Notes

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These findings highlight the role of the hexose monophosphate shunt in fueling NO synthesis and suggest that microglial NO production in the brain may be limited at sites of low glucose availability, such as abscesses or other compartmentalized infections.Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions, with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 (DPP-4) inhibitors might increase the risk of intestinal obstruction, but real-world evidence for this severe adverse event is lacking. Thus, the objective of this study was to determine whether GLP-1 RAs and DPP-4 inhibitors are associated with an increased risk of intestinal obstruction compared with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. We used the United Kingdom Clinical Practice Research Datalink and linked databases to assemble two new-user, active comparator cohorts (2013-2019). The first included 25,617 and 67,261 GLP-1 RA and SGLT-2 inhibitor users, respectively. The second included 131,927 and 40,615 DPP-4 inhibitor and SGLT-2 inhibitor users, respectively. Propensity score fine stratification weighted Cox proportional hazards models were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of intestinal obstruction requiring hospitalization. GLP-1 RAs were associated with an increased risk of intestinal obstruction compared with SGLT-2 inhibitors (1.9 vs. check details 1.1 per 1000 person-years, respectively; HR 1.69, 95% CI 1.04-2.74). The highest HR was observed after 1.6 years of use (HR 3.48, 95% CI 1.79-6.79). DPP-4 inhibitors were also associated with an increased risk (2.7 vs. 1.0 per 1000 person-years; HR 2.59, 95% CI 1.52-4.42), with the highest HR observed after 1.8 years of use (HR 9.53, 95% CI 4.47-20.30). The number needed to harm after one year of use was 1223 and 603 for GLP-1 RAs and DPP-4 inhibitors, respectively. In this large real-world study, GLP-1 RAs and DPP-4 inhibitors were associated with an increased risk of intestinal obstruction.
In the United States, 89% of counties have no clinics providing abortion care. Though training residents increases intention to provide abortion care, rates of postresidency abortion provision are low. This study, conducted at one family medicine residency program in the Southwest United States, examines graduates' postresidency practice of abortion care in the context of their intent to provide during residency training.

We collected cross-sectional data from a survey of graduates of University of New Mexico Family Medicine Residency from 2005 to 2017. We performed a mixed-methods analysis using descriptive statistics and conceptual content analysis, including a new methodology of performing content analysis of four subgroups based on intention to provide abortion care at different time points.

The response rate was 46%, with 54 responses to 115 surveys. Only 35% residents who intended to provide abortion care had done so after graduation from residency. Barrier analysis revealed that the three most fr anticipate and address challenges to postresidency provision. The study also provides some insight into residents with no intention to provide abortion care in residency who develop an intention to provide abortion care after graduation, which is a group of people for whom there is little information.
Clinical teachers (or preceptors) have expressed uncertainties about medical student expectations and how to assess them. The Association of American Medical Colleges (AAMC) created a list of core skills that graduating medical students should be able to perform. Using this framework, this innovation was designed to provide medical students specific, progressive clinical skills training that could be observed.

We used the AAMC skills to develop observable events, called Observed Practice Activities (OPAs), that students could accomplish with their outpatient preceptors. Preceptors and students were trained to use the OPA cards and all students turned in the cards at the end of the rotation.

Seventy-nine of 115 preceptors and 80 of 149 students completed evaluations on the OPA cards. Both students (60%) and preceptors (70%) indicated the OPA cards were helpful for knowing expectations for a third-year medical student, although preceptors found the cards to be of greater value than the students.

The OPAs found the cards to be helpful to understand expectations of a third-year medical student in our course. The OPA cards could be adapted by other schools to evaluate progressive skill development throughout the year.
In family medicine, leadership is critical for health care delivery, advancing curricula, research, and quality improvement. Systematic reviews of leadership development programs in health care identify limitations, calling for innovative designs and rigorous assessment. Our objective was to evaluate the impact of applying master class principles to leadership development in academic family medicine.

