Bhagra, Anjali

The clinical use of ultrasound has dramatically increased, necessitating early ultrasound education and the development of new tools in ultrasound training and assessment. The goal of this study was to devise a novel low‐resource examination that tested the anatomical knowledge and technical skill of early undergraduate medical students in a gross anatomy course. The team‐based ultrasound objective structured practice examination (OSPE) was created as a method for assessing practical ultrasound competencies, anatomical knowledge, and non‐technical skills such as teamwork and professionalism. The examination utilized a rotation of students through four team roles as they scanned different areas of the body. This station‐based examination required four models and four instructors, and tested ultrasound skills in the heart, abdominal vessels, abdominal organs, and neck regions. A Likert scale survey assessed student attitudes toward the examination. Survey data from participants (n = 46) were examined along with OSPE examination grades (n = 52). Mean and standard deviations were calculated for examination items and survey responses. Student grades were high in both technical (96.5%). and professional (96.5%) competencies with structure identification scoring the lowest (93.8%). There were no statistical differences between performances in each of the body regions being scanned. The survey showed that students deemed the examination to be fair and effective. In addition, students agreed that the examination motivated them to practice ultrasound. The team‐based OSPE was found to be an efficient and student‐favored method for evaluating integrated ultrasound competencies, anatomical knowledge, team‐work, and professional attributes.

Purpose Integrative therapies such as yoga are potential treatments for many psychological and physical symptoms that occur during and/or after treatment for cancer. The purpose of the current study was to evaluate the patient-perceived benefit of yoga for symptoms commonly experienced by breast cancer survivors. Methods 1,049 breast cancer survivors who had self-reported use of yoga on a follow up survey, in an ongoing prospective Mayo Clinic Breast Disease Registry (MCBDR), received an additional mailed yoga-focused survey asking about the impact of yoga on a variety of symptoms. Differences between pre- and post- scores were assessed using Wilcoxon Signed Rank Test. Results 802/1,049 (76%) of women who were approached to participate, consented and returned the survey. 507/802 (63%) reported use of yoga during and/or after their cancer diagnosis. The vast majority of respondents (89.4%) reported some symptomatic benefit from yoga. The most common symptoms that prompted the use of yoga were breast/chest wall pain, lymphedema, and anxiety. Only 9% of patients reported that they had been referred to yoga by a medical professional. While the greatest symptom improvement was reported with breast/chest wall pain and anxiety, significant improvement was also perceived in joint pain, muscle pain, fatigue, headache, quality of life, hot flashes, nausea/vomiting, depression, insomnia, lymphedema, and peripheral neuropathy, (all p-values <0.004). Conclusion Data supporting the use of yoga for symptom management after cancer are limited and typically focus on mental health. In this study, users of yoga often reported physical benefits as well as mental health benefits. Further prospective studies investigating the efficacy of yoga in survivorship are warranted.

Objective Increasing adoption of social media have revolutionized communications between individuals, groups, and organizations This research study was designed to assess the knowledge, skills, and attitudes of internal medicine physicians’ awareness and engagement with social media (sometimes referred to as #SoMe) within the digital landscape of healthcare delivery. Methods An audience-response survey focused on social media “ Social media in Healthcare: Physician Survey,” was administered during the “A Systematic Approach to Medically Unexplained Symptoms” continuing medical education conference. The Conference took place between August 22, 2019 and August 24, 2019. Data was collected on August 23, 2019. A range of 103 (59.5%) to 112 (64.7%) of the total 173 attendees participated in this cross-sectional audience-response survey, depending on the questions answered. Results Most responders were between the ages of 35 and 65 years (79.6%) and female (60.2%). A majority of responders were aware of social media terminology (88.7%), and many had used it personally (46.7%), but only 12% knew how to use social media to search medical topics, 18% used it to network professionally and most (68.9%) had a distrust of social media when it came to the protection of their privacy or their patients’ privacy. Overall, about 29.6% indicated an interest in future continued medical education focused on social media (and 27.4% were neutral). Conclusions Approximately half of the responders used social media but far less engaged its platforms for professional use likely due to privacy related concerns. Distance from academic institutions, where professional social media use is more common likely, played a role in aversion. Awareness of social media’s role in healthcare has increased among physicians in practice, however their participation and knowledge of opportunities remains limited.

