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What lipodystrophies teach us about the metabolic syndrome.

ABSTRACT: Lipodystrophies are the result of a range of inherited and acquired causes, but all are characterized by perturbations in white adipose tissue function and, in many instances, its mass or distribution. Though patients are often nonobese, they typically manifest a severe form of the metabolic syndrome, highlighting the importance of white fat in the "safe" storage of surplus energy. Understanding the molecular pathophysiology of congenital lipodystrophies has yielded useful insights into the biology of adipocytes and informed therapeutic strategies. More recently, genome-wide association studies focused on insulin resistance have linked common variants to genes implicated in adipose biology and suggested that subtle forms of lipodystrophy contribute to cardiometabolic disease risk at a population level. These observations underpin the use of aligned treatment strategies in insulin-resistant obese and lipodystrophic patients, the major goal being to alleviate the energetic burden on adipose tissue.

SUBMITTER: Mann JP

PROVIDER: S-EPMC6763226 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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What lipodystrophies teach us about the metabolic syndrome.

Mann Jake P JP Savage David B DB

The Journal of clinical investigation 20190805 10

Lipodystrophies are the result of a range of inherited and acquired causes, but all are characterized by perturbations in white adipose tissue function and, in many instances, its mass or distribution. Though patients are often nonobese, they typically manifest a severe form of the metabolic syndrome, highlighting the importance of white fat in the "safe" storage of surplus energy. Understanding the molecular pathophysiology of congenital lipodystrophies has yielded useful insights into the biol ...[more]

PMID: 31380809

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Project description:BACKGROUND:Teach Back is a health communication strategy used to confirm patient understanding in a non-shaming way. Although Teach Back is widely recommended as a best practice strategy for improving patient outcomes and organizational health literacy, there is lack of consensus in the literature on the definition of Teach Back and the best methods for training health care workers (HCWs). Our experience suggests that if you teach specific, observable skills, these can be identified in practice and potentially measured in research. BRIEF DESCRIPTION OF ACTIVITY:We created a training program, the 5Ts for Teach Back, based on a standardized operational definition of Teach Back and five specific, observable components. Participants use a Teach-Back Observation Tool to identify the 5Ts in practice and during peer evaluation. The program incorporates lecture, observation, practice, and videos with good and bad examples of Teach Back. IMPLEMENTATION:The training was offered to HCWs in a large academic health care system. Flexible training options ranged from a single 4-hour training to a more comprehensive program that included clinic-specific scenarios, peer coaching, and refresher activities over a 6-month period. RESULTS:The 5Ts for Teach Back operationalizes the definition of Teach Back and provides a model for training HCWs in the use of Teach Back. The 5Ts for Teach Back can be used to train any HCW. A single training session does not guarantee proficiency in practice. Through coaching and refresher activities, competence in Teach Back increases. LESSONS LEARNED:Teaching entire clinical units may increase effectiveness, because Teach Back becomes embedded in the unit culture. The Observation Tool can be used for training, coaching, and evaluation. The standardized method and Observation Tool are potentially useful when evaluating Teach Back during outcomes and patient satisfaction research. [HLRP: Health Literacy Research and Practice. 2020;4(2):94-103.] PLAIN LANGUAGE SUMMARY: Health care workers may be clearer when giving information to patients if they use Teach Back. Studies do not show what methods are best for training health care workers how to do Teach Back. The 5Ts method breaks Teach Back into five skills that help health care workers do it well. The 5Ts can also confirm use and may be helpful for research.

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What lipodystrophies teach us about the metabolic syndrome.

Publications

What lipodystrophies teach us about the metabolic syndrome.

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