Weatherly, Renee M.

Introduction: Limited research explores dermoscopy use among physician associates (PAs), outside of one prior study examining dermoscopy in PA student education. This study sought to investigate dermoscopy use among practicing PAs and its impact on their overall diagnostic confidence, including in darker skin tones, when differentiating between benign and malignant skin lesions. Methods: An anonymous survey was developed in 2023 with input from experts in dermoscopy and survey creation to assess PA confidence in skin lesion evaluation as well as PA dermoscopy knowledge and use, perceptions, barriers to use, and prior education. The dermoscopy survey was included as an optional module in the 2024 American Academy of Physician Associates (AAPA) Salary Survey. Results: Of 3,174 invited PAs, 995 (31.4%) responded. Most had never used dermoscopy in practice (81%) but knew or recognized the term (71%). A majority (53%) believed PAs should be trained in dermoscopy during PA school, and 26% reported no interest in future dermoscopy use. Dermatology PAs reported more frequent dermoscopy use and generally greater confidence in evaluating skin lesions, both overall and in darker skin tones, than PAs in other specialties. PAs in surgical (OR=0.2, 95% CI 0.1-0.6) and medical (OR=0.3, 95% CI 0.2-0.5) subspecialties were less likely to use dermoscopy at least annually compared with PAs in primary care. PAs in rural areas were more likely to feel confident in differentiating skin lesions than those in urban areas (OR 2.9, 95% CI 1.7-5.0). Conclusion: Dermoscopy use is associated with higher overall skin lesion assessment confidence. Wider adoption, especially outside dermatology, requires training, increased advocacy, and expanded education.

Introduction/Objective: As fewer physicians enter primary care, Advanced Practice Providers (APPs) play an increasingly important role in meeting the demand for patient care. Factors contributing to work status changes among primary care APPs are not well studied. We aimed to evaluate differences in primary care APP work status across electronic health record (EHR) workload measures. Methods: We conducted a retrospective cohort study within a Midwestern healthcare system from 2020 to 2022, evaluating the relationship between primary care APP work status defined as retention at current full-time equivalent (FTE), reduction of FTE within primary care, or relocation outside of primary care and 3 time-based EHR workload metrics. Descriptive statistics, univariate, and multivariable analyses were reported. Results: There were no differences between work status (retained, reduced, or relocated) across the EHR workload measurements of in-basket time per appointment, system time per appointment and note time per appointment ( P > .05) on univariate analysis. With multivariable analysis, there was no difference in likelihood of combined relocation/reduction adjusting for EHR workload variables ( P > .05). Conclusion: The EHR workload was not associated with work status changes for primary care APPs in our study. Further exploration is needed to identify factors that may contribute to reduction in primary care APP workforce capacity.

