeping and eating at abnormal circadian times.1 In a previously performed cross-sectional study, shift work was associated with higher levels of triglycerides, lower levels of high-density lipoprotein cholesterol, and higher odds of metabolic syndrome in a multiple logistic regression analysis (OR 2.4; 95% CI 1.1 to 5.0).2 We performed an analysis of the cross-sectional NHANES data3 for 2007–2008 and compared the different metabolic parameters between regular daytime workers and shift workers. Shift workers included …

Three Decades of Follow-up of Adults After Recovery From Invasive Pneumococcal Pneumonia

Background: Streptococcus pneumoniae infection is the most common cause of community‐acquired pneumonia in adults. Invasive pneumococcal disease (IPD) carries a high case fatality rate. We investigated the lifespan of adults who recovered from IPD during a 32‐year follow‐up. Materials and Methods: We determined whether adults discharged after an episode of IPD from hospitals affiliated with the Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia from 1983‐2003 were alive on June 30, 2014. Lifespan was assessed by Kaplan‐Meier methodology, Cox proportional hazards multivariate analysis, life expectancy using life tables for West Virginia, years of potential life lost and serotype occurrence. Results: The study group comprised 155 adults who survived IPD. They had a mean age at discharge of 64.6 years, mean lifespan after IPD of 7.1 years, mean expected lifespan after IPD of 17.0 years, mean age at death of 71.6 years and a mean life expectancy of 81.6 years. Only 14 (9.0%) patients lived longer than their life expectancy. Of the 13 comorbid diseases analyzed, cancer and neurologic diseases and the number of comorbid diseases suffered by each patient were the significant variables associated with survival. The mean years of potential life lost was 9.936 years. Only serotype 12 of 31 serotypes recovered occurred more often in patients who survived for 11 or more years after discharge (relative risk = 3.44, 95% CI: 1.19‐9.95). Conclusions: The fact that most adult patients who recovered from IPD died before their documented life expectancy argues for the pernicious severity of IPD and the importance of immunization of adults with pneumococcal vaccines.

Role of adipokines and inflammatory markers in postmenopausal hypertension

BACKGROUND The role of inflammatory markers and adipokines contributing to the development of postmenopausal hypertension, has not been established. The aim of our study was to assess the complex association between blood pressure, obesity, menopausal status, adipokines and inflammatory mediators in postmenopausal women. METHODS We recruited 38 women seen at our Endocrinology Clinic and collected anthropometric measures and blood pressure and obtained serum samples for inflammatory markers and adipokine levels. Out of 38 women, 23 (60%) were postmenopausal. RESULTS In the pre-menopausal and postmenopausal women, there were no significant differences in measured adipokines and inflammatory markers based on hypertensive status. When obesity was eliminated, significantly higher levels of EGF, IL-8, MCP1 and TNF-α and lower levels of IL-1α and IL-3 were observed in the postmenopausal group (P<0.05). Women with higher waist-to-hip ratio (WHR) had a significant trend towards lower adiponectin levels as compared to those with lower WHR (P=0.014 and P=0.04, respectively). CONCLUSIONS There was a significant difference in pro-inflammatory markers in non-obese, pre- and post-menopausal women. These higher inflammatory markers might play a role in the development of post-menopausal hypertension.

Femoral Neck Bone Mineral Density in Persons Over 50 Years Performing Shiftwork: An Epidemiological Study.

Objective: Shiftwork has been associated with bone loss due to hormonal fluctuations. Our aim was to assess the femoral neck bone mineral density and content in persons over 50 years performing shiftwork. Methods: We performed analysis on the femoral neck bone mineral parameters in persons over age 50 years from the National Health and Nutrition Examination Survey cross-sectional data for 2010 to 2011 in regular and shiftworkers. We also assessed the degree of moderate physical activity and smoking in both groups. Results: Middle-aged men performing shiftwork had significantly higher total femur bone mineral content (37.33 ± 11.00 vs 34.09 ± 10.45, P = 0.01) and femoral neck bone mineral content (4.57 ± 1.07 vs 4.29 ± 1.0, P = 0.03). This difference was not seen in middle aged women. Conclusions: Shiftwork does not seem to affect bone mineral density in those performing moderate physical activity.

After-Hours Pediatric Care Compared With Emergency Department Care A Retrospective Charge Analysis

Objective. To compare financial charges between children treated and released from an emergency department (ED) with those evaluated in an after-hours (AH) pediatric clinic. Methods. Medical records were retrospectively reviewed for 200 children <15 years of age treated in a hospital-based ED and compared with 200 children seen in an AH pediatric clinic. Our main outcome was median overall patient charges by clinic setting. We additionally examined charges by the 6 most common disease diagnoses. Results. Median charges for children treated and released from the ED were