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Purpose To report on the implementation of a telephone medicine curriculum as part of the core clerkship in pediatrics for students at Johns Hopkins University School of Medicine and evaluate the curriculum's effect on student performance on a telephone medicine case as part of a required objective structured clinical exam (OSCE). Method Using a prospective cohort design with a convenience sample of third-year medical students during the 2016-2017 and 2017-2018 academic years, the authors compared the OSCE scores of students assigned to the curriculum to both historical and concurrent control groups of students who had not received the curriculum. Additionally, the authors compared the costs of the recommended testing by students in each group using the 2018 Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule. Results Students assigned to the telephone medicine curriculum (students in the intervention group) had a significantly higher mean overall score on the simulated OSCE telephone medicine case compared to the students in the control groups who did not receive the curriculum (the mean score for students in the intervention group was 7.38 vs 6.92 for students in the control groups, P = .02). Additionally, the intervention group had statistically significantly lower costs for their recommended testing compared to the control groups (the median value for tests ordered by students in the intervention group was $27.91 vs $51.23 for students in the control groups, P = .03). CONCLUSIONS;: Implementing a dedicated telephone medicine curriculum for medical students improves their overall performance and delivery of high-value care via telephone medicine as part of an OSCE. Medical educators should pursue ongoing research into effective methods for teaching medical students and residents how to navigate digital encounters.

Background: Caregiver values and preferences with regard to oral immunotherapy (OIT) for treatment of food allergies are not widely reported. Understanding caregiver perspectives is integral to establishing shared decision-making in the treatment of food allergy. Objective: We aimed to understand caregiver opinions that may influence caregivers in their decisions about OIT through social media. Methods: We searched a popular parenting web site for posts related to OIT from December 2008 to September 2019. We applied a Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to review posts for inclusion, performed thematic content analysis to determine common themes, and calculated frequencies for each theme and subtheme. Posts and comments were included if they contained discussions about OIT for immunoglobulin E‐mediated food allergy and were excluded if they were duplicates, comments from an original post from the original user, or comments on a nonrelevant original post. Results: Of 1300 posts and comments retrieved, 174 were included (13%). Most were excluded because they did not directly address OIT for food allergy. Relevant posts could fall into multiple themes and were categorized under three main themes: attitudes (n = 128, “I am scared to do OIT but scared not to!”), logistics (n = 168, “We will be doing this once LO [little one] is a little older”), and questions (n = 32, “How does it work?”). Conclusion: Caregivers communicate with each other through social media, expressing attitudes, logistics, and questions about OIT. Understanding these lay perspectives may help guide clinicians in counseling and engage caregivers in decision-making.

IntroductionThe shape of the glucose curve during an oral glucose tolerance test (OGTT) reflects β-cell function in populations without diabetes but has not been as well studied in those with diabetes. A monophasic shape has been associated with higher risk of diabetes, while a biphasic pattern has been associated with lower risk. We sought to determine if phenotypic or metabolic characteristics were associated with glucose response curve shape in adults with type 2 diabetes treated with metformin alone.Research design and methodsThis is a cross-sectional analysis of 3108 metformin-treated adults with type 2 diabetes diagnosed ResultsThe monophasic profile was the most common (67.8% monophasic, 5.5% biphasic, 26.7% continuous rise). The monophasic subgroup was younger, more likely male and white, and had higher body mass index (BMI), while the continuous rise subgroup was more likely female and African American/black. HOMA2-S and fasting glucose did not differ among the subgroups. The biphasic subgroup had the highest early, late, and total insulin and C peptide responses (all pConclusionsBased on the large multiethnic GRADE cohort, sex, race, age, and BMI were found to be important determinants of the shape of the glucose response curve. A pattern of a continuously rising glucose at 2 hours reflected reduced β-cell function and may portend increased glycemic failure rates.Trial registration numberNCT01794143.

JM Miller, AC Blackman, HT Wang. Ann Allerg Asthma Immunol . 2020:124(4):379–384 The authors investigated the effect of food allergy on quality of life (FAQoL), factors associated with worse FAQoL, and the differences in FAQoL between adolescents versus younger children with food allergy. Children aged 0 to 17 years with a food allergy were recruited from the Allergy Clinic at Texas Children’s Hospital from June 2017–June 2019. 150 children (aged 0–12) and 24 adolescents (13–17) participated. Patients who had outgrown their food allergy were excluded. Eighty-eight percent of children and 95.8% of adolescents were peanut allergic. Forty-seven percent of children and 79.2% of adolescents had experienced anaphylaxis. Parents completed the food allergy quality of life questionnaire (FAQLQ)-Parent form as a proxy for children 0–12 years. Adolescents, age 13 to 17 years, completed the FAQLQ-teenager form. The FAQLQs use a 7-point Likert scale and higher scores reflect worse QoL. The FAQLQs measure …

