Kim McFann - Academia.edu (original) (raw)

Papers by Kim McFann

Advances in Chronic Kidney Disease, 2010

Pediatric Diabetes, 2014

Insulin resistance increases during adolescence in those with type 1 diabetes mellitus (T1DM), co... more Insulin resistance increases during adolescence in those with type 1 diabetes mellitus (T1DM), complicating glycemic control and potentially increasing cardiovascular disease (CVD) risk. Metformin, typically used in type 2 diabetes mellitus (T2DM), is a possible adjunct therapy in T1DM to help improve glycemic control and insulin sensitivity. We hypothesized that metformin would improve metabolic parameters in adolescents with T1DM. This randomized, double-blinded, placebo-controlled trial included 74 pubertal adolescents (ages: 13-20 yr) with T1DM. Participants were randomized to receive either metformin or placebo for 6 months. Glycated hemoglobin (HbA1c), insulin dose, waist circumference, body mass index (BMI), and blood pressure were measured at baseline, 3 and 6 months, with fasting lipids measured at baseline and 6 months. Total daily insulin dose, BMI z-score and waist circumference significantly decreased at 3 and 6 months compared to baseline within the metformin group, even among normal-weight participants. In the placebo group, total insulin dose and systolic blood pressure increased significantly at 3 months and total insulin dose increased significantly at 6 months. No significant change was observed in HbA1c at any time point between metformin and placebo groups or within either group. Low-dose metformin likely improves BMI as well as insulin sensitivity in T1DM adolescents, as indicated by a decrease in total daily insulin dose. The decrease in waist circumference indicates that fat distribution is also likely impacted by metformin in T1DM. Further studies with higher metformin doses and more detailed measurements are needed to confirm these results, their underlying mechanisms, and potential impact on CVD in T1DM youth.

The Laryngoscope, 2012

Objectives/Hypothesis-Develop a standardized letter of recommendation (SLOR) for otolaryngology r... more Objectives/Hypothesis-Develop a standardized letter of recommendation (SLOR) for otolaryngology residency application that investigates the qualities desired in residents and letter writer's experience. Compare this SLOR to narrative letters of recommendation (NLOR). Study Design-Prospective SLOR/NLOR Comparison. Methods-The SLOR was sent to a NLOR writer for each applicant. The applicant's NLOR/ SLOR pair was blinded and ranked in seven categories by three reviewers. Inter-rater reliability and NLOR/SLOR rankings were compared. Means of cumulative NLOR and SLOR scores were compared to our departmental rank list. Results-Thirty-one SLORs (66%) were collected. The SLORs had higher inter-rater reliability for applicant's qualifications for otolaryngology, global assessment, summary statement, and overall letter ranking. Writer's background, comparison to contemporaries/predecessors, and letter review ease had higher inter-rater reliability on the NLORs. Mean SLOR rankings were higher for writer's background (p=0.0007), comparison of applicant to contemporaries/predecessors (p=0.0031), and letter review ease (p<0.0001). Mean SLOR writing time was 4.17±2.18 minutes. Mean ranking time was significantly lower (p<0.0001) for the SLORs (39.24±23.45 seconds) compared to the NLORs (70.95±40.14 seconds). Means of cumulative SLOR scores correlated with our rank list (p=0.004), whereas means of cumulative NLOR scores did not (p=0.18). Means of cumulative NLOR and SLOR scores did not correlate (p=0.26). Conclusions-SLORs require little writing time, save reviewing time, and are easier to review compared to NLORs. Our SLOR had higher inter-rater reliability in 4 of 7 categories and was correlated with our rank list. This tool conveys standardized information in an efficient manner.

Advances in Chronic Kidney Disease, 2010

Pediatric Diabetes, 2014

Insulin resistance increases during adolescence in those with type 1 diabetes mellitus (T1DM), co... more Insulin resistance increases during adolescence in those with type 1 diabetes mellitus (T1DM), complicating glycemic control and potentially increasing cardiovascular disease (CVD) risk. Metformin, typically used in type 2 diabetes mellitus (T2DM), is a possible adjunct therapy in T1DM to help improve glycemic control and insulin sensitivity. We hypothesized that metformin would improve metabolic parameters in adolescents with T1DM. This randomized, double-blinded, placebo-controlled trial included 74 pubertal adolescents (ages: 13-20 yr) with T1DM. Participants were randomized to receive either metformin or placebo for 6 months. Glycated hemoglobin (HbA1c), insulin dose, waist circumference, body mass index (BMI), and blood pressure were measured at baseline, 3 and 6 months, with fasting lipids measured at baseline and 6 months. Total daily insulin dose, BMI z-score and waist circumference significantly decreased at 3 and 6 months compared to baseline within the metformin group, even among normal-weight participants. In the placebo group, total insulin dose and systolic blood pressure increased significantly at 3 months and total insulin dose increased significantly at 6 months. No significant change was observed in HbA1c at any time point between metformin and placebo groups or within either group. Low-dose metformin likely improves BMI as well as insulin sensitivity in T1DM adolescents, as indicated by a decrease in total daily insulin dose. The decrease in waist circumference indicates that fat distribution is also likely impacted by metformin in T1DM. Further studies with higher metformin doses and more detailed measurements are needed to confirm these results, their underlying mechanisms, and potential impact on CVD in T1DM youth.

The Laryngoscope, 2012

Objectives/Hypothesis-Develop a standardized letter of recommendation (SLOR) for otolaryngology r... more Objectives/Hypothesis-Develop a standardized letter of recommendation (SLOR) for otolaryngology residency application that investigates the qualities desired in residents and letter writer's experience. Compare this SLOR to narrative letters of recommendation (NLOR). Study Design-Prospective SLOR/NLOR Comparison. Methods-The SLOR was sent to a NLOR writer for each applicant. The applicant's NLOR/ SLOR pair was blinded and ranked in seven categories by three reviewers. Inter-rater reliability and NLOR/SLOR rankings were compared. Means of cumulative NLOR and SLOR scores were compared to our departmental rank list. Results-Thirty-one SLORs (66%) were collected. The SLORs had higher inter-rater reliability for applicant's qualifications for otolaryngology, global assessment, summary statement, and overall letter ranking. Writer's background, comparison to contemporaries/predecessors, and letter review ease had higher inter-rater reliability on the NLORs. Mean SLOR rankings were higher for writer's background (p=0.0007), comparison of applicant to contemporaries/predecessors (p=0.0031), and letter review ease (p<0.0001). Mean SLOR writing time was 4.17±2.18 minutes. Mean ranking time was significantly lower (p<0.0001) for the SLORs (39.24±23.45 seconds) compared to the NLORs (70.95±40.14 seconds). Means of cumulative SLOR scores correlated with our rank list (p=0.004), whereas means of cumulative NLOR scores did not (p=0.18). Means of cumulative NLOR and SLOR scores did not correlate (p=0.26). Conclusions-SLORs require little writing time, save reviewing time, and are easier to review compared to NLORs. Our SLOR had higher inter-rater reliability in 4 of 7 categories and was correlated with our rank list. This tool conveys standardized information in an efficient manner.