Salonen, Bradley R.

Background: Artificial intelligence (AI) is increasingly being integrated into healthcare, with applications ranging from predictive analytics to clinical decision support. In clinical nutrition, AI tools offer opportunities to improve workflow efficiency, enhance dietary assessment, and personalize nutrition care. Despite growing interest, little is known about registered dietitian nutritionists’ (RDNs) perceptions of AI in clinical practice. The aim of the present study was to assess RDNs’ attitudes toward AI use within a large healthcare system, along with their perceived barriers in this regard. Methods: A cross-sectional survey was developed through expert review and distributed electronically via REDCap to RDNs across Mayo Clinic’s academic campuses and affiliated health system sites. The 23-item survey included Likert-scale items addressing AI’s potential utilization within clinical care, perceived benefits and risks, and readiness for adoption. Responses were summarized using descriptive statistics. Factor analysis identified underlying constructs related to AI attitudes. Differences stratified by age and years of experience were evaluated using ANOVA. Results: Of the 185 RDNs invited, 64 (35%) responded. Two factors emerged: optimism regarding AI usage (Cronbach’s α = 0.94) and skepticism about implementation (α = 0.76). The overall mean ± SD score for optimism was 0.1 ± 0.6 (neutral), while skepticism averaged 1.0 ± 0.6 (moderate). Skepticism differed by years of experience (p = 0.012), with the lowest levels observed among RDNs with ≥21 years of practice. No significant differences were observed across age groups. Discussion: RDNs demonstrated neutral attitudes toward AI use but expressed concerns about accuracy, training, and implementation challenges. Addressing these concerns through education and structured implementation strategies may facilitate successful adoption of AI in dietetic practice.

Abstract Background Clinical nutrition (CN) is becoming increasingly complex because of the rising prevalence of chronic illness, cancer, and malnutrition‐related conditions such as short bowel syndrome and refeeding syndrome. Despite its clinical significance, nutrition education among US physicians remains limited. Simultaneously, large language model (LLM)–based artificial intelligence assistants (AIAs) have emerged as tools to support complex clinical decision‐making but remain largely untested in CN. Methods This retrospective study evaluated four LLM‐based AIAs—ChatGPT (OpenAI), OpenEvidence (OpenEvidence Inc), Gemini (Google, Google DeepMind), and Copilot (Microsoft Corporation)—using five complex CN cases from our nutrition support service. Each AIA was queried with patient‐specific CN questions. Responses were blinded and reviewed by five physician CN experts using an eight‐item assessment tool evaluating clarity, relevance, evidence, and clinical utility. Results All AIAs produced clinically appropriate responses, with Gemini scoring highest in relevance (4.04) and clarity (4.16). Overall satisfaction scores ranged from 3.08 (Copilot) to 3.84 (Gemini). Citation quality and originality of insights varied and were generally limited, and no consistent differences in performance were observed across the five cases among the four AIAs. Conclusion LLM‐based AIAs can reliably replicate expert reasoning in CN. Although not yet a source of novel clinical insights, the true potential of this approach may lie in its application among physicians without specialized expertise in CN, helping to bridge existing knowledge gaps in nutrition care. Presenting full clinical cases, as shown in this study, could support AIA‐enabled e‐consultation in the future, thereby addressing gaps in CN education.

Background Coronavirus Disease 2019 (COVID-19) has led to dramatic changes including social distancing, closure of schools, travel bans, and issues of stay-at-home orders. The health-care field has been transformed with elective procedures and on-site visits being deferred. Telemedicine has emerged as a novel mechanism to continue to provide care. However, there remains a paucity of data regarding its efficacy in nutrition support, especially in patients with chronic intestinal failure (CIF). Objective Describe the utilization of telehealth in the routine management of CIF, particularly in the initiation and training of home parenteral nutrition (HPN). Methods A case series presenting our experience with the use of telemedicine to provide training for HPN for three patients. The manuscript describes the utility of telehealth in providing remote and adequate training for patients commenced on HPN during COVID-19 pandemic. Results Since the onset of the COVID-19 pandemic, we have successfully provided virtual training to three patients, including two who were noted to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and one patient who could not be transferred to our facility for training. For SARS-CoV-2 positive patients, the risk of transmission to nursing staff with 8–10 h of face-to-face training in two cases was felt to be too significant for in-person training. We determined that the best option would be to stabilize parenteral nutrition in the hospital and perform virtual training. Although virtual training was successfully performed, it was felt that training in this manner took much longer, required frequent adjustment of the tablet device to ensure patient remained in field of view, and made it difficult to connect with the patient emotionally. Conclusions Telemedicine has significantly improved care provided during COVID-19 as a modality for effective training on HPN, while in-person communication was significantly limited due to the pandemic. However, when possible, it should be used in a manner that complements but does not supplant standard care.

