Purpose: The purpose of this study is to define the prevalence of vitamin B 12 deficiency in a type 2 diabetic population within a primary care practice. Metformin use and advanced age are associated with vitamin B 12 deficiency and often present in type 2 diabetic patients, yet the prevalence of vitamin B 12 deficiency in the diabetic population is unknown.Methods: We conducted a cross-sectional study of 203 outpatient type 2 diabetic patients at a large military primary care clinic. Patients completed a survey and had B 12 levels measured. Patients with borderline B 12 levels also had methylmalonic acid and homocysteine levels drawn. Serum B 12 levels <100 pg/mL or serum B 12 levels of 100 to 350 pg/mL with elevation of serum methylmalonic acid >243 nmol/L or homocysteine >11.9 nmol/L defined B 12 deficiency. Descriptive statistics described frequency and means.2 and student's t tests were used to analyze associations between categorical and continuous variables, respectively. Multivariate logistical regression identified covariates independently associated with B 12 deficiency.Results: Twenty-two percent (n ‫؍‬ 44) of diabetic patients had metabolically confirmed B 12 deficiency. Patients on metformin had lower serum B 12 levels (425.99 pg/mL vs 527.49 pg/mL; P ‫؍‬ .012) and were at increased risk for B 12 deficiency (P ‫؍‬ .04), as defined by a serum B 12 level <350 pg/mL. Prevalence of B 12 deficiency was significantly lower for patients using a multivitamin (odds ratio, 0.31; 95% CI, 0.15-0.63).Conclusions :

There is a high prevalence of current and ever use ESD among active duty service members assigned to a US Army Infantry Division. Data from similar studies suggest that this rate is growing. The rates of ESD use in military populations should continue to be monitored as the clinical utility of these devices continues to be investigated.

Background Graduate medical education programs lack enough faculty trained in quality improvement (QI). A major barrier to increasing the number of faculty competent in QI is insufficient time to engage in training. Research is missing on the effectiveness of short faculty development workshops to teach academic faculty QI principles and promote participation and mentorship in QI projects. Objective The authors assessed the ability of a four-hour experiential QI workshop to increase faculty proficiency in QI principles, enhance faculty involvement in QI, and improve resident mentorship in QI. Methods From 2016 to 2017, the authors conducted seven QI faculty development workshops at a large academic medical center with 12 ACGME training programs. We evaluated the workshop using pre- and post-workshop surveys, as well as six- and twelve-month follow up surveys. Results Sixty-five faculty participated in seven workshops over 13 months. All participants completed pre- and post-workshop surveys, while 38% (n = 25) responded to the six- and twelve-month follow up surveys. Overall, the workshop significantly increased confidence to lead and mentor residents on a QI project (25% pre vs. 72% post, p < .001), increased ability to teach QI (8% pre vs. 36% post, p < .001), increased participation in planning and decision making on a QI team (32% pre vs. 50% post, p = .002), and increased the mean number of QI projects implemented (.45 pre vs. 1.24 post; p < .05). Conclusion A four-hour QI workshop is a quick and effective training method to develop academic faculty to teach and mentor residents in QI. The principles taught increased perceived knowledge, confidence in mentorship, and participation in QI.

Introduction Holistic review, in which medical schools seek to balance applicant attributes and experiences alongside traditional academic metrics in making admissions decisions, has been in place for over a decade. Medical school applicants and the admissions’ community are still trying to understand the impact of holistic review on the composition of those medical schools choose to interview and accept. Materials and Method The study cohort included all candidates who applied to Uniformed Services University of the Health Sciences (USU) in 2014, 2015, and 2016 (N = 8,920). We conducted logistic regression analysis to examine the associations between the sociodemographic, academic, and military service variables of applicants applying to the School of Medicine and offers for interview. Results Medical College Admission Test scores and undergraduate grade point averages were important in predicting who would receive an interview. Having military experience, being a woman, and being self-reported African American race also predicted a higher likelihood of receiving an interview invitation. For example, controlling for all other variables in the model, if an applicant had previous military experience, the odds of being invited for interview was about 4 times that of an applicant who had no previous military experience. Leave this for the text and discussion. The resulting pool of interviewed and accepted students more increasingly represented the Military Health Service population served. Conclusions The use of holistic review generated a class with a composition different from that which would be predicted by Medical College Admission Test and grade point average alone. Further, holistic review produced an interview pool and class more representative of the wider Military Health Service beneficiary population. In the case of USU, holistic review allowed the school to better meet its mission to create a representative class able to “care for those in harm’s way.”