Julia J. Chang, MD

All Publications

• Patient and caregiver perspectives of fluid discharge protocols following pituitary surgery. Journal of clinical & translational endocrinology Chang, J. J., Amano, A., Brown-Johnson, C., Chu, O., Gates-Bazarbay, V., Wipff, E., Kling, S. M., Alhadha, M., Carlos Fernandez-Miranda, J., Vilendrer, S. 2024; 35: 100336

  Abstract

  Post-operative fluid restriction after transsphenoidal surgery (TSS) for pituitary tumors may effectively prevent delayed hyponatremia, the most common cause of readmission. However, implementation of individualized fluid restriction interventions after discharge is often complex and poses challenges for provider and patient. The purpose of this study was to understand the factors necessary for successful implementation of fluid restriction and discharge care protocols following TSS.Semi-structured interviews with fifteen patients and four caregivers on fluid discharge protocols were conducted following TSS. Patients and caregivers who had surgery before and after the implementation of updated discharge protocols were interviewed. Data were analyzed inductively using a procedure informed by rapid and thematic analysis.Most patients and caregivers perceived fluid restriction protocols as acceptable and feasible when indicated. Facilitators to the protocols included clear communication about the purpose of and strategies for fluid restriction, access to the care team, and involvement of patients' caregivers in care discussions. Barriers included patient confusion about differences in the care plan between teams, physical discomfort of fluid restriction, increased burden of tracking fluids during recovery, and lack of clarity surrounding desmopressin prescriptions.Outpatient fluid restriction protocols are a feasible intervention following pituitary surgery but requires frequent patient communication and education. This evaluation highlights the importance of patient engagement and feedback to effectively develop and implement complex clinical interventions.

  View details for DOI 10.1016/j.jcte.2024.100336

  View details for PubMedID 38545460

  View details for PubMedCentralID PMC10965805

• Fertility issues in hypopituitarism. Reviews in endocrine & metabolic disorders Chen, J., Chang, J. J., Chung, E. H., Lathi, R. B., Aghajanova, L., Katznelson, L. 2023

  Abstract

  Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.

  View details for DOI 10.1007/s11154-023-09863-9

  View details for PubMedID 38095806

• Use of the Community of Inquiry Framework to Measure Student and Facilitator Perceptions of Online Flipped Classroom Compared with Online Lecture Learning in Undergraduate Medical Education. Advances in medical education and practice Chang, J. J., Hain, A., Dosiou, C., Gesundheit, N. 2023; 14: 963-972

  Abstract

  Background: The COVID-19 pandemic and a movement away from traditional lecture-based learning have increased the use of online flipped classroom (FC) and active learning models in medical education. The Community of Inquiry (CoI) framework for online learning may be used to evaluate the effectiveness and strengths of the online FC model compared with other learning formats.Methods: An observational survey study was conducted to measure medical student and facilitator perceptions of an online FC endocrinology tutorial compared with online lecture experiences. For the tutorial, students were instructed to watch short, pre-recorded lecture videos on thyroid pathophysiology prior to class. During class, small groups of students were paired with a faculty facilitator in online Zoom rooms for case discussion. Students were surveyed using the CoI framework to assess elements of cognitive, social, and teaching presence between the two online learning modalities. Facilitators were also surveyed. Survey questions were rated on a 5-point Likert scale.Results: Fifty-three out of 92 students (58% response rate) and seven out of eight facilitators (88% response rate) completed surveys. In general, students felt that online FC learning improved cognitive, teaching, and social presence compared with online lecture. Areas of cognitive presence (mean score 3.9 ± 1.0 SD), such as stimulating curiosity and applying concepts, were highly rated. Certain elements of social presence (3.6 ± 0.9) and teaching presence (3.7 ± 0.9), such as expression of emotion and communication of expectations, garnered lower ratings. All surveyed facilitators felt that online FC was more effective and enjoyable to teach than online lectures but did not feel it was superior to in-person instruction.Conclusion: Medical students and facilitators viewed an online FC tutorial in endocrinology positively. Most, but not all, areas of the CoI framework were enhanced with the online FC tutorial compared with online lecture-based learning.

  View details for DOI 10.2147/AMEP.S413201

  View details for PubMedID 37701423

• Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special. Journal of fungi (Basel, Switzerland) Villar-Prados, A., Chang, J. J., Stevens, D. A., Schoolnik, G. K., Wang, S. X. 2021; 7 (8)

  Abstract

  A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole's mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.

