Croghan, Ivana T.

Objective To describe the process and outcome of creating a patient cohort in the early stages of the COVID-19 pandemic in order to better understand the process of and predict the outcomes of COVID-19. Patients and Methods A total of 1169 adults aged 18 years of age or older who tested positive in Mayo Clinic Rochester or the Mayo Clinic Midwest Health System between January 1 and May 23 of 2020. Results Patients were on average 43.9 years of age and 50.7% were female. Most patients were white (69.0%), and Blacks (23.4%) and Asians (5.8%) were also represented in larger numbers. Hispanics represented 16.3% of the sample. Just under half of patients were married (48.4%). Common comorbid conditions included: cardiovascular diseases (25.1%), dyslipidemia (16.0%), diabetes mellitus (11.2%), chronic obstructive pulmonary disease (6.6%), asthma (7.5%), and cancer (5.1%). All other comorbid conditions were less the 5% in prevalence. Data on 3 comorbidity indices are also available including the: DHHS multi-morbidity score, Charlson Comorbidity Index, and Mayo Clinic COVID-19 Risk Factor Score. Conclusion In addition to managing the ever raging pandemic and growing death rates, it is equally important that we develop adequate resources for the investigation and understanding of COVID-19-related predictors and outcomes.

Objective To estimate the health care workers (HCWs) self-reported stress, resilience, and coping during the COVID-19 pandemic, and to determine inter-professional differences. Participants and Methods An email survey was sent to 474 HCW at a Midwestern HealthCare facility between April 9, 2020 and April 30, 2020. A total of 311 (65.6%) responses were received by May 31, 2020. The survey utilized 3 validated instruments: Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), Brief Resilience Coping Scale (BRCS). Results Of the 311 responses, 302 were evaluated: 97 from nonmedical staff with patient contact (NMPC); 86 from nonmedical staff with no patient contact (NMNPC); 62 from medical doctors (MD), physician assistants (PA) and nurse practitioners (NP); and 57 from nurses. Significant differences were noted across job categories for stress and resilience, with nurses reporting highest PSS scores (effect estimates: −2.72, P = .009 for NMNPC; −2.50, P = .015 for NMPC; −3.21, P = .006 for MD/NP/PA respectively), and MD/NP/PA group with highest BRS scores: nurses (−0.31, P = .02); NMPC (−0.3333, P = .01); and NMNPC (−0.2828, P = .02). Younger personnel had higher stress (−1.59 per decade of age, P < .01) and more resilience (0.11 per decade of age, P = .002). Conclusion These self-reported data indicate that MD/NP/PA had the highest resilience scores and the nurses had highest stress levels. Efforts are warranted to include all HCWs in systematic stress mitigating interventions with particular attention to understand specific factors contributing to stress for the nursing team.

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.

Objective: Clinical decision support systems (CDDSs) in the electronic medical record (EMR) have been implemented in primary care settings to identify patients due for cancer screening tests, while functioning as a real time reminder system. There is little known about primary care providers (PCPs) perspective or user acceptance of CDSS. The purpose of this study was to investigate primary care provider perceptions of utilizing CDSS alerts in the EMR to promote increased screening rates for breast cancer, cervical cancer, and colorectal cancer. Methods: An electronic survey was administered to PCPs in a Midwest Health Institution community internal medicine practice from September 25, 2019 through November 27, 2019. Results: Among 37 participants (9 NP/Pas and 28 MD/DOs), the NP/PA group was more likely to agree that alerts were helpful (50%; P-value = .0335) and the number of alerts (89%; P = .0227) in the EMR was appropriate. The NP/PA group also was more likely to find alerts straightforward to use (78%, P = .0239). Both groups agreed about feeling comfortable using the health maintenance alerts ( MD/DO = 79%; NP/PA = 100%). Conclusion: CDSSs can promote and facilitate ordering of cancer screening tests. The use of technology can promptly identify patients due for a test and act as a reminder to the PCP. PCPs identify these alerts to be a beneficial tool in the EMR when they do not interrupt workflow and provide value to patient care. More work is needed to identify factors that could optimize alerts to be even more helpful, particularly to MD/DO groups.

AbstractBackgroundDespite malnutrition being associated with increased mortality and morbidity, there continues to be great difficulty in defining criteria and implementing widespread screening. Tools used to diagnose decreased fat‐free mass (FFM [sarcopenia]) should be easy to use, relatively inexpensive, and safe. Bioelectrical impedance analysis (BIA) has the potential to meet these criteria, but reliability across body mass index (BMI) classes is a concern.MethodsA total of 176 healthy ambulatory participants (aged 18–65 years) were recruited equally (n = 44) in 4 BMI categories: (1) 18.5–24.9, (2) 25.0–29.9, (3) 30–34.9, and (4) ≥35.0. Participants were fasting overnight and had S‐MFBIA (InBody 770) measurements the next morning, with DXA being performed subsequently within 30 minutes.ResultsThe measurement (mean ± SD) for FFM with DXA was 52.8 ± 11.0, and BIA was 53.6 ± 11.0. Delta (S‐MFBIA vs DXA) was 0.8 ± 2.2 (5% limits of agreement −3.5 to +5.2), and concordance correlation coefficient (CCC) was 0.98 (95% CI, 0.97–0.98). The measurements (mean ± SD) for PBF with DXA was 37.5 ± 10.6% and S‐MFBIA was 36.6 ± 11.3%. Delta (S‐MFBIA vs DXA) was −0.9 ± 2.6 (5% limits of agreement 6.0 to +4.2), and CCC was 0.97 (95% CI, 0.96–0.98). The CCC according to the 4 BMI groups for FFM and PBF was between 0.96–0.98 and 0.90–0.94, respectively.ConclusionsFFM and PBF measured by S‐MFBIA had good agreement with DXA across all BMI categories measured in the current study of ambulatory participants.