Abstract Introduction Medical education is moving to conceptualise feedback as a bidirectional learning conversation. Within this conversation, learners experience a tension between assessment and feedback. That perceived tension affects learners’ outward performances. In this study, we aimed to characterise residents’ experiences with this tension and its effect on learner authenticity within feedback conversations. Methods In this constructivist grounded theory study, the authors were informed by Goffman's theory of impression management. During data analysis, Dweck's theory of mindset was adopted. The authors conducted semi‐structured interviews with 15 internal medicine residents. Data collection and analysis were conducted iteratively, using constant comparison to identify themes coinciding with impression management and mindset, ultimately developing a theoretical model to help explain residents’ responses to tensions within feedback conversations. Results Residents constantly felt ‘scrutinized’, and this affected their engagement in feedback conversations. They staged a performance within those conversations, linked to their underlying mindset: growth or fixed. Growth mindset was characterised by a focus on development as a physician and was associated with asking questions and seeking opportunities for growth. Fixed mindset was characterised by a focus on achieving a favourable evaluation and was associated with a hesitation to ask questions when faced with uncertainty and admit opportunities for growth, because they were concerned about impression management. Context influenced mindset and impression management. Residents adopted a fixed mindset and managed impressions when they perceived the permanence or consequences of evaluations within feedback. Residents adopted a growth mindset when they trusted the supervisor. Discussion Residents assess the context of feedback conversations, altering the authenticity of their behaviours. Context, including the perceptions of formal assessment and relationships with supervisors, affected residents’ mindset and impression management. Providing space for relationship‐building and clarifying the purpose and structure of assessment may be helpful in supporting effective learning conversations in graduate medical education.

In recent years, the use of point of care ultrasound (POCUS) in clinical practice has increased substantially . Many medical schools have introduced ultrasound skills training into their curriculum which starts early in anatomy courses . Few, if any, of these programs assess students’ ultrasound knowledge and skills in a simulated clinical team environment. Anatomy Ultrasound Objective Structural Practical Examination (OSPE) implemented as a part of practical examination provides such an opportunity to asses both traditional and non‐traditional discipline‐independent skills, competencies and attributes. As part of the seven‐week anatomy course at Mayo Clinic Alix School of Medicine, first‐year medical students attended four ultrasound sessions. Each session included a short didactic module followed by hands‐on practice guided by near‐peer teachers. For the final examination, four‐member student teams were required to work collaboratively to perform four different scans during which students interacted with multiple standardized patients and rotated responsibility for obtaining an image, orienting the image, and identifying assigned structures. Students were graded using a rubric and received a team‐score based on tasks associated with individual roles of team members. In addition to ultrasound skills, the nature of their professional interactions with patient, communication skills, and situational awareness were assessed. The average team score was 96%. The students completed a survey at the conclusion of the anatomy course in which they rated the OSPE experience very positively. Team‐based OSPE examination was a clinically relevant and effective mechanism to simultaneously evaluate anatomic knowledge, clinical skills, and non‐traditional discipline‐independent skills that were emphasized during the anatomy course. Support or Funding Information

Abstract Background Nurse leaders who are mothers are at significant risk for experiencing stress, burnout, and occupational fatigue. Authentic Connections (AC) Groups is an intervention shown to be effective for fostering resilience among at‐risk moms, including physicians; however, it has not previously been tested with nurse leaders. Aims Our aims were to test the feasibility and acceptability of the AC Groups intervention with nurse leader mothers and examine its effects on participant resilience, as measured by increased self‐compassion and decreased distress, depression, perceived stress, and burnout. Methods A randomized controlled trial design was employed for this pilot study, with 36 nurse leaders at Mayo Clinic. AC participants attended group sessions for an hour per week for 12 weeks. Control group members were provided 1 hr per week of free time over 12 weeks. Multiple self‐report psychological measures were completed at baseline, post‐intervention, and 3‐month follow‐up. Results The AC Groups intervention was feasible and well‐received by nurse leaders. Session attendance rates averaged 92%. Despite the small n ’s, repeated measures of Analysis of Variance showed significantly greater improvements ( p < .05) for participants in the AC Groups than control condition for depression, self‐compassion, and perceived stress, with large effect sizes ( 0.18–0.22). In addition, effect sizes for anxiety and feeling loved approximated the moderate range ( 0.05 and .07). Linking Evidence to Action The AC intervention shows promise as a feasible intervention for mitigating nurse leader mothers’ stress by positively impacting indices of well‐being, including depression, self‐compassion, and perceived stress. Given, the prevalence of stress and burnout among nurse leaders, the effectiveness of the AC intervention in fostering resilience in this population has significant implications for research and practice. Further research is warranted with larger numbers from multiple sites, longer follow‐up periods, and biomarker measures of stress.

Background: Breast cancer diagnosis and treatment affect quality of life and stress and are associated with fatigue. Meditation interventions are effective strategies for patients with breast cancer but are often limited by poor access, high cost, substantial time commitment, and poor adherence. In this feasibility study, we investigated the use of a portable, wearable, electroencephalographic device for guided meditation practices by breast cancer patients during the period from breast cancer diagnosis until 3 months after surgical treatment. Methods: We enrolled women (age = 20-75 years) who had received a recent diagnosis of breast cancer and planned to undergo surgical treatment. Participants were randomly assigned to perform guided meditation with the device (intervention group) or receive CD-based stress-reduction education (control group). Surveys were used to measure stress, quality of life, and fatigue at baseline, within 4 days before surgery, up to 14 days after surgery, and at 3 months after surgery. Results: In the intervention group, 15 of 17 participants (88.2%) completed the study; in the control group, 13 of 13 participants completed the study (100%). Participants in both groups had less fatigue and stress and improved quality of life at 2 weeks and 3 months after surgery compared with baseline, but there were no significant intergroup differences at any time point. Conclusion: The use of this wearable electroencephalographic device for meditation is a feasible strategy for patients with breast cancer.