Objective: Multicancer Detection (MCD) tests, such as the GRAIL Galleri, offer a novel approach to cancer screening by detecting cancer-specific methylation patterns in cell-free DNA through a single blood sample. This study evaluated an 18-month implementation of MCD testing in a tertiary ambulatory internal medicine clinic. Patients and Methods: Between June 2022 and November 2023, 2244 asymptomatic (without symptoms attributed to cancer) patients underwent MCD testing. The study focused on operational workflows, patient and physician education, and diagnostic follow-up of positive results. Standardized materials, including electronic health record (EHR) workflows, FAQs, and diagnostic pathways, were developed to facilitate implementation. Challenges included managing false positives, patient anxiety, costs, and ethical considerations. Results: Of the 2244 patients tested, 17 (0.76%) had positive results, and 15 underwent further diagnostic evaluation. Cancer was confirmed in 11 (73.3%) patients, including cases of breast, colon, esophageal, lymphoma, ovarian, and pancreatic cancers. Four patients had no identifiable malignancy despite comprehensive work-up. Conclusions: MCD testing is feasible in routine clinical workflows, with 73% of positive cases yielding cancer diagnoses. While promising, further research is required to assess long-term outcomes, cost-effectiveness, and optimal implementation strategies of cancer interception in broader healthcare settings.

Background: Over 30% of patients with COVID-19 have persistent symptoms that last beyond 30 days and referred to as Long COVID. Long COVID has been associated with a persistent elevation in peripheral cytokines including interleukin-6, interleukin-1β, and tumor necrosis factor-α. This study reports cytokine profiles of patients in our clinic across SARS-COV-2 variant epochs. Methods: The clinical cytokine panel was analyzed in patients with Long COVID during periods that were stratified according to variant epoch. The 4 variant epochs were defined as: (1) wild-type through alpha, (2) alpha/beta/gamma, (3) delta, and (4) omicron variants. Results: A total of 390 patients had the clinical cytokine panel performed; the median age was 48 years (IQR 38-59) and 62% were female. Distribution by variant was wild-type and alpha, 50% (n = 196); alpha/beta/gamma, 7.9% (n = 31); delta, 18% (n = 72); and omicron, 23% (n = 91). Time to cytokine panel testing was significantly longer for the earlier epochs. Tumor necrosis factor-α ( P < .001) and interleukin 1β ( P < .001) were significantly more elevated in the earlier epochs (median of 558 days in wild-type through Alpha epoch vs 263 days in omicron epoch, P < .001)). Nucleocapsid antibodies were consistently detected across epochs. Discussion: When stratified by variant epoch, patients with early epoch Long COVID had persistently elevated peripheral pro-inflammatory cytokine levels when compared to later epoch Long COVID. Patients with Long COVID have similar clusters of symptoms across epochs, suggesting that the underlying pathology is independent of the peripheral cytokine signature.

Abstract Introduction/Objective: To assess the clinical utility of the FM/a® chemokine-cytokine assay in diagnosing fibromyalgia at an academic medical center. Methods: We performed a cross-sectional study on 50 patients diagnosed with fibromyalgia at a specialty fibromyalgia clinic between January 1, 2021 through July 31, 2021. Patients completed questionnaires and provided a venous blood sample sent to EpicGenetics, to complete the FM/a® test. Demographic, symptom, and historical data was obtained from chart review. Statistical analysis was performed. Results: Of 50 patients with a clinical diagnosis of fibromyalgia, the FM/a® test was positive in 45 (90%). Performance of the FM/a® test compared to the 2016 ACR criteria yielded an odds ratio of 3.5 with sensitivity of 0.91, specificity of 0.25. Univariate regression demonstrated an area under the curve (AUC) of 0.7337, which improved to 0.89 when adjusted for age, gender, and race. When compared to the 1990 ACR criteria, a positive FM/a® test had an odds ratio of 2.33 with sensitivity 0.92 and specificity 0.17. Univariate regression analysis demonstrated an AUC of 0.571, when adjusted for age, gender and race, AUC was similar at 0.585. Conclusion: The FM/a® test performed well overall, though inferiorly compared to the 1990 and 2016 ACR diagnostic criteria. When adjusted for age, gender, and race the test performed almost equivalently to the 2016 ACR criteria. The FM/a® test may be useful in general clinical practices to differentiate patients who are more likely to have FM.

