Emilia Huvinen, M.D., Ph.D., from Helsinki University Hospital in Finland, and colleagues randomly assigned individuals with a body mass index (BMI) ≥30 kg/m2 and/or prior GDM to lifestyle intervention and control groups before pregnancy or in early pregnancy; genetic and GDM data were available for 516 participants. Based on 50 risk variants for type 2 diabetes, a polygenic risk score (PRS) was calculated.
The researchers found that the PRS was associated with higher glycemic levels (fasting glucose and/or hemoglobin A1c) and a lower insulin secretion index in the second and third trimesters and at 12 months postpartum; in addition, the PRS was associated with a higher occurrence of GDM and glycemic abnormalities at 12 months postpartum. When the data were analyzed for participants who did not have GDM at the first study visit during pregnancy, an interaction was seen between the PRS and lifestyle intervention during pregnancy and postpartum. The intervention was effective in reducing the age-adjusted occurrence of GDM only among those with the highest genetic risk when the analysis was performed among women in tertiles according to PRS (odds ratio, 0.37). In the same group, the risk for glycemic abnormalities was reduced at 12 months postpartum after additional adjustment (odds ratio, 0.35).
“Including a type 2 diabetes PRS in the risk assessment may help to identify those women at highest risk and thus benefitting most from targeted intervention,” the authors write.
Although physician assistant (PA) students who completed their core clinical rotation were found to be more confident in patient communication and clinical assessment skills after receiving training on opioid-use disorder (OUD), students receiving didactic instruction also reported improved confidence following the OUD instruction, according to research presented at the American Academy of Physician Assistants (AAPA) annual meeting, held May 18 to 22, 2019, in Denver, Colorado.
Students in the didactic Behavioral Medicine course at Mercer College of Health Professions in Atlanta, Georgia, participated in a lecture series on OUD that included standardized patients to simulate a realistic presentation of patients with clinical pain complaints and provided screening, diagnosis, and counseling techniques. Students in the clinical course received the same instruction following completion of their core clinical rotation. Faculty observers provided students with feedback on patient interaction, empathy, use of professional medical terminology, opioid risk and benefit assessment, universal monitoring strategies, and including patients in the treatment decision-making process.
A survey administrated to both groups before and after the patient simulation assessed the students’ confidence in history taking, patient education and counseling, formulating a treatment plan, analyzing urine drug screen results, and overall OUD treatment knowledge. A total of 75 students completed the survey. Compared with students receiving didactic instruction, those who had completed their clinical rotation reported greater confidence in their ability to discuss abnormal urine drug screen results with patients, as well as their patient education and counseling skills. Following the patient simulation presentation, both cohorts demonstrated improved confidence; however, those who had completed their clinical rotation had higher perceived confidence in history-taking skills, patient education and counseling skills, and the ability to formulate a treatment plan.
Although the results of this research demonstrate the overall benefit of integrating OUD instruction in PA education, “[d]etermining the most efficacious timing for the insertion of OUD training is beneficial, and allows for improved student confidence,” the authors concluded.
Elizabeth M. Webber, from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a targeted systematic review to update the evidence on the effectiveness of screening for COPD and COPD treatment. Data were included from three trials or analyses of pharmacologic treatment published since 2015 with 20,058 participants, 13 trials on nonpharmacologic interventions with 3,657 participants, and two large observational studies addressing the harms of pharmacologic treatment with 243,517 participants. The researchers found that the results from the clinical trials of pharmacologic therapy were consistent with the previous review, supporting the 2016 USPSTF recommendation. Across a range of outcomes, no consistent benefit was seen for any type of nonpharmacologic treatment.
Based on these findings and using a reaffirmation process, the USPSTF concludes with moderate certainty that screening asymptomatic adults for COPD has no net benefit. Consequently, the USPSTF recommends against screening asymptomatic adults for COPD (D recommendation).
“While screening for COPD in people without symptoms is not recommended, health care professionals can still help prevent their patients from getting COPD,” USPSTF Chair Carol Mangione, M.D., M.S.P.H., said in a statement. “Most cases of COPD are caused by smoking, so it’s essential health care professionals support their patients, including young people, in not starting to smoke and helping those who do smoke quit.”
Final Recommendation Statement
Brown SD, Solh TM, Mattingly JR. Integration of medication-assisted treatment into the physician assistant curriculum: when is the best time? Presentation at: The American Academy of Physician Assistants (AAPA) Annual Meeting; May 18-22, 2019; Denver, CO. Poster 293.
This article originally appeared on Clinical Advisor