Abstract Background: Several studies have suggested that vitamin D may have antiproliferative and anticarcinogenic properties and a protective effect against breast cancer. Alaskan Natives have demonstrated high rates of vitamin D deficiency, particularly in young individuals. Hence, high breast density has been associated with increased breast cancer risk. Therefore, we examined the association between serum vitamin D levels and mammographic breast density in a population of Alaskan Native women. Methods: Patients seen in the Mayo Clinic-Alaska Native Medical Center telemedicine program from December 2014 to December 2017 were offered to enroll in the study. Consent was obtained by a study coordinator in Minnesota using a telemedicine platform. Participants were asked to complete the Breast Cancer Risk Questionnaire, which includes questions on hormonal, lifestyle factors and family history. Serum vitamin D levels (25-hydroxyvitamin D2 and D3) were obtained and later correlated with mammographic breast density (percent density). Data were summarized with frequencies and percentages or medians and interquartile ranges (IQR), as appropriate. Pearson correlation was used to estimate the association between breast density and vitamin D levels. Results: 33 women were included; median age was 53 years (IQR 45-58), 70% self-identified as American Indian/Alaskan Native, 12% as White, 6% as Native Hawaiian/Pacific islander and 12% as other. Median BMI was 31 kg/m² (IQR 26.4-34.3), menarche was at age 12 or older for 23 (70%) of the participants and 20 women were postmenopausal at the time enrollment. 10 participants had a hysterectomy, of whom 60% also had oophorectomy. 76% reported history of hormonal birth control use and 23% postmenopausal hormonal supplementation. Median number of pregnancies was 3 (IQR 2-5), and 20 women reported breastfeeding. Fifteen women were current or former smokers (&gt;100 cigarettes) and 19 reported none or low alcohol consumption. Median serum vitamin D level was 39 ng/mL (IQR 30-52) and 9 (27%) women had low vitamin D levels. In regard to breast density, median percentage (average of images) was 15% (IQR 7.5-24.9) with a median dense area of 21.8 cm² (IQR 16.4-34.2). Median time from blood draw to mammogram was 110 days (IQR 41-172) and 19 (58%) participants were taking vitamin D supplementation at the time of study enrollment; doses ranged from 400 to 50,000 units. No correlation was identified between breast density and serum vitamin D levels (correlation=0.02). Conclusion: In this cohort, no association between serum vitamin D levels and breast density was observed. More than half of the participants were on vitamin D supplementation and this could have obscured our observations. Larger studies controlling for vitamin supplementation are needed, as this association could potentially impact breast cancer rates in populations at risk for vitamin D deficiency. Citation Format: Narjust Duma, Ivana Croghan, Sarah Jenkins, Loni Neal, Karthik Ghosh, Sandhya Pruthi. Assessing vitamin D and mammographic breast density in a population of Alaskan Native women [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C088.

Abstract Objective: Weight gain and vasomotor symptoms (VMS) are common complaints in midlife women going through the menopause transition. A selective serotonin 2C (5-HT2C) receptor agonist, lorcaserin, which was previously approved by the Food and Drug Administration for weight loss, has unreported observational evidence suggesting improvement in VMS with its use. The goal of this pilot study was to evaluate the efficacy of lorcaserin for weight loss and management of VMS in overweight midlife women. Methods: This was a 24-week open label pilot study of 20 overweight midlife women, aged 45-60 years, who were experiencing severe VMS. Participants received lorcaserin at the standard dose of 10 mg twice daily for 12 weeks, followed by 12 weeks of observation off the drug. The primary outcomes were changes in weight and subjectively reported VMS. Results: At the end of 12 weeks, mean change in weight was −2.4 kg (90% CI, −3.2 to −1.7, P < 0.001). However, the participants returned to the baseline weight at 24 weeks. Participants also reported significant subjective improvement in VMS, with a mean ± SD change in self-reported hot flash frequency from baseline to week 12 of −5.4 ± 3.9 (decrease of 1.4 standard deviations). There was a rapid increase in the frequency of VMS within 2 weeks of discontinuation of lorcaserin with a tendency to approach the baseline frequency of VMS. Conclusions: In addition to its weight loss-inducing effect, 5-HT2C receptor modulation may have an additional beneficial effect on VMS in midlife women. A treatment option that targets both weight and VMS in midlife women is attractive. Video Summary: http://links.lww.com/MENO/A622.