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Article: The Application of Exercise Prescription Education in Medical Training.

Sprys-Tellner, Thomas / Levine, Diane / Kagzi, Asim

Journal of medical education and curricular development

2023 Volume 10, Page(s) 23821205231217893

Abstract: Objective: Physical inactivity is a significant contributor to many acute and chronic medical conditions. While the dangers of physical inactivity (PA) are well understood and physicians have the desire to address them, a lack of education in exercise ... ...

Abstract	Objective: Physical inactivity is a significant contributor to many acute and chronic medical conditions. While the dangers of physical inactivity (PA) are well understood and physicians have the desire to address them, a lack of education in exercise prescription (ERx) may be a barrier to properly prescribing exercise to patients. The aim of this research was to determine the effectiveness of an ERx medical education lecture and provide evidence for the need for formal ERx education among students and physicians in training with a secondary goal of further exploring medical student and resident habits and beliefs about PA and ERx. Methods: A one-hour education session was developed based on the American College of Sports Medicine principles of ERx. Pre- and postsurveys were administered immediately before and after the curriculum session to Wayne State University School of Medicine medical students and residents to assess perceived ERx knowledge level and confidence levels for prescribing aerobic and resistance exercise to patients. Virtual curriculum sessions were held over Zoom. Results: A total of 144 presurvey and 119 postsurvey results were analyzed. The mean perceived ERx knowledge level significantly increased from 4.67/10 ± 1.98 to 7.35/10 ± 1.56 ( Conclusion: A one-hour session to educate medical students and residents on how to write an ERx improved perceived knowledge and confidence in this subject matter. Although further study is needed to determine long-term knowledge retention and the impact on ERx behavioral practice in a patient care setting, this study provides preliminary evidence to justify its inclusion as a regular component of the medical school curriculum.
Language	English
Publishing date	2023-11-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2798123-X
ISSN	2382-1205
ISSN	2382-1205
DOI	10.1177/23821205231217893
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes.

Moses, Tabitha E H / Waineo, Eva / Levine, Diane / Greenwald, Mark K

The American journal on addictions

2023 Volume 32, Issue 4, Page(s) 376–384

Abstract: Background and objectives: Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical ... ...

Abstract	Background and objectives: Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical students believe MOUD training should occur during undergraduate medical education (UME). As legislation surrounding buprenorphine prescribing shifts, it is timely to consider how best to incorporate MOUD training into UME. Methods: At the start of 3rd year, all students (n = 290) received a survey regarding experiences working with people with OUDs, and beliefs and knowledge regarding harm reduction and treatment. During orientation, students completed an 8-h online MOUD training. Afterwards, students completed another survey, including questions about training perceptions. Results: One-third of students (32.8%) completed MOUD training and both surveys. Before training, 60.0% had not heard of the waiver, but 82.1% endorsed interest in prescribing buprenorphine. Despite mixed feelings about training content and delivery, 79.1% believed future classes should receive it. Most thought it should be integrated longitudinally throughout the curriculum rather than as separate online training. Conclusion and scientific significance: Medical students want more MOUD education throughout their training; however, the 8-h online training may be less-than-optimal. As this training is no longer required to prescribe buprenorphine, there is an opportunity to modify the content presented. There is an urgent need for physicians with the knowledge and willingness to treat patients with OUD. Introducing integrated training about MOUD should help future physicians feel confident in their knowledge to treat patients and comfortable applying for the waiver.
MeSH term(s)	Humans ; Students, Medical ; Education, Medical, Undergraduate ; Feedback ; Buprenorphine/therapeutic use ; Opioid-Related Disorders ; Attitude ; Opiate Substitution Treatment ; Analgesics, Opioid/therapeutic use
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
Language	English
Publishing date	2023-02-27
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1141440-6
ISSN	1521-0391 ; 1055-0496
ISSN (online)	1521-0391
ISSN	1055-0496
DOI	10.1111/ajad.13395
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Article: Gamification for the Win in Internal Medicine Residency: A Longitudinal, Innovative, Team-Based, Gamified Approach to Internal Medicine Board-Review.

Dakroub, Allie H / Weinberger, Jarrett J / Levine, Diane L

Cureus

2022 Volume 14, Issue 3, Page(s) e22822

Abstract: Background: Game-based learning is an engaging and effective educational strategy in medical education. The Internal Medicine resident board review at our institution was considered dull and poorly attended by trainees. We hypothesized that a gamified, ...

