Clapp, Adrianna D.M.

Background: A 21-question Lifestyle Medicine Assessment (LMA) tool was recently developed to quickly evaluate the lifestyle medicine domains (Avoidance of Substance Use, Nutrition, Connection, Movement, and Recovery). In this study, we used the LMA tool to complete a preliminary analysis of family medicine providers, a group that is known to face challenging lifestyle demands and burnout. Objective: The primary purpose was to assess the LMA domain scores and determine if significant differences exist (among the domains). The secondary purpose was to complete a correlation matrix for the LMA domain scores to better understand the strength of the relationships (among domains). Methods: The participants were 35 family medicine providers and all completed the LMA. The maximum LMA score is 50 (each of the five domains is scored 0-10 points). Pairwise comparisons were used to determine if there were significant differences among the five domain scores (P < .05) and Pearson correlation was used to assess correlations between domains. Results: The overall LMA score was moderate (34.68 ± 6.26). The Recovery domain score (4.71 ± 2.91) was significantly lower (P < 0.01) than the other domains (Connection = 6.94 ± 2.16; Nutrition = 7.41 ± 2.00; Movement = 6.26 ± 2.94; Avoidance of Substance Use = 9.35 ± 1.28). The Avoidance of Substance Use score was significantly higher than the other domains ( P < .01). Overall, the correlation scores among the domains were weak (all r-scores were ≤0.34). Conclusions: For this group of providers, there appears to be substantial room for improvement in four of the five domains. The domain of greatest concern appears to be Recovery. The weak correlation scores suggest that domain scores tend to be independent of each other, and that assessment results are unique to the individual.

Menstrual irregularities and abnormal uterine bleeding have been increasingly reported following severe acute respiratory syndrome coronavirus 2 infection, likely due to viral-induced endocrine disruption and immune dysregulation. A woman in her late 30s, with previously regular menses, developed persistent abnormal uterine bleeding after recovering from coronavirus disease 2019. Lab work-up over the next 2 years demonstrated high follicle-stimulating hormone, low anti-Müllerian hormone, low estrogen, and borderline antinuclear antibody titers. A pelvic ultrasound showed low antral follicle count, and she had challenges with fertility preservation. The patient was suspected of having an exaggerated immune reaction to severe acute respiratory syndrome coronavirus 2 infection with her strong family history of autoimmune disease and borderline antinuclear antibody, which may have led to an autoimmune-induced premature ovarian insufficiency. This case highlights the need to recognize post-viral menstrual irregularities and endocrine dysfunction as a potential consequence of coronavirus disease 2019. Clinicians should consider postinfectious endocrine disturbances in patients with new-onset abnormal uterine bleeding or infertility and evaluate for immune-mediated mechanisms when appropriate. Further research is needed to elucidate the long-term impact of coronavirus disease 2019 on reproductive health.

Abstract: A 49-year-old short-board goofy-stance competitive surfer presented with a 3-month history of bilateral, left foot pain associated with tender soft tissue plantar nodules. Magnetic resonance imaging of the left foot revealed foci of fibrotic tissue within the subcutaneous tissue adjacent to the first and fifth metatarsophalangeal joints compatible with surfers' knots . The patient underwent conservative treatment with oral ibuprofen as needed before competitions, topical diclofenac gel, wide toe box shoes, and use of a double-thick traction pad on his surfboard to alleviate the friction between the metatarsophalangeal joints of his left foot and the surfboard. He reported improvement of symptoms and full return to surfing at 8-month follow-up. We present a case of surfers' knots overlying the left first and fifth metatarsophalangeal joints of a male competitive surfer and highlight recommendations for successful conservative treatment options for symptomatic athletes.

OBJECTIVE The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. METHODS A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. RESULTS There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. CONCLUSION Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.

Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor’s disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor’s disease often resolves spontaneously with supportive care, as in this patient’s case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.

Abstract Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.

Context: Athletes are a unique group of patients whose activities, particularly in high-contact sports such as wrestling and football, place them at high risk of developing skin conditions. The correct diagnosis of sports dermatoses requires familiarity with their clinical characteristics. It is critical that primary care physicians recognize the most common skin disorders to provide prompt treatment and prevent transmission. Evidence Acquisition: The Mayo Clinic library obtained articles from 2012 onward related to dermatologic conditions in athletes. Study Design: Review article. Level of Evidence: Level 3. Results: Dermatologic diseases in athletes are often infectious and contagious due to close-contact sports environments. Sports-related dermatoses include bacterial infections, such as impetigo, ecthyma, folliculitis, abscesses, furuncles, carbuncles, erysipelas, and cellulitis; fungal infections, such as tinea and intertrigo; viral infections, such as herpes, verrucae, and molluscum contagiosum; and noninfectious conditions, such as acne, blisters, and contact dermatitis. Conclusion: This article aims to address the manifestations of the most common cutaneous diseases in athletes on the first primary care visit. It discusses the appropriate tests and most recent evidence-based treatments for each ailment. It also addresses return-to-play recommendations related to the guidelines and regulations of selected sports organizations in the United States. Strength of Recommendation Taxonomy (SORT): C.