Approximately 10-80% of patients with Cystic Fibrosis (CF) have vitamin D deficiency. Obtaining therapeutic vitamin D levels has been a challenge for CF care providers using current recommended high-dose oral ergocalciferol (400,000 IU over 2 months). The objective of this study was to evaluate the safety and efficacy of a 2-week, very high dose ergocalciferol (700,000 IU over 14 days) repletion strategy in children and young adults with CF. As part of a quality improvement initiative, a prospective cohort study was performed from January through May 2007. Phase I included identifying individuals with CF who were subtherapeutic in 25-OH D. In phase II, 50,000 IU of ergocalciferol was prescribed for a 14 day term and administered daily. During phase III, a post treatment 25-OH D level was obtained to determine improvement. Baseline demographics and clinical characteristics were obtained at study entry. Stratification of the post 25-OHD levels was defined. Eighteen individuals with CF participated in the study. The mean age was 17+/-5 years (range 6-25 years). One hundred percent were pancreatic insufficient and required pancreatic enzyme replacement. All 18 had 25-OHD levels less than 30 ng/mL pre-treatment. Seventeen of the 18 (94%) participants became therapeutic in the 2-week interval. No patients had values considered high abnormal (100-150 ng/mL) or toxic (>150 ng/mL). Mean change was noted at an increase of 37.3+/-22 ng/mL in the 2-week period (p<0.001). Pre and peripubertal individuals had a significantly greater increase in 25-OH D levels. The results of this study demonstrate that very high dosing of vitamin D using oral ergocalciferol over a 14 day period is an effective strategy in achieving therapeutic levels of 25-OH vitamin D in children and young adults with CF. We believe this regimen deserves further study.

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ScienceAlthough mandatory newborn screening throughout the United States for cystic fibrosis (CF) has resulted in increased sweat chloride testing for infants, obtaining an adequate volume of sweat to perform this test has remained a challenge. Currently, the standard as established by the National Clinical and Laboratory Standards Institute (NCCLS) for patients older than 3 months is to achieve a less than 5% quantity not sufficient rate (QNS) rate. 1 Nonetheless, studies 2-4 examining QNS rates at various health care centers show significant variability, with data published from accredited CF centers 2 demonstrating QNS rates as high as 19% for infants older than 3 months. For infants who may undergo a sweat test at age 3 months or younger as part of a newborn and infant screening program, QNS rates are higher, with a value of 32.8% reported in one study. 3 Recently, a goal of less than 10% QNS was suggested for infants undergoing sweat testing as part of newborn screening. 2,3 Further, although several consensus statements and guidelines 2-4 detail ways to achieve lower QNS rates, data that demonstrate results achievable via a comprehensive quality improvement (QI) effort are lacking.Screening of newborns for CF using the dried-blood spot 2-tiered immunoreactive trypsinogen/DNA method began in 2008 in the state of Illinois. All positive screening results require subsequent sweat chloride testing. 5 The Cystic Fibrosis Center of Chicago (CFCC) at St. Alexius Medical Center (SAMC) was selected as one of the designated newborn screening centers for the state of Illinois for sweat testing. The laboratory at SAMC is accredited by the College of American Pathologists (CAP) and for implementing the newborn and infant screening program at the CFCC at SAMC. Clinical and Laboratory Standards Institute (CLSI) guidelines for sweat testing 1 were closely followed and several technicians were selected to perform this test. After an initial testing period, reevaluation and development of an ongoing QI program for sweat testing were instituted to improve the QNS rates in all age groups. MethodsAll sweat tests were performed by pilocarpine iontophoresis via the Macroduct coil sweat collection system (Wescor, Logan, UT) and quantitatively analyzed for chloride concentration using a digital coulometric chloridometer (LabConco, Kansas, MO). All tests from the beginning of the program in Abstract Background: Obtaining an adequate volume of sweat to measure chloride is a challenge for many cystic fibrosis centers. The standard for patients older than 3 months is a less than 5% quantity not sufficient (QNS) rate; the suggested goal for patients aged 3 months or younger is a less than 10% QNS rate. St. Alexius Medical Center (SAMC) began performing sweat chloride testing in 2008. After an initial period of testing, a quality improvement (QI) program for sweat testing was instituted to improve QNS rates.

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This brief report presents a model that incorporates an analogous “see-one,” “do-one,” “teach-one” pedagogical strategy and experiential learning for mastery of health literacy principles by first-year Master of Science in Physician Assistant Studies students. Students completed a series of health literacy activities including classroom-based lecture (see-one), hands-on application of health literacy activities (do-one), and application and peer-instruction of health literacy best practices with other health science students (teach-one) as part of a two-semester hands-on learning experience. A health literacy knowledge examination, qualitative student feedback, and faculty review of content application were used to assess for effectiveness. Students demonstrated a significant and sustained positive change in knowledge examination scores complemented by positive faculty poster review. Physician Assistant student health literacy knowledge is increased and sustained after application of see-one, do-one, teach-one strategy with students demonstrating health literacy considerations in real-client application during experiential learning. Education programs seeking to meet the call for health professionals prepared to address gaps in health literacy should consider a see-one, do-one, teach-one and experiential learning approach over multiple semesters. [ HLRP: Health Literacy Research and Practice. 2021;5(1):e70–e77.]