Abstract	Background: Game-based learning is an engaging and effective educational strategy in medical education. The Internal Medicine resident board review at our institution was considered dull and poorly attended by trainees. We hypothesized that a gamified, longitudinal, team-based approach to board review would rejuvenate board review and improve learner perception of quality and attendance. Methods: We sought to improve the resident perception of and participation in board review through an innovative longitudinal, team-based, game-based intervention, the "Cohort Cup". The "Cohort Cup" was developed and implemented over a 22-week intervention period from November 2017 to May 2018. Teams (cohorts) competed in real-time against one another. Evaluation methods include a pre/post attitudes survey on a 5-point Likert scale (1 - strongly disagree, 5 - strongly agree) and attendance data. Findings: Of 105 residents eligible to participate, 82 completed the pre-intervention survey, and 74 completed the post-intervention survey. We observed statistically significant increases in self-perceptions of engagement, the perceived value of the sessions, and preferences for game-based learning. Self-perceptions of learner engagement improved from 2.74 to 3.8. The value of the educational experience increased from 2.68 to 3.95. Preferences for game-based learning improved from 3.77 to 4.32. Board review attendance doubled. Residents commented the intervention improved class bonding. Board passage rate increased from 86% to 97%. Conclusions: Our game-based intervention successfully rejuvenated our board review. We observed more joy in the learning environment and improvements in resident engagement, and in their attitudes regarding board review. Game-based learning can be a valuable educational tool and can be a positive facet of educational communities.
Language	English
Publishing date	2022-03-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.22822
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Article: Improving Food Insecurity Education in Medical School Through Integrative Service Learning.

Rea, Samantha / Jarodiya, Jay / Berschback, Madeline / Levine, Diane

Journal of medical education and curricular development

2022 Volume 9, Page(s) 23821205221096286

Abstract: Introduction: The COVID-19 pandemic has left more than 38% of households food insecure in the United States. Improved education of food security topics in medical school can improve screening for food insecurity and improve health outcomes. The first ... ...

Abstract	Introduction: The COVID-19 pandemic has left more than 38% of households food insecure in the United States. Improved education of food security topics in medical school can improve screening for food insecurity and improve health outcomes. The first aim of this study was to address if participation in an experiential integrative service learning program improved medical students' understanding of food insecurity. The second aim was to compare knowledge of food insecurity between the general body of medical students and those who participated in the service learning program. Methods: This was a cohort study at a large medical school in southeast Michigan in 2019-2020. We administered the Food Insecurity for Health Professionals (FISHP) survey to medical student participants; higher scores on the FISHP survey suggest higher knowledge and comfort with food security topics. We administered online Qualtrics surveys to the volunteer group before and after volunteering 12 hours at an urban farm. We also administered a one-time survey to a control group of medical students. We performed univariable and bivariable statistical analyses with StataSE 16. The study was exempted by the institutional IRB. Results: Medical students in the volunteer group (n = 18) and the control group (n = 66) completed online surveys. Participants in the volunteer group had increased knowledge of food security after volunteering in the service learning program (p = .03). There was a statistically significant difference between the mean FISHP scores for the control group and the volunteer group (p = .001). Conclusion: Medical student participation in an experiential integrative service learning program improved knowledge of food security topics and increased comfort discussing food insecurity with patients, compared to students who did not participate. Experiential integrative service learning may improve holistic patient care through physician recognition of food insecurity and other social determinants of health.
Language	English
Publishing date	2022-05-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2798123-X
ISSN	2382-1205
ISSN	2382-1205
DOI	10.1177/23821205221096286
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Article: A Rare Case of Isolated Pulmonary Cryptococcoma in an Immunocompromised Host.

Dbaibou, Jana / Levine, Diane L

Cureus

2020 Volume 12, Issue 4, Page(s) e7748

Abstract: Cryptococcosis is an opportunistic fungal infection found in both immunocompromised and non-immunocompromised patients; however, it is particularly prevalent in those with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). ... ...

