Demonstrating competence in clinical skills is key to course completion for medical students. Methods of providing clinical instruction that foster immediate learning and potentially serve as longer-term repositories for on-demand revision, such as online videos demonstrating competent performance of clinical skills, are increasingly being used. However, their impact on learning has been little studied. The aim of this study was to determine the value of adjunctive on-demand video-based training for clinical skills acquisition by medical students in endocrinology.

Objective: To compare the prevalence and clinical characteristics of early gestational diabetes (eGDM) and associated birth outcomes among women of different ethnic groups. Methods: This is a secondary analysis of an international, multicenter randomized controlled trial of treating eGDM among pregnant women with GDM risk factors enrolled at < 20 weeks’ gestation. GDM diagnosis was made using WHO-2013 criteria. Ethnicity was classified by self-identification. While Europids required at least one risk factor for recruitment, for others, ethnicity itself was a risk factor. Results: Among women of Europid (n = 1567), South Asian (SA: n = 971), East and South-East Asian (ESEA: n = 498), Middle Eastern (ME: n = 242), and Māori and Pasifika (MP: n = 174) ethnicities; MP (26.4%) had the highest eGDM crude prevalence compared with Europid (20.3%), SA (24.7%), ESEA (22.3%), and ME (21.1%) (P < .001). Compared with Europid, the highest eGDM adjusted odds ratio (aOR) was seen in SA (2.43 [95% CI 1.9-3.11]) and ESEA (aOR 2.28 [95% CI 1.68-3.08]); in late GDM, SA had the highest prevalence (20.4%: aOR 2.16 [95% CI 1.61-2.9]). Glucose patterns varied between ethnic groups and ESEA were predominantly diagnosed with eGDM through post-glucose load values, while all other ethnic groups were mainly diagnosed on fasting glucose values. There were no differences in the eGDM composite primary outcome or neonatal and pregnancy-related hypertension outcomes between the ethnic groups. Conclusion: In women with risk factors, eGDM was most prevalent in SA and ESEA women, particularly identified by the post-glucose load samples. These findings suggest an early oral glucose tolerance test should particularly be performed in women from these ethnic groups.

Problem. Clinical features of Graves’ hyperthyroidism (GH) generally improve during pregnancy and rebound in the postpartum period. It is unclear whether the ophthalmopathy that is associated with GH and, less often, Hashimoto’s thyroiditis (HT) changes in parallel with the thyroid associated antibody reactions and clinical features or runs a different course.Method of Study. We retrospectively studied 19 patients with autoimmune thyroid disease over 22 pregnancies: 9 pregnancies with GH and 13 with HT. Ophthalmopathy was defined by NOSPECS class.Results. Thyroid peroxidase (TPO) and thyroglobulin (Tg) antibody titres decreased during pregnancy and rose in the postpartum period. During pregnancy, 5 patients with GH and 4 patients with HT developed mild ophthalmopathy and two patients with GH and HT developed new upper eyelid retraction (UER). In the postpartum period, eye scores improved in 3 patients with GH and 3 with HT, remained stable in two and 5 patients, respectively, and worsened in 2 patients with GH and one with HT.Conclusions. In patients with mild to moderate eye signs associated with GH and HT, the orbital and thyroid reactions ran different courses during pregnancy. Since no patient had severe ophthalmopathy, we cannot draw definitive conclusions from this preliminary study.

Background: Our studies over recent years have focused on some new ideas concerning the pathogenesis for the orbital reaction that characterizes Graves’ ophthalmopathy namely, that there are antigens expressed by thyroid tissue and orbital tissue where they are targeted by autoantibodies and/or sensitized T cells, leading to orbital inflammation. While this has been well studied for the thyroid stimulating hormone-receptor, the possible role of another major thyroid antigen, Thyroglobulin (TG), has been largely ignored. Methods: We identified novel variant 1623 A/G single nucleotide polymorphism (SNP) (rs180195) in the promoter of TG gene associated with autoimmune thyroid disorders. We genotyped the TG SNPs rs2069566, rs2076739, rs121912646, rs121912647, rs121912648, rs121912649, rs121912650, rs137854433, rs137854434, and rs180195 by MassARRAY SNP analysis using iPLEX technology in a cohort of 529 patients with thyroid autoimmunity with and without ophthalmopathy, and controls. Results: We showed that variant 1623 A/G SNP (rs180195) in the promoter of TG gene is a marker for thyroid autoimmunity, but not for ophthalmopathy. We showed that there was a significant difference in the distribution of the major allele (G) vs minor allele (A) in patients with Hashimoto’s thyroiditis (HT). In HT the wild-type (GG) genotype was less common. We showed that the genotypes homozygous AA and heterozygous GA rs180195 SNP in the promoter of TG gene were more closely associated with thyroid autoimmunity than the wild-type (GG) polymorphism, and are thus, markers of autoimmunity. Conclusion: rs180195 SNP was previously identified by Stefan et al independently of us, who showed that this TG SNP predisposed to autoimmune thyroid diseases. However, this is the first study to explore the association between TG SNPs and HT. Our findings support the notion that the thyroid and orbital disorders are not part of the same disease, ie, “Graves’ disease” or “Hashimoto’s disease”, but separate autoimmune disorders.

Background and objective Effective contraception is important for pregnancy planning and reducing adverse pregnancy outcomes in women with diabetes mellitus (DM). The aim of this study was to explore preconception care practices and contraception use among women with DM. Methods The study used a cross-sectional structured questionnaire to survey women with DM aged 16-49 years in Nepean Blue Mountains Local Health District (NBMLHD), a Western Sydney tertiary referral centre. Results A total of 107 of 215 (49.7%) women completed the questionnaire. While 80.4% were aware of DM-related pregnancy risks, preconception advice was reported by only 46.8% of the 47 previously or currently pregnant women. Most women had used condoms (87.2%) and/or the combined oral contraceptive pill (74.4%). Many did not know if intrauterine contraception (61.7%) or contraceptive implants (43.7%) were safe in DM. Discussion Despite being aware of the risks of DM in pregnancy, less than half of the women had sought preconception care, and many had poor knowledge of the most reliable contraceptive methods.