Recent Publications by CFE Educators

There is considerable need for effective and accessible treatment for opioid use disorder. Our study explored differences in buprenorphine treatment retention and duration, with a focus on selected sociodemographic factors and treatment indicators, in two different settings: an office-based buprenorphine induction and stabilization clinic (OBIC) and a community-based primary care clinic (CPC). This nonexperimental retrospective chart review compared demographic information and buprenorphine treatment details, including treatment retention and duration. There were no statistically significant differences in buprenorphine treatment indicators between the OBIC and CPC groups, with two exceptions: the number of written buprenorphine prescriptions was significantly greater for the OBIC group, as was the number of filled buprenorphine prescriptions. Given similar treatment retention and duration in two different buprenorphine treatment settings, our findings suggest that access to buprenorphine treatment in standard integrated care settings can be supplemented by novel treatment structures such as the OBIC in order to increase access to care during the current opioid epidemic.

BACKGROUND

Growing evidence shows that clinical and molecular subtypes of prostate cancer (PCa) have specific risk factors. Observational studies suggest that physical activity may lower the risk of aggressive PCa. To our knowledge, the association between physical activity and PCa defined by TMPRSS2:ERG has not been evaluated.

OBJECTIVE

To prospectively examine the association between physical activity and risk of PCa defined by clinical features and TMPRSS2:ERG.

DESIGN, SETTING, AND PARTICIPANTS

We studied 49160 men aged 40-75 yr in the Health Professionals Follow-up Study from 1986 to 2012. Data was collected at baseline and every 2 yr with >90% follow-up. Total and vigorous physical activity were measured in metabolic equivalent of task (MET)-h/wk.

OUTCOME MEASURES AND STATISTICAL ANALYSIS

Advanced PCa was defined as stage T3b, T4, N1, or M1 at diagnosis and lethal PCa as distant metastases or death due to disease over follow-up. Presence of TMPRSS2:ERG was estimated by immunohistochemistry of ERG protein expression. Cox proportional hazards models were used to obtain multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of subtype-specific PCa.

RESULTS AND LIMITATIONS

During 26 yr of follow-up, 6411 developed PCa overall and 888 developed lethal disease. There were no significant associations between total physical activity and risk of PCa in the overall cohort. In multivariable-adjusted models, men in the highest quintile of vigorous activity had a significant 30% lower risk of advanced PCa (HR: 0.70, 95% CI: 0.53-0.92) and 25% lower risk of lethal PCa (HR: 0.75, 95% CI: 0.59-0.94) than men in the lowest quintile of vigorous activity. The association was independent of screening history. Vigorous activity was not associated with total PCa in the overall cohort but was inversely associated among highly screened men (top vs bottom quintile, HR: 0.83, 95% CI: 0.70-0.97). Of all cases, 945 were assayed for ERG (48% ERG-positive). Men with higher vigorous activity had a lower risk of ERG-positive PCa (top vs bottom quintile, HR: 0.71, 95% CI: 0.52-0.97). There was no significant association with the risk of ERG-negative disease (p heterogeneity=0.09).

CONCLUSIONS

Our study confirms that vigorous physical activity is associated with lower risk of advanced and lethal PCa and provides novel evidence for a lower risk of TMPRSS2:ERG-positive disease.

PATIENT SUMMARY

The identification of modifiable lifestyle factors for prevention of clinically important prostate cancer (PCa) is needed. In this report, we compared risk of PCa in men with different levels of physical activity. Men with higher vigorous activity had a lower risk of developing advanced and lethal PCa and PCa with the common TMPRSS2:ERG gene fusion.

OBJECTIVES

To determine the role of academic authors, funders, and contract research organisations in industry funded trials of vaccines, drugs, and devices and to determine lead academic authors' experiences with industry funder collaborations.

DESIGN

Cross sectional analysis of trial publications and survey of lead academic authors.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The most recent 200 phase III and IV trials of vaccines, drugs, and devices with full industry funding, at least one academic author, published in one of the top seven high impact general medical journals (, , , , , , and ).