  View details for DOI 10.3390/jof7080620

  View details for PubMedID 34436160

• A RETROSPECTIVE STUDY EXAMINING PHENTERMINE ON PRECONCEPTION WEIGHT LOSS AND PREGNANCY OUTCOMES. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Chang, J. J., Lathi, R. B., Kim, S. H. 2020

  Abstract

  Background: Obesity is a well-known risk factor for infertility. However, use of weight loss medications prior to conception is underutilized. The objectives of our study are to describe weight loss, pregnancy rates, and live birth rates after short-term phentermine use in women with obesity and infertility. Methods: This was a retrospective analysis of 55 women (18-45 years old) who were overweight or obese, diagnosed with infertility, and prescribed phentermine for weight loss in an ambulatory endocrinology clinic at a single, tertiary level academic medical center. Main outcome measures were mean percent weight change at 3 months after starting phentermine and pregnancy and live birth rates from start of phentermine to June 30, 2017. Results: Median duration of phentermine use was 70 days (Q1, Q3 [33, 129]). Mean ± SD percent weight change at 3 months after starting phentermine was -5.3 ± 4.1% (p < 0.001). The pregnancy rate was 60% and live birth rate was 49%. There was no significant difference in pregnancy rates (52% vs. 68%, p = 0.23) or live birth rates (44% vs. 54%, p = 0.50) in women who lost ≥5% vs. <5% of their baseline weight. Number of metabolic comorbidities was negatively associated with pregnancy rate. Phentermine was generally well tolerated with no serious adverse events. Conclusions: Phentermine can produce clinically significant weight loss in women with obesity during the preconception period. Higher pregnancy or live birth rates were not observed with greater degree of weight loss with phentermine.

  View details for DOI 10.4158/EP-2019-0609

  View details for PubMedID 32407664

• LIMITED CARBOHYDRATE REFEEDING INSTRUCTION FOR LONG-TERM WEIGHT MAINTENANCE FOLLOWING A KETOGENIC, VERY-LOW-CALORIE MEAL PLAN. Endocrine practice Chang, J. J., Bena, J., Kannan, S., Kim, J., Burguera, B., Kashyap, S. R. 2017

  Abstract

  Weight-loss maintenance following very-low-calorie meal plans is poorly studied. This report describes weight-loss efficacy and predictors of weight-loss maintenance of a ketogenic, very-low-calorie meal plan (protein-sparing modified fast, PSMF) in people with obesity.A total of 127 consecutive adults in the PSMF meal plan (27.2 ± 19.5 weeks) and 48 adults on a conventional, hypocaloric meal plan (23.6 ± 20.8 weeks) were retrospectively studied for percent weight change from baseline to end of intervention and at 6, 12, and 24 months postintervention. Baseline factors were analyzed for correlations with weight-loss maintenance.At end of intervention, weight loss from baseline was greater for the PSMF group compared to the conventional intervention group (-12.4% vs. -2.6%; P<.001) but was similar between groups by 12 months postintervention. PSMF subjects who attended follow-up visits to receive instruction on gradual and limited carbohydrate refeeding after ketosis saw significant weight loss at the end of PSMF compared to those who did not follow-up to receive instruction (-17.5% vs. -8.0%; P<.001) and maintained greater weight loss through 12 months post-PSMF (-9.8% vs. -1.5%; P<.001). Higher baseline body mass index correlated with less weight loss at 12 months post-PSMF (P = .035).PSMF results in effective short-term weight loss of more than 5% from baseline weight. Follow-up for limited carbohydrate refeeding instruction is important for weight-loss maintenance up to 2 years after initial weight loss.BMI = body mass index; PSMF = protein-sparing modified fast.

  View details for DOI 10.4158/EP161383.OR

  View details for PubMedID 28225305

• A Student-Led Introduction to Lesbian, Gay, Bisexual, and Transgender Health for First-Year Medical Students FAMILY MEDICINE Grosz, A. M., Gutierrez, D., Lui, A. A., Chang, J. J., Cole-Kelly, K., Ng, H. 2017; 49 (1): 52-56

  Abstract

  Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant health disparities. This is in part because many physicians are not sensitive to, and/or are underprepared to address, LGBT-specific concerns. To help meet this need, we, a group of second- and fourth-year medical students with faculty oversight, organized a session on LGBT health for first-year medical students.The three second-year and one fourth-year student authors designed a mandatory session for the 167 first-years at Case Western Reserve University School of Medicine in Cleveland, OH. The 2-hour session consisted of a student-delivered presentation, a patient panel, and a small-group session. Students' LGBT health knowledge and confidence in providing care were assessed anonymously before and after the session, and individuals' pre- and post-session assessments were paired using student-generated identifiers.A total of 73 complete, matched pre-/post-session assessments were received. Students' familiarity with LGBT terminology and demographics increased significantly after the session. Students' perceived preparedness and comfort in providing LGBT-specific care significantly improved in most areas as well. Students strongly praised the session, in particular the patient panel.A student-led educational session on LGBT health can effectively improve first-year medical students' LGBT knowledge and confidence to provide care.

  View details for Web of Science ID 000397087700009

  View details for PubMedID 28166581

• The protein-sparing modified fast for obese patients with type 2 diabetes: what to expect. Cleveland Clinic journal of medicine Chang, J., Kashyap, S. R. 2014; 81 (9): 557-565

  Abstract

  The protein-sparing modified fast (PSMF) is a very-low-calorie diet containing mostly protein and little carbohydrate. This article reviews the principles of the PSMF and its potential benefits in terms of weight loss, glycemic control, insulin resistance, cardiovascular risk factors, and related complications for patients with type 2 diabetes.

  View details for DOI 10.3949/ccjm.81a.13128

  View details for PubMedID 25183847