Atrial fibrillation is the most common symptomatic arrhythmia that is associated with stroke. Contemporary management of the disease is focused on anticoagulation to prevent stroke, coupled with catheter ablation to limit symptoms and prevent deleterious cardiac remodeling. Emerging data highlights the importance of lifestyle modification by managing sleep apnea, increasing physical activity, and weight loss. There is significant data that supports a link between the autonomic nervous system, arrhythmia development, and atrial fibrillation therapy. It is likely that lifestyle modification through these techniques that are aimed to reduce stress may also mediate atrial fibrillation development through this mechanism. This review examines how mind and body practices such as meditation, yoga, and acupuncture may influence the autonomic nervous system and mitigate atrial fibrillation progression and regression. Available evidence from molecular and anatomical levels through to clinical observations and translational clinical trials were scrutinized and a case established for these interventions as potential powerful mediators of anti-arrhythmic benefit.

Abstract Introduction: There is insufficient knowledge about the feasibility and effect of mind-body intervention on QOL and stress at initial diagnosis and shortly after undergoing breast cancer surgical treatment. The pre-operative and post-operative period can be stressful, distressing and anxiety provoking for many women. Mind-body interventions such as meditation, relaxation and mindfulness can offset distress and is an option to cope with the stresses of treatment. We investigated the role of wearable mindfulness based technology in patients newly diagnosed breast cancer patients. Methods: This randomized study compared the Muse EEG mindfulness sensing headset device (n=16) to a stress reduction education control group (n=13). Primary outcomes included quality of life (QOL), stress, and fatigue via validated, standardized scales/subscales: Functional Assessment of Cancer Therapies – General (FACT-G), Multidimensional Fatigue Symptom Inventory – Short Form (MFSI-SI), and the Perceived Stress Scale (PSS). Participants from an academic cancer center were randomized to the wearable device or stress education material prior to surgery. Participants completed questionnaires at initial diagnosis and at specific time points during the breast cancer surgical journey: pre-surgery, post-surgery (2 weeks), and at 3 months. Usage was directly from Muse and via written log. Was It Worth It (WIWI) survey was conducted at 3 months. Results: Mindfulness via the headset devise was feasible and worthwhile (71.4% intervention group). The scales of QOL, fatigue, and stress improved in both groups at 3 months compared to baseline (MFSI-E, MFSI-M, MFSI-V, FACT-EWB, and PSS). Participants randomized to the mindfulness headset device had improved fatigue and QOL at 2 weeks post-operatively (MFSI-E, MFSI-V, MFSI-T, FACT-PWB, FACT-EWB) and in total MFSI at 3 months. The results were not significantly different between groups. High mindfulness headset utilizers (&gt;30 sessions) compared to below average utilizers differed at the 3 month visit in fatigue and QOL (MFSI-G, MFSI-P, FACT-PWB, and FACT-Total). Conclusion: Our study demonstrated that the use of wearable mindfulness sensing headset device was feasible, simple to use, low cost, and integrated into the surgical breast cancer journey. Overall, among breast cancer patients undergoing surgery there was improvement in QOL, fatigue, and stress with mind-body interventions around surgery compared to baseline. Participants randomized to the wearable mindfulness headset device trended toward outcomes sooner (2 week follow-up) and with high utilization. Further research is needed to determine significance of these outcomes and long term impact in care of cancer survivors. Citation Format: Pruthi S, Millstine DM, Bhagra A, Nguyen M-D. Effect of wearable wellness brain sensing mindfulness-based technology in newly diagnosed surgical breast cancer patients: A randomized intervention [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-12.

Background: The nursing literature contains numerous studies on stress management interventions for nurses, but their overall levels of evidence remain unclear. Holistic nurses use best-available evidence to guide practice with self-care interventions. Ongoing discovery of knowledge, dissemination of research findings, and evidence-based practice are the foundation of specialized practice in holistic nursing. This literature review aimed to identify the current level of evidence for stress management interventions for nurses. Method: A systematic search and review of the literature was used to summarize existing research related to stress management interventions for nurses and recommend directions for future research and practice. Results: Ninety articles met the inclusion criteria for this study and were categorized and analyzed for scientific rigor. Various stress management interventions for nurses have been investigated, most of which are aimed at treatment of the individual versus the environment. Contemporary studies only moderately meet the identified standards of research design. Issues identified include lack of randomized controlled trials, little use of common measurement instruments across studies, and paucity of investigations regarding organizational strategies to reduce nurses’ stress. Conclusion: Future research is indicated to include well-designed randomized controlled trials, standardized measurement tools, and more emphasis on interventions aimed at the environment.