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Practice Makes Perfect: Objective Structured Clinical Examinations Across the UME-to-GME Continuum Improve Care of Transgender Simulated Patients

Beltran, Christine P.; Wilhite, Jeffrey A.; Hayes, Rachael W.; Loschiavo, Caleb; Crotty, Kelly; Adams, Jennifer; Hauck, Kevin; Crowe, Ruth; Kudlowitz, David; Katz, Karin; Gillespie, Colleen; Zabar, Sondra; Greene, Richard E.
Background Residents lack confidence in caring for transgender individuals. More exposure and practice throughout training is needed. Objective To explore whether and how prior exposure to transgender health skills during medical school impacted competency with these skills during residency. Methods In 2022, all 101 internal medicine residents at New York University Grossman School of Medicine participated in an objective structured clinical examination (OSCE) station as part of their annual formative assessment where they cared for a standardized patient (SP) who identified as transgender. Three SPs who were members of the transgender community were recruited through online and social media forums. Two resident groups (continuum vs noncontinuum) differed in their prior experiences with transgender OSCEs during medical school. We analyzed SPs"™ ratings of resident performance using checklist data and SP open-ended feedback to compare performance between groups and resident post-OSCE evaluations to understand residents"™ perceptions of the educational value of the case. Results Residents with prior experience with transgender SPs (continuum) were more frequently recommended by SPs (88% [21 of 24] vs 70% [54 of 77]) to a family member or friend, were all rated professional (100% [24 of 24] vs 94% [72 of 94]) and scored better in pain information-gathering (92% vs 65%, mean summary score) and gender-affirming care skills (67% vs 52%, mean summary score). Noncontinuum residents lacked experience, missed opportunities to ask about gender identity, and needed work on demonstrating comfort and using proper language. Most residents completing a post-OSCE evaluation (80%, 41 of 51) rated the case as "very valuable." Conclusions Spaced practice and feedback through early exposure to transgender OSCEs were valuable for skill acquisition, giving continuum residents a learning advantage compared to noncontinuum residents.
ISSN: 1949-8349
CID: 5660082

Continuous glucose monitoring and 1-h plasma glucose identifies glycemic variability and dysglycemia in high-risk individuals with HbA1c < 5.7%: a pilot study

Dorcely, Brenda; Sifonte, Eliud; Popp, Collin; Divakaran, Anjana; Katz, Karin; Musleh, Sarah; Jagannathan, Ram; Curran, Margaret; Sevick, Mary Ann; Aleman, José O; Goldberg, Ira J; Bergman, Michael
PMID: 35729471
ISSN: 1559-0100
CID: 5265672

Manhattan Veterans Affairs Medical Center Diabetes Prevention Clinic

Dorcely, Brenda; Bergman, Michael; Tenner, Craig; Katz, Karin; Jagannathan, Ram; Pirraglia, Elizabeth
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes the establishment of a Diabetes Prevention Clinic for veterans with prediabetes.
PMID: 32699479
ISSN: 0891-8929
CID: 4681252

Continuous Glucose Monitor Predicts Glycemic Variability in High-Risk Individuals with HbA1c < 5.7% [Meeting Abstract]

Dorcely, Brenda; Sifonte, Eliud; Divakaran, Anjana; Katz, Karin; Jagannathan, Ram; Goldberg, Ira J.; Bergman, Michael
ISSN: 0012-1797
CID: 4604612

Unexpected Hurdle in the Race: Hypophosphatasia Unmasked by the Female Athlete Triad

Fink, Dorothy A; Pasculli, Rosa M; Wright, Alana; Katz, Karin; Agrawal, Nidhi; Turner, Ryan; Cardone, Dennis A
Hypophosphatasia should be considered for any patient who presents with multiple metatarsal stress fractures and a low alkaline phosphatase.
PMID: 31834173
ISSN: 1537-8918
CID: 4235012

Central diabetes insipidus emerging after steroid replacement in pituitary apoplexy

Yang, Dixon; Newman, Samantha K; Katz, Karin; Agrawal, Nidhi
PMID: 31061075
ISSN: 1488-2329
CID: 3905712