Abstract	Cryptococcosis is an opportunistic fungal infection found in both immunocompromised and non-immunocompromised patients; however, it is particularly prevalent in those with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Patients with isolated pulmonary cryptococcosis can present with heterogeneous symptoms. The rarity of this entity makes it difficult to recognize and diagnose. We present a case of a 54-year-old female with poorly controlled HIV and seizure disorder, who presented with suspected seizures. Her CD4 count was 7. Due to fever and headache, cryptococcal meningitis was suspected, and she was empirically started on liposomal amphotericin and flucytosine. Computed tomography (CT) of the head was negative for any acute intracranial process. Serum cryptococcal antigen was positive; however cerebrospinal fluid (CSF) studies from lumbar puncture (LP) were entirely negative, including CSF cryptococcal antigen. CT thorax demonstrated interval development of two solid pulmonary nodules in the right upper lobe (RUL). There was no other evidence of disseminated cryptococcal disease. CT-guided biopsy of the larger RUL was compatible with Cryptococcus species. Fungal cultures of sputum and blood were negative. The patient improved, and therapy was de-escalated from liposomal amphotericin and flucytosine to oral fluconazole, with a plan to complete a six- to twelve-month course of therapy. This case illustrates that in rare cases, Cryptococcal disease may still be localized despite having a positive serum Cryptococcal antigen. It also emphasizes the importance of a thorough investigation with multimodal diagnostic tools to evaluate for disseminated Cryptococcal disease, especially in those with a history of immunocompromise.
Language	English
Publishing date	2020-04-20
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.7748
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Article ; Online: Overcoming obesity: Weight-loss drugs are underused.

Kanj, Amjad / Levine, Diane

Cleveland Clinic journal of medicine

2020 Volume 87, Issue 10, Page(s) 602–604

MeSH term(s)	Anti-Obesity Agents ; Health Policy ; Humans ; Obesity ; Prescription Drugs
Chemical Substances	Anti-Obesity Agents ; Prescription Drugs
Keywords	covid19
Language	English
Publishing date	2020-10-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.87a.19102
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Article ; Online: 'When will I be free': Lessons from COVID-19 for Child Protection in South Africa.

Haffejee, Sadiyya / Levine, Diane Thembekile

Child abuse & neglect

2020 Volume 110, Issue Pt 2, Page(s) 104715

Abstract: Background: COVID-19 has highlighted and amplified structural inequalities; drawing attention to issues of racism, poverty, xenophobia as well as arguably ineffective government policies and procedures. In South Africa, the pandemic and the resultant ... ...

Abstract	Background: COVID-19 has highlighted and amplified structural inequalities; drawing attention to issues of racism, poverty, xenophobia as well as arguably ineffective government policies and procedures. In South Africa, the pandemic and the resultant national lockdown have highlighted the shortcomings in the protection and care of children. Children in alternative care are particularly at risk as a result of disrupted and uncoordinated service delivery. Objective: The aim of this study was to explore the experiences and impact of the pandemic and the resulting social isolation on the wellbeing and protection of children living in a residential care facility. Methods and participants: We used qualitative, participatory approaches - specifically draw-and-write methods - to engage with 32 children (average age = 13.5 years) living in a residential care facility in Gauteng. Findings: Children in care demonstrated an awareness of the socio-economic difficulties facing communities in South Africa, and shared deep concerns about the safety, well-being and welfare of parents and siblings. Although they expressed frustration at the lack of contact with family members, they acknowledged the resources they had access to in a residential care facility, which enabled them to cope and which ensured their safety. Discussion and conclusion: We focus our discussion on the necessity of a systemic response to child welfare, including a coordinated approach by policy makers, government departments and child welfare systems to address the structural factors at the root of inequality and inadequate, unacceptable care. This response is essential not only during COVID-19 but also in pre- and post-pandemic context.
MeSH term(s)	Adaptation, Psychological ; Adolescent ; COVID-19/prevention & control ; COVID-19/psychology ; Child ; Child Protective Services ; Child Welfare/economics ; Child, Foster ; Disease Transmission, Infectious/prevention & control ; Family ; Female ; Government Regulation ; Health Policy ; Health Resources ; Healthcare Disparities/economics ; Humans ; Male ; Pandemics/prevention & control ; Schools ; Social Isolation ; Socioeconomic Factors ; South Africa
Keywords	covid19
Language	English
Publishing date	2020-09-04
Publishing country	England
Document type	Journal Article
ZDB-ID	799143-5
ISSN	1873-7757 ; 0145-2134
ISSN (online)	1873-7757
ISSN	0145-2134
DOI	10.1016/j.chiabu.2020.104715
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Article: Valproate-Induced Encephalopathy Presenting at Therapeutic Blood Concentrations: A Case Report and Literature Review.

