Parent-Reported Usability of a Patient Portal-Based Asthma Care Tool for Parents of Children With Asthma.

INTRODUCTION: This study evaluates our new EHR-integrated patient portal for asthma care (PAC) management module for parents of children with asthma. The module includes a previsit asthma intake questionnaire via the portal. The parent answers are integrated into the providers clinic progress note to support clinical decision-making. Our goals were to measure the functionality and usability of the PAC module and to understand facilitators and barriers to its use for parents. METHODS: Parents of children ages 0-11 years old (n = 45) completed the PAC modules asthma intake questionnaires prior to their upcoming pediatric pulmonology clinic visit. To assess functionality, provider progress notes were manually reviewed to measure the amount of key asthma-related data captured. Differences in percent data captured with and without the PAC module were compared. Electronic surveys capture demographics, usability data (the System Usability Scale [SUS]), and open-ended experiential feedback about the module. Analysis included descriptive statistics for demographics and usability, as well as the constant comparative method for open-ended feedback. RESULTS: The PAC module at this early stage of design significantly improved the capture of key asthma data in physician notes, increasing from 77% to 92% (p < 0.001). The average SUS score (83.8) indicated high usability. Favorable aspects of the module that were identified included time savings and ease of use. CONCLUSION: Our PAC module enhanced data capture of key asthma management elements and demonstrated high parental usability. We will continue to refine the module through an iterative approach based on end-user feedback, with future expansion planned for broader patient populations

Low expression of gamma-glutamyl hydrolase mRNA in primary colorectal cancer with the CpG island methylator phenotype

The CpG island methylator phenotype (CIMP+) in colorectal cancer (CRC) is defined as concomitant and frequent hypermethylation of CpG islands within gene promoter regions. We previously demonstrated that CIMP+ was associated with elevated concentrations of folate intermediates in tumour tissues. In the present study, we investigated whether CIMP+ was associated with a specific mRNA expression pattern for folate- and nucleotide-metabolising enzymes. An exploratory study was conducted on 114 CRC samples from Australia. mRNA levels for 17 genes involved in folate and nucleotide metabolism were measured by real-time RT-PCR. CIMP+ was determined by real-time methylation-specific PCR and compared to mRNA expression. Candidate genes showing association with CIMP+ were further investigated in a replication cohort of 150 CRC samples from Japan. In the exploratory study, low expression of γ-glutamyl hydrolase (GGH) was strongly associated with CIMP+ and CIMP+-related clinicopathological and molecular features. Trends for inverse association between GGH expression and the concentration of folate intermediates were also observed. Analysis of the replication cohort confirmed that GGH expression was significantly lower in CIMP+ CRC. Promoter hypermethylation of GGH was observed in only 5.6% (1 out of 18) CIMP+ tumours and could not account for the low expression level of this gene. CIMP+ CRC is associated with low expression of GGH, suggesting involvement of the folate pathway in the development and/or progression of this phenotype. Further studies of folate metabolism in CIMP+ CRC may help to elucidate the aetiology of these tumours and to predict their response to anti-folates and 5-fluorouracil/leucovorin.K. Kawakami, A. Ooyama, A. Ruszkiewicz, M. Jin, G. Watanabe, J. Moore, T. Oka, B. Iacopetta and T. Minamot

Reversal of tumorigenicity and the block to differentiation in erythroleukemia cells by GATA-1. Cancer Res

ABSTRACT Oncogenic transformation usually inhibits normal cell differentiation processes. Certain chemical agents can force some tumor cells to resume their differentiation program and undergo cell cycle arrest, an approach termed differentiation therapy. Mouse erythroleukemia (MEL) cells represent an important cell culture model system for investigating the principles of differentiation therapy. MEL cells are malignant erythroblasts that are blocked from differentiating into mature erythroid cells because of inappropriate expression of the transcription factor PU.1, which binds to and represses GATA-1, a key transcriptional stimulator of red blood cell differentiation. We report here that the block to differentiation in MEL cells can be overcome by providing the cells with additional GATA-1. A conditionally active form of GATA-1 can trigger the cells to differentiate, undergo terminal cell division, and lose their tumorigenicity. We also show that the gene for the cell cycle inhibitor p21 is transcriptionally regulated by GATA-1 and is a likely downstream effector of GATA-1 that helps to promote differentiation and proliferation arrest

Socioeconomic factors and test preparation strategies are related to success on the USMLE Step 2 clinical knowledge (CK) exam: a single-institution study

Abstract Background Since the elimination of numerical scoring of the United States Medical Licensing Examination (USMLE) Step 1, the perceived importance of USMLE Step 2 Clinical Knowledge (CK) scores in residency placement has increased. It is known that socioeconomic status (SES) and other demographic factors can be barriers to success in standardized assessment, but few recent studies report the relationship between student demographics, including SES, with Step 2 CK scores in the context of exam practice material access and usage. In this study, we investigated predictors of Step 2 CK success across two years at one institution. Methods A survey regarding Step 2 CK exam preparation and demographic factors was administered to two student cohorts at a New York medical school in 2022 and 2023. The cohorts were comprised of all students in a given class year who had taken Step 2 CK. De-identified survey responses were linked to metrics including Step 1, Step 2 CK, shelf exam, and Medical College Admission Test (MCAT) scores. Results The mean Step 2 CK score among the respondents (n = 213) was 254 ± 13. There was a strong positive correlation between Step 2 CK score and composite shelf scores (rho = 0.80, p < 0.01). Almost all participants used the UWorld question-bank to prepare for the exam (98.1%), and completion of more than 2500 unique questions was associated with better exam performance (256 vs. 252, p = 0.04). On bivariate analysis, students had significantly lower mean Step 2 CK scores if they self-identified as socioeconomically disadvantaged (SED) (250 vs. 256, p < 0.01) and self-reported that financial limitations prevented them from purchasing study resources (249 vs. 257, p < 0.01). In adjusted models, there was no longer a relationship between self-identified SED and Step 2 CK score (beta=-3.50, 95% CI (-8.25, 1.26), p = 0.15). Conclusions This study provides insight into the relationship between exam performance, study habits, and demographic factors at a single institution where students, on average, performed above the national mean on Step 2 CK. Results support that Step 2 CK scores are modulated by a high composite shelf score, number of unique UWorld questions completed, dedicated study period length, and socioeconomic inequity. Trial registration Study registered with our institutional IRB (IRB number 20177537)