Purpose of review The intent of this review is to highlight any recent changes in the delivery of parenteral nutrition to the geriatric population. The percentage of patients in the geriatric age group increases clinical awareness of the potential risks and benefits of appropriate parenteral nutrition delivery, which is crucial to well tolerated and optimum outcomes. Recent findings The major recent finding is the increased awareness of risk of parenteral nutrition in the elderly population. Summary The implications of this very brief review expose the need for further focused studies to better clarify the specifics of parenteral nutrition in this vulnerable ageing population. The importance of nutritional risk assessment cannot be overstated. With the rapidly expanding volume of geriatric population, the need for more data to better understand the delicate balance in parenteral nutrition therapy for both the acute care setting and home parenteral population is needed.

Abstract Intestinal failure (IF) is a rare disease that requires ongoing intravenous supplementation to sustain growth and health. Advancements in parenteral nutrition (PN) and central venous access in the 1960s and 1970s transformed a life‐limiting disease to a chronic one in which patients are able to administer hydration, electrolytes, micronutrients, and macronutrients in the comfort of their home. However, despite ongoing advancements in the field of home PN (HPN), complications—whether related to central venous catheters or PN itself—remain common and can be associated with significant morbidity and mortality. Central venous access can be associated with thrombosis, central line–associated bloodstream infection, or damage and can result in loss of access over time. PN can be associated with IF‐associated liver disease or hyperglycemia. The key to preserving central venous access and quality of life and maintaining health for patients with chronic IF (CIF) is education focused on prevention and prompt management of CIF complications as they arise. This education typically takes place at the time of initiation of HPN, either in the hospital setting or in the patient's home. The present manuscript describes the historical progression of HPN, prevalence and characteristics of CIF, and an in‐depth discussion of the most common catheter‐related and PN‐related complications and their management, along with a discussion of our education and training process.

AbstractObjectivesDysfunction in smell or taste is well recognized phenomenon in patients infected with SARS‐CoV‐2. This study aimed to quantify the incidence and associated co‐morbidities of reported olfactory or gustatory dysfunction in patients who tested positive for SARS‐CoV‐2.MethodsFrom March 23, 2020 through July 31, 2020, 192,683 patients were tested for SARS‐CoV‐2 at Mayo Clinic. These patients with a positive test were contacted via telephone by physicians at Mayo Clinic and information gathered on patient demographics, comorbidities, symptoms and clinical risk stratification based on these factors.ResultsTwo thousand two hundred and fifty patients tested positive for SARS‐CoV‐2 (1.2%). Six hundred and sixty‐seven (29.6%) of these patients reported loss of smell or taste. Factors found to be correlated with reporting loss of smell or taste on multivariate analysis were: younger age, female sex, or symptoms of chest pain or tightness, cough, or headache and lower clinical risk category. Coronary artery disease (CAD) was associated with not reporting loss of taste or smell.ConclusionOf 2250 patients testing positive for SARS‐CoV‐2 at Mayo Clinic, 667 reported loss of taste and smell. Patients who reported loss of smell or taste were younger, female and more likely to report cough, chest pain, headache, or history of chronic obstructive pulmonary disease (COPD), but overall had fewer high‐risk comorbidities. Those who were older, male, and a reported history of CAD were less likely to report chemosensory dysfunction. Our data are the largest single institution data reporting COVID‐19 associated loss of smell or taste, and the first to associate COPD and CAD as factors that affect rates of reported chemosensory dysfunction.Level of evidenceIIB.