Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study

Author(s):  
Loretta Hsueh ◽  
Adam T. Hirsh ◽  
Tamika Zapolski ◽  
Mary de Groot ◽  
Kieren J. Mather ◽  
...  
2017 ◽  
Vol 22 (6) ◽  
pp. 444-452 ◽  
Author(s):  
Jeremy S. Stultz ◽  
Michael Forder ◽  
Amy L Pakyz

OBJECTIVES To assess student pharmacist best activity scores and related exam question performance based on the number of pediatric virtual patient activity (VPA) attempts. METHODS A 40-point asthma VPA was implemented and included three possible randomized scenarios. A 60-point meningitis VPA was implemented and included three possible randomized scenarios followed by an additional three possible randomized scenarios only if the first scenario was correctly completed. Points were awarded in the VPA based on appropriateness of treatment decisions. Students were allowed unlimited VPA attempts individually and as a group in class. Three exam questions were based on a fourth scenario of each randomized portion of the VPAs. The Kruskal-Wallis test, Mann-Whitney U test, and T-test were used for statistical comparisons when appropriate. RESULTS Of 132 students, median individual best asthma VPA scores were 15.25, 22, and 30 for those with 1, 2, and ≥3 asthma attempts, respectively (p < 0.001). Median individual best meningitis VPA scores were 4, 5, 7, and 45.5 for those with 1, 2, 3 to 4, and ≥5 attempts, respectively (p < 0.001). Median number of group VPA attempts was higher among students who correctly answered the exam question related to the first randomized meningitis scenario (10 versus 4, p = 0.015), although no differences in attempts were found for the other related questions (all p > 0.05). CONCLUSIONS Students who completed the VPAs more times achieved greater individual best scores. Students who correctly answered related exam questions had a higher number of group VPA attempts only when continuation of the VPA required correct randomized scenario completion.


2017 ◽  
Vol 11 (4) ◽  
pp. 839-841 ◽  
Author(s):  
David Price

The FDA recently expanded the approved use of Dexcom’s G5 Mobile continuous glucose monitoring (CGM) system to allow for diabetes treatment decisions. This decision is expected to reduce the burden of SMBG testing and increase the adoption and persistent use of CGM. The safety of nonadjunctive CGM use was questioned because of sporadic large discrepancies between CGM and SMBG values. These data were viewed in the context of complaints found in the FDA MAUDE database and social media postings. This commentary provides additional perspective on the inferences that can be drawn from these reports and the risk of nonadjunctive use of CGM data.


2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.


2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.


2015 ◽  
Vol 26 (5) ◽  
pp. 1010-1015 ◽  
Author(s):  
John Melissas ◽  
Drakos Peirasmakis ◽  
Vasileios Lamprou ◽  
John Papadakis

Author(s):  
Norio Baba ◽  
Norihiko Ichise ◽  
Syunya Watanabe

The tilted beam illumination method is used to improve the resolution comparing with the axial illumination mode. Using this advantage, a restoration method of several tilted beam images covering the full azimuthal range was proposed by Saxton, and experimentally examined. To make this technique more reliable it seems that some practical problems still remain. In this report the restoration was attempted and the problems were considered. In our study, four problems were pointed out for the experiment of the restoration. (1) Accurate beam tilt adjustment to fit the incident beam to the coma-free axis for the symmetrical beam tilting over the full azimuthal range. (2) Accurate measurements of the optical parameters which are necessary to design the restoration filter. Even if the spherical aberration coefficient Cs is known with accuracy and the axial astigmatism is sufficiently compensated, at least the defocus value must be measured. (3) Accurate alignment of the tilt-azimuth series images.


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