MJ Gallant, AK Ellis. Ann Allerg Asthma Immunol . 2020;124(3):283–287 To determine the effect of prenatal and early-life exposure to a combination of 7 indoor allergens (air fresheners, candles, mold, cats, dogs, carpet, and environmental tobacco smoke [ETS]) on allergic sensitization at age 2. This is a secondary analysis of the Kingston Allergy Birth Cohort, from Ontario, Canada, that was established in 2011. Women 18 years or older in the second or third trimester of pregnancy were recruited for the study. A subset of 92 women from the cohort were included in this analysis. The 92 women included completed prenatal surveys about their environment and surveys at 6 months ( n = 76), 1 year ( n = 72), and 2 years ( n = 81) after the child was born. Questionnaires …

H Mirzakhani, VJ Carey, R Zeiger. Clin Exp Allergy. 2019;49(4):419–429 To examine the relationship between parental asthma, maternal asthma control during pregnancy, and vitamin D status on risk of asthma or recurrent wheeze in children at 3 years of age. This was a secondary analysis of the Vitamin D Antenatal Asthma Reduction Trial, a randomized, double-blind, placebo-controlled clinical trial of vitamin D supplementation versus placebo in pregnant women to prevent recurrent wheeze and asthma in their offspring. Data consisted of 806 women and their partners and infants, with data from birth up to 3 years of age. The mother or father was required …

SF Nilsson, G Lilja, H Jarnbert-Pettersson, J Alm. Clin Exp Allergy. 2019;49(3):308–316 To evaluate the clinical importance of low specific immunoglobulin E (IgE) to hen’s egg, cow’s milk, and peanut at 6 months in relation to doctor’s diagnosis of allergy-related disease at 5 years of age. Families in Sweden were recruited between 2004 and 2011 (ALADDIN prospective birth cohort). This study included 372 children, all of whom contributed a blood sample at 6 months and at 1, 2, and/or 5 years of age. Fifty percent were girls, 17% were born via cesarean delivery, and 26% were breastfed exclusively for 6 months. At 6 months, 11% had a doctor’s diagnosis of asthma, 12% had a diagnosis of eczema, 3% had a diagnosis …

Background It is unknown whether caregiver perception of a child's asthma control, independent of guideline-based asthma control assessment, is a predictor of future acute visits. Objective To determine whether caregiver-reported asthma control is an indicator of future risk of acute visit. Methods Two study populations of low-income, minority 5- to 17-year-old children with persistent asthma were included. Questionnaires administered at baseline and at 3, 6, 9, and 12 months captured symptoms, short-acting β-agonist use, acute visits in the previous 3 months, and caregiver-reported asthma control. Well-controlled, not well-controlled, and very poorly controlled asthma were defined using National Asthma Education and Prevention Program guideline-based assessment. Relationships between caregiver-reported control and acute visits in the subsequent 3 months were examined. Results At baseline, both populations were predominantly black/African American (91% and 79%) with public insurance (85% and 88%) and very poorly controlled asthma (47% and 50%). In both populations, most caregivers reported that their child's asthma was well controlled (73% and 69%). In both populations, participants whose caregivers reported that their child had uncontrolled asthma had greater odds of having an acute visit in the following 3 months as compared with participants whose caregivers reported that their child's asthma was well controlled, independent of guideline-based control, age, sex, race, controller medication, insurance, and atopy (odds ratio [95% CI], 2.4 [1.4-4.2] and 1.6 [1.1-2.4]). Conclusions Among predominantly low-income minority children with asthma, caregiver-reported asthma control may provide information about the risk of future acute visit for asthma that is complementary to guideline-based control assessment.

The advantages and disadvantages of premixed intravenous admixtures are discussed in the context of their effects on hospital pharmacy practice. Premixed i.v. admixtures offer the advantages of preparation-time savings, assurance of properly reconstituted drugs, lengthy expiration dating, and appropriate labeling. However, because not all drugs will be available from all three i.v. solution manufacturers, hospitals may be forced to use several types of i.v. containers and administration sets. Storage-space requirements will be increased, as the pharmacy will need to stock both premixed and unmixed products. Health-care personnel may be confused about whom to call (the drug manufacturer or the i.v. manufacturer) for drug information on premixed admixtures. Quantity discounts will likely decrease as fewer base i.v. solutions and unmixed drug products are purchased. Plans should be made now to shift personnel from admixture preparation to clinically oriented programs and to develop new workload indicators for pharmacy departments.

This paper will cover a fully-integrated 32b VLSI processing system with six VLSI chips, containing up to 600,000 transistors/chip. Chips are: 32b CPU, I/O processor, memory controller, 128Kb RAM and 528Kb ROM.

The advantages and disadvantages of premixed intravenous admixtures are discussed in the context of their effects on hospital pharmacy practice. Premixed i.v. admixtures offer the advantages of preparation-time savings, assurance of properly reconstituted drugs, lengthy expiration dating, and appropriate labeling. However, because not all drugs will be available from all three i.v. solution manufacturers, hospitals may be forced to use several types of i.v. containers and administration sets. Storage-space requirements will be increased, as the pharmacy will need to stock both premixed and unmixed products. Health-care personnel may be confused about whom to call (the drug manufacturer or the i.v. manufacturer) for drug information on premixed admixtures. Quantity discounts will likely decrease as fewer base i.v. solutions and unmixed drug products are purchased. Plans should be made now to shift personnel from admixture preparation to clinically oriented programs and to develop new workload indicators for pharmacy departments.