RESULTS

Employees of industry funders co-authored 173 (87%) of publications; 183 (92%) trials reported involvement of funders in design, and 167 (84%) reported involvement of academic authors. Data analysis involved the funder in 146 (73%) trials and the academic authors in 79 (40%). Trial reporting involved the funder in 173 (87%) trials and academic authors in 197 (99%). Contract research organisations were involved in the reporting of 123 (62%) trials.Eighty (40%) of 200 lead academic authors responded to the survey. Twenty nine (33%) of the 80 responders reported that academics had final say on the design. Ten responders described involvement of an unnamed funder and/or contract research organisation employee in the data analysis and/or reporting. Most academic authors found the collaboration with industry funder beneficial, but 3 (4%) experienced delay in publication due to the industry funder and 9 (11%) reported disagreements with the industry funder, mostly concerning trial design and reporting.

CONCLUSIONS

Industry employees and academic authors are involved in the design, conduct, and reporting of most industry funded trials in high impact journals. However, data analysis is often conducted without academic involvement. Academics view the collaboration as beneficial, but some report loss of academic freedom.

Microaggressions and expressions of overt discrimination negatively affect the experience of medical trainees at all levels. Mistreatment of trainees, including abusive and discriminatory behavior by patients and families, occurs commonly and is receiving increased attention in both the medical literature and popular press. Heightened awareness of the problem has sparked a call to engage in substantive conversations about bias in health professions education. The emphasis on direct observation in medical education makes the bedside a common setting for educators to witness these behaviors firsthand. Many educators are committed to developing a positive climate for learners but lack the training and skills to facilitate discussions about discrimination. As a result, these difficult but important conversations may not occur. The authors present a three-phase approach to responding to microaggressions and discrimination toward trainees from patients, and offer a communication toolkit that frontline medical educators can use in their daily practice.

Objective

To describe the routine use of telemedicine-enabled neurologic care in an academic outpatient MS and neuroimmunology clinic and quantify its role in reducing patient burden.

Methods

Between January 2017 and December 2017, we surveyed patients and MS neurologists after 50 consecutive routinely scheduled televideo visits and a convenience sample of 100 in-clinic visits. Summary statistics were calculated and comparisons performed.

Results

Overall, 98% televideo participants found the technology easy to use, and only 17% believed that an in-person examination would have more effectively addressed their needs for the visit. MS neurologists reported achieving their clinical goals in 47/48 (98%) of televideo visits and an adequate physical examination with 2 exceptions (possible cauda equina syndrome and visual field loss). Three emergency department referrals were avoided due to televideo availability. Telemedicine reduced travel burden, including a mean (±SD) travel distance of 160 (±196) miles and avoiding overnight lodging and air travel. Telemedicine also reduced indirect costs, including time off work (65% of employed patients) and caregiver burden (30% avoided caregiver time off from work/obligations). Across 8 domains of provider interpersonal communication skills, telemedicine and in-clinic participants rated only 1 domain to be different (eye contact), and overall, 96% of in-clinic and 100% of telemedicine participants agreed/strongly agreed that their clinical goals had been met.

Conclusions

When incorporated as part of the continuum of MS/neuroimmunology care, clinic to in-home telemedicine reduces travel and caregiver burden and enables efficient, convenient, and effective follow-up.

INTRODUCTION

Current methods to evaluate root position either are inaccurate (panoramic radiograph) or expose patients to relatively large amounts of radiation (cone-beam computed tomography [CBCT]). A method to evaluate root position by generating an expected root position (ERP) setup was recently reported but has not been validated. The purpose of this study was to quantitatively assess the accuracy and reliability of the ERP setup with adequate statistical power.

METHODS

This retrospective study included 15 subjects who had completed phase 2 orthodontic treatment. An ERP setup was generated for all patients after treatment. The ERP setup was compared with the posttreatment CBCT scan, which served as the control. The mesiodistal angulation and buccolingual inclination of all teeth in both the ERP setup and the posttreatment CBCT scan were measured and compared. Bland-Altman analysis was used to assess interoperator reliability, intraoperator reliability, and agreement between the ERP setup and the posttreatment CBCT scan.

RESULTS

Bland-Altman plots showed high interoperator and intraoperator reliabilities. These plots also showed strong agreement between the ERP setup and the posttreatment CBCT scan; 11.8% of teeth measured for mesiodistal angulation and 9.6% of teeth measured for buccolingual inclination were outside the ±2.5° range of clinical acceptability.

CONCLUSIONS

We validated that the method to generate an ERP setup to evaluate root position for posttreatment orthodontic assessment is accurate and reliable.