The 1-h post-load plasma glucose as a novel biomarker for diagnosing dysglycemia

Jagannathan, Ram; Buysschaert, Martin; Medina, José Luis; Katz, Karin; Musleh, Sarah; Dorcely, Brenda; Bergman, Michael
Identifying the earliest moment for intervention to avert progression to prediabetes and diabetes in high-risk individuals is a substantial challenge. As β-cell function is already compromised in prediabetes, attention should therefore be focused on identifying high-risk individuals earlier in the so-called pre-prediabetes stage. Biomarkers to monitor progression and identify the time point at which β-cell dysfunction occurs are therefore critically needed. Large-scale population studies have consistently shown that the 1-h plasma glucose (1-h PG) ≥ 155 mg/dl (8.6 mmol/l) during the oral glucose tolerance test detected incident type 2 diabetes and associated complications earlier than fasting plasma glucose or 2-h plasma glucose levels. An elevated 1-h PG level appears to be a better alternative to HbA1c [5.7-6.4% (37-47 mmol/mol)] or traditional glucose criteria for identifying high-risk individuals at a stage when ß-cell function is substantially more intact than in prediabetes. Diagnosing high-risk individuals earlier proffers the opportunity for potentially reducing progression to diabetes, development of microvascular complications and mortality, thereby advancing benefit beyond that which has been demonstrated in global diabetes prevention programs.
PMID: 29383586
ISSN: 1432-5233
CID: 2933782

Reducing the prevalence of dysglycemia: is the time ripe to test the effectiveness of intervention in high-risk individuals with elevated 1 h post-load glucose levels?

Bergman, Michael; Jagannathan, Ram; Buysschaert, Martin; Medina, Jose Luis; Sevick, Mary Ann; Katz, Karin; Dorcely, Brenda; Roth, Jesse; Chetrit, Angela; Dankner, Rachel
Identifying the earliest time point on the prediabetic continuum is critical to avoid progressive deterioration in beta-cell function. Progressively rising glucose levels even within the "normal range" occur considerably late in the evolution to diabetes thus presenting an important opportunity for earlier diagnosis, treatment, and possible reversal. An elevated 1 h postprandial glucose level, not detected by current diagnostic standards, may provide an opportunity for the early identification of those at risk. When the 1 h post-load glucose level is elevated, lifestyle intervention may have the greatest benefit for preserving beta-cell function and prevent further progression to prediabetes and diabetes. In view of the considerable consistent epidemiologic data in large disparate populations supporting the predictive capacity of the1 h post-load value for predicting progression to diabetes and mortality, the time is therefore ripe to evaluate this hypothesis in a large, prospective multicenter randomized trial with lifestyle intervention.
PMID: 28124259
ISSN: 1559-0100
CID: 2418602

Novel biomarkers for prediabetes, diabetes, and associated complications

Dorcely, Brenda; Katz, Karin; Jagannathan, Ram; Chiang, Stephanie S; Oluwadare, Babajide; Goldberg, Ira J; Bergman, Michael
The number of individuals with prediabetes is expected to grow substantially and estimated to globally affect 482 million people by 2040. Therefore, effective methods for diagnosing prediabetes will be required to reduce the risk of progressing to diabetes and its complications. The current biomarkers, glycated hemoglobin (HbA1c), fructosamine, and glycated albumin have limitations including moderate sensitivity and specificity and are inaccurate in certain clinical conditions. Therefore, identification of additional biomarkers is being explored recognizing that any single biomarker will also likely have inherent limitations. Therefore, combining several biomarkers may more precisely identify those at high risk for developing prediabetes and subsequent progression to diabetes. This review describes recently identified biomarkers and their potential utility for addressing the burgeoning epidemic of dysglycemic disorders.
PMID: 28860833
ISSN: 1178-7007
CID: 2678842

Type 1 Diabetes: Research for Pancreatic Replacement, Transplantation and Regeneration

Katz, Karin; Greene, Loren Wissner
ISSN: 1944-0030
CID: 2112642