Fischer, Karen M

Background Cardiac rehabilitation (CR) leads to increased exercise capacity (VO 2 peak) and risk reduction of major adverse cardiovascular events (MACEs). Women exhibit blunted VO 2 peak improvements following CR. The purpose was to examine sex differences in the clinical predictors of VO 2 peak improvement and odds of MACEs following CR. Methods From 1999 to 2017, all consecutive patients undergoing cardiopulmonary exercise testing before and after CR were included. Sex differences in peak exercise metrics in response to CR were compared. Multiple logistic regression models were fit to assess clinical predictors of VO 2 peak improvement (defined as >0% from pre‐CR) and MACEs following CR for men and women. Results A total of 513 men and 158 women were included. Men had greater increases in VO 2 peak than women following CR ( P =0.001). For men, independent predictors of VO 2 peak improvement following CR included higher CR session attendance (odds ratio [OR], 1.04 [95% CI, 1.02–1.06]), peripheral artery disease (OR, 0.47 [95% CI, 0.25–0.86]), and pre‐CR VO 2 peak (OR, 0.98 [95% CI, 0.97–0.99]) (all, P <0.02). Independent predictors of lower odds of MACEs following CR in men included higher number of CR sessions (OR, 0.97 [95% CI, 0.95–0.99]), pre‐CR VO 2 peak (OR, 0.98 [95% CI, 0.97–0.99]), surgical CR indication (OR, 0.34 [95% CI, 0.18–0.68]), and no history of peripheral artery disease (OR, 2.94 [95% CI, 1.60–5.38]) (all, P <0.02). For women, the selected clinical characteristics were not statistically significant independent predictors of VO 2 peak improvement or odds of MACEs (except for diabetes) following CR. Conclusions These findings suggest that clinical predictors of VO 2 peak improvement and odds of MACEs following CR are sex specific.

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.

<b>Background:</b> Inclusion of point-of-care ultrasound (POCUS) within medical education is increasing. A lack of clinical preceptors ready to teach POCUS to physician assistant (PA) students has been discovered. Understanding the barriers to student use of POCUS in clinical education will inform curricular planning.<br /> <b>Methods:</b> Qualitative survey research was completed on 212 previously identified PA student preceptors. Descriptive statistics outlining frequencies of responses were completed.<br /> <b>Results:</b> The most frequently identified barriers included lack of preceptor experience with POCUS (63.7%), lack of access to a device (47.6%), and lack of familiarity with POCUS (45.2%). Time and lack of experience with POCUS were more commonly identified by inpatient providers. Lack of clinical indications and device access were more frequent in outpatient preceptors.<br /> <br /> <b>Discussion:</b> As programs incorporate POCUS, creating intentional opportunities for POCUS education on clinical rotations is needed. The differences in barriers based on practice type allow targeted intervention based on specific rotations.