Vitamin D (VitD) is an essential nutrient for preventing rickets in breastfeeding infants. Maternal supplementation is the preferred method for infant nutrition, yet concentrations of VitD and 25-hydroxyvitamin D (25OHD) in breastmilk are low unless the mother consumes substantial doses of vitamin D. Recently, we reported that sulfate-conjugated forms of vitamin D (VitD-S) and 25-hydroxyvitamin D (25OHD-S) are present in breast milk. Freshly expressed breast milk from mothers who were vitamin D-sufficient (serum 25OHD >50 nmol/L) contained approximately 6 nmol/L VitD-S and 0.5 nmol/L 25OHD-S. It is hypothesized that these sulfated metabolites are contributing to the total vitamin D nutritional value of milk; however, their physiological roles in infant nutrition are not yet understood. In order to assess their nutritional value, we evaluated two aspects that can affect the delivery and uptake of the nutrients by infants: breast milk storage and infant digestion. The United States Centers for Disease Control and Prevention recommends that breast milk can be stored safely at room temperature (22°C) for ≤4 hours, in refrigeration (4°C) for <4 days, or frozen (-20°C) for 6 months. After implementing the recommended storage conditions on breast milk samples, the metabolites, VitD-S and 25OHD-S, were measured by LC-MS/MS and UV spectroscopy. We observed that in breast milk stored at room temperature or 4°C, the metabolites undergo molecular degradation by isomerization within 24 hrs. Therefore, breast milk stored overnight (>8 h) in refrigeration will not provide the sulfated vitamin D metabolites to the infants. To evaluate molecular integrity of the sulfated metabolites during infant digestion, we collected saliva and fecal matter samples from infants, 1-6 months of age, who were either exclusively breastfed or breastfed and supplemented with formula ( ClinicalTrials.gov , NCT 06203041). The sulfatase enzymatic activity was assessed in the saliva and fecal matter samples by colorimetric assay. Overall, the sulfatase activity (mean ± SD) in saliva was 0.8 ± 0.7 nM/mg/min, ranging 0.0-2.5 nM/mg/min (n=13). The sulfatase activity in fecal samples was significantly greater than saliva ( P = 0.009), averaging 1.8 ± 1.4 nM/mg/min and ranging 0.1-4.9 nM/mg/min (n = 9) across infant samples. In a comparison between infants based on diet, we observed greater sulfatase activity in the fecal matter of exclusively breastfed infants than in infants that were breastfed with formula ( P = 0.056). This observational study is ongoing and not yet statistically powered. The presence of sulfatase activity in the infant digesta suggests that VitD-S and 25OHD-S are subject to enzymatic sulfate hydrolysis prior to absorption. Furthermore, infants who are exclusively breastfed may utilize the hydrolysis pathway more effectively than infants who are supplemented with formula. In summary, the nutritional value of VitD-S and 25OHD-S is affected by both milk storage and infant digestion. Future clinical studies investigating vitamin D nutrition in breastfed infants should consider evaluating storage of breast milk and diet of the infant as important parameters in the statistical models and analyses. The Mayo Clinic Parker D. Sanders & Isabella G. Sanders Professor of Family Medicine Endowment, Mayo Clinic Women’s Health Center Pilot Award Project. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Background: Proper diagnosis in primary care is crucial due to the large number of skin cancer diagnoses each year and its associated growing economic burden. Understanding how primary care providers can be best trained in dermoscopy is instrumental in helping primary care providers differentiate benign and malignant cutaneous lesions so that appropriate action can be taken (eg, biopsy/referral to dermatology or reassurance). Objective: To assess the success of concise dermoscopy training among primary care providers. Design: A cohort study was conducted in primary care at Mayo Clinic, Rochester, including primary care physicians, nurse practitioners, and physician assistants in internal medicine and family medicine. Diagnostic accuracy was measured on standardized testing through image-based recognition and in clinical practice through observation of referral and biopsy patterns both before and after dermoscopy education, focused on the TADA plus method. Results: Forty-three primary care providers completed the image-based recognition tests, with significant improvement in mean score measured after dermoscopy training workshop (20%). Among the thirteen primary care providers who continued to use dermoscopy in clinical practice, a significant improvement (31%) in mean clinical diagnostic accuracy was observed comparing 1 year of practice data before versus after dermoscopy training. Conclusion: Improvement in diagnostic accuracy with utilization of the TADA plus method translates into clinical practice. Therefore, training primary care providers in dermoscopy may improve the dermatologic care patients receive in primary care, especially in rural or medically underserved areas where access to dermatology is limited.

AbstractBackgroundFrailty and decreased functional status are risk factors for adverse kidney transplant (KT) outcomes. Our objective was to examine the efficacy of an exercise intervention on frailty and decreased functional status in a cohort of patients with advanced chronic kidney disease (CKD).MethodsWe conducted a prospective study involving 21 adults with ≥stage 4 CKD who were (a) frail or pre‐frail by Fried phenotype and/or (b) had lower extremity impairment [short physical performance battery score ≤10]. The intervention consisted of two supervised outpatient exercise sessions per week for 8 weeks.ResultsAmong our cohort, median participant age was 62 years (interquartile range, 53‐67) and 85.7% had been evaluated for KT. Following the study, participants reported satisfaction with the intervention and multiple frailty parameters improved significantly, including fatigue, physical activity, walking time, and grip strength. Lower extremity impairment also improved (90.5%‐61.9%, P = .03). No study‐related adverse events occurred.ConclusionsPreliminary data from this study suggest that a supervised, outpatient exercise intervention is safe, acceptable, feasible, and associated with improved frailty parameters, and lower extremity function, in patients with advanced CKD. Further studies are needed to confirm these findings and determine whether this prehabilitation strategy improves KT outcomes.