Pavar, Gautham / Xu, Nicole / Sawar, Kinan / Trivedi, Vichar / Levine, Diane L

Cureus

2023 Volume 15, Issue 1, Page(s) e33559

Abstract: Patients presenting with hyperammonemic encephalopathy are likely to have hepatic encephalopathy. However, valproate (an anticonvulsant and mood stabilizer) can also cause hyperammonemic encephalopathy and belongs on the differential for patients taking ... ...

Abstract	Patients presenting with hyperammonemic encephalopathy are likely to have hepatic encephalopathy. However, valproate (an anticonvulsant and mood stabilizer) can also cause hyperammonemic encephalopathy and belongs on the differential for patients taking it, especially if there are recent contributory medication changes. We present a case report of a 61-year-old woman with valproate-induced hyperammonemic encephalopathy but with an initial valproate level within the therapeutic range (50-100 mcg/dL). After withholding valproate and before additional treatment could be initiated, she became fully alert and oriented. We present a literature review exploring valproate toxicity and treatment. Our case shows that clinical suspicion for valproate-induced hyperammonemic encephalopathy is warranted even if the valproate level is within the therapeutic range.
Language	English
Publishing date	2023-01-09
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.33559
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Article: The role of multisystemic resilience in fostering critical agency: UK adolescents during the COVID-19 Pandemic.

Weidman, Sarah / Levine, Diane T / Louwagie, Fransiska / Blackmore, Kara / Theron, Linda C / Stekel, Dov J

Current psychology (New Brunswick, N.J.)

2023 , Page(s) 1–15

Abstract: Critical agency (CA) refers to an individual's feeling of power in relation to social inequalities. Research has demonstrated that high CA is associated with positive adolescent outcomes, however, less is known about what supports are important for its ... ...

Abstract	Critical agency (CA) refers to an individual's feeling of power in relation to social inequalities. Research has demonstrated that high CA is associated with positive adolescent outcomes, however, less is known about what supports are important for its development. Moreover, a large majority of the literature is based on studies from the US and various countries in Africa; although the UK is saturated with inequalities there is little research within a UK context. In this paper we examine (a) the validity of using an existing measure of CA with a sample of UK adolescents and (b) the extent to which resilience supports account for variance in CA. Our analysis identified two distinct factors of CA: justice-oriented and community-oriented. High CA in both factors was explained by resilience supports associated with peer relationships (p < 0.01). Our findings push us towards new relational, ecological ways of understanding adolescent CA. We close by instantiating a translational framework for those devising policies in support of youth resilience and CA. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-023-04578-1.
Language	English
Publishing date	2023-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2021598-8
ISSN	1936-4733 ; 1046-1310
ISSN (online)	1936-4733
ISSN	1046-1310
DOI	10.1007/s12144-023-04578-1
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Article ; Online: Idiopathic portal vein thrombosis not related to hepatic disease or malignancy.

Alkassis, Samer / Zaher, Nathan / Kaloti, Zaid / Levine, Diane

BMJ case reports

2021 Volume 14, Issue 11

Abstract: Acute portal vein thrombosis (PVT) is a rare disorder defined by the sudden occlusion of the portal vein, which could be partial or complete. Prothrombotic states, inherited or acquired, are thought to be the cause in patients without cirrhosis or ... ...

Abstract	Acute portal vein thrombosis (PVT) is a rare disorder defined by the sudden occlusion of the portal vein, which could be partial or complete. Prothrombotic states, inherited or acquired, are thought to be the cause in patients without cirrhosis or malignancy. However, the aetiology of some cases remains idiopathic despite a multidisciplinary diagnostic approach. The initial diagnostic modality to confirm PVT is either contrast-enhanced abdominal (CT) or MRI; as it can identify predisposing factors, and detect evidence of complications. Eliciting the underlying aetiology is critical to guide overall management and prevent future recurrence. The purpose of treatment is to stop thrombus extension and achieve portal vein patency by anticoagulation to optimise outcomes. Herein, we present an unusual case of spontaneous PVT in a young woman. We will also discuss the evaluation of patients without obvious aetiology.
MeSH term(s)	Anticoagulants/therapeutic use ; Female ; Humans ; Neoplasms ; Portal Vein/diagnostic imaging ; Thrombosis ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/drug therapy
Chemical Substances	Anticoagulants
Language	English
Publishing date	2021-11-09
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-245620
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