We used mixed methods to assess the impact of an innovative master class program on 15 emerging leaders in a large academic department of family medicine. The program consisted of five sessions where family physician masters shared their wisdom, techniques, and feedback with promising leaders. Quantitative evaluation involved participants' ratings of each session's content and delivery using a 5-point Likert scale. We assessed postcourse semistructured interviews with participants qualitatively using descriptive thematic content analysis.

Individual sessions were highly evaluated, with a combined mean of 4.research is warranted to assess organizational impact and applicability to other settings.The sometimes-paradoxical emergent behavior of complex systems may be explained by the interaction of simple rules. The paradox of primary care-that systems based on primary care have healthier populations, fewer health inequities, lower health care expenditures, and better system-level evidence-based disease care, despite less evidence-based care for individual diseases-may be explained by the iterative interaction among three simple rules that describe the generalist approach (1) Recognize a broad range of problems/opportunities; (2) Prioritize attention and action with the intent of promoting health, healing, and connection; and (3) Personalize care based on the particulars of the individual or family in their local context. These are complemented by three simple rules for specialist care that represent current approaches to quality and health care system improvement (1) Identify and classify disease for management; (2) Interpret through specialized knowledge; (3) Generate and carry out a management plan. Health care systems that support the enactment of the simple rules of the generalist approach are likely to have more effective primary and specialty care, and greater population health, equity, quality, and sustainable cost.
Community-based residency programs are an important strategy to address rural and underserved primary care shortages, however, health centers report both benefits and challenges to training. This study aims to understand the impact of new Teaching Health Center (THC) residency programs on health center staffing, patient service, quality of care, and provider productivity.

Using the Uniform Data System, we used inverse propensity score weighting to create a balanced sample of new THC and non-THC health centers in 2010. Using 2018 data, we applied propensity score weighted regressions to examine changes in staffing, service, quality of care, and productivity in THC versus non-THC health centers.

In 2018, health centers with new THC programs were associated with increased physician (16.40, P<.01) staffing, yet decreased physician visits per full-time equivalent (-425.3, P<.01) relative to non-THC centers. New THC centers had increased delivery visits (231.0, P<.05), and had a greater rate of early entry into prenatal care (4.90%, P<.01).

New residency programs are associated with increased provider recruitment, expanded patient service, and some improved health outcomes, but also with potential decreased provider productivity in health centers.
New residency programs are associated with increased provider recruitment, expanded patient service, and some improved health outcomes, but also with potential decreased provider productivity in health centers.
The COVID-19 pandemic resulted in significant changes to the US residency application process for medical school graduates. Due to the lack of in-person activities, family medicine programs have utilized various social media platforms to connect with their applicants. In this paper, we describe how family medicine residency programs have adapted for the 2021 application cycle by using social media platforms.

We evaluated all family residency programs listed on the Electronic Residency Application Service (ERAS) for the presence of departmental and residency Twitter, Instagram, and Facebook accounts. We reviewed programs' websites and social media posts for posts regarding virtual opportunities for prospective applicants. We noted family medicine virtual subinternship opportunities on the Visiting Student Application Service (VSAS). We collected data from October 17, 2020 through November 2, 2020.

Of 675 identified family medicine residency programs, 372 (55%) had some form of social media presence. Open house opportunities were offered by 46 (6.8%) programs on Twitter, 60 (8.9%) programs on Instagram, and 64 (9.5%) programs on Facebook. One hundred ninety-five of 578 residency-specific accounts were created after March 1, 2020; Instagram accounts (103 of 195) represented most of these; five virtual subinternships were identified on VSAS.

Family medicine residency programs have adapted to the challenges that came with the COVID-19 pandemic by increasing social media outreach, particularly through Instagram. This has allowed residency programs to virtually communicate with prospective applicants during an unprecedented application cycle.
Family medicine residency programs have adapted to the challenges that came with the COVID-19 pandemic by increasing social media outreach, particularly through Instagram. This has allowed residency programs to virtually communicate with prospective applicants during an unprecedented application cycle.
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