Fischer, Karen M.

Abstract Funding Acknowledgements Type of funding sources: None. Background Falls are the leading cause of injury-related morbidity and mortality among older adults in the United States, including those with cardiovascular disease. Cardiac rehabilitation (CR) helps to optimize functional capacity, strength, and balance in patients with cardiovascular disease and, in theory, may reduce the risk of falls. However, little evidence has been published in this regard. Purpose The purpose of this study was to assess the association between CR participation and risk of falls in a community-based sample of individuals 65 years of age and older with cardiovascular disease who were eligible for CR participation. Methods Individuals from Southeastern MN and Western WI, USA, 65 years of age and older who had experienced a cardiovascular event that qualified them for CR (MI, PCI, CABG, Valve Surgery, Transplant) between January 1, 2000, and December 31, 2018, were included in this study. Participation in CR (≥1 sessions, CR-group) and subsequent falls (moderate or severe, using the Campbell classification system) were ascertained using the Rochester Epidemiology Project records-linkage system. Logistic model to create propensity weighting were used to test the association between CR participation and falls after adjustment for potentially confounding factors. Results A total of 5004 individuals met inclusion criteria for the study, with 2183 (44%) included in the CR group and 2821 (56%) in the non-CR group (CR was indicated, but the individual did not participate). Overall, 1122 patients experienced a fall within the first 5 years (16% of those in the CR-group, 23% of those in the non-CR group). After adjustment, CR participation was not associated with falls, but older individuals, females, and those with a history of falls were more likely to have had a fall, compared to young individuals, males, and those without a history of a fall. Conclusions While CR is beneficial for patients with cardiovascular disease, our study did not find evidence of an association between CR participation and fall risk in individuals 65 years of age and older who have cardiovascular disease. Additional research is needed to evaluate the role of CR components that may potentially reduce modifiable risk factors for falls and thereby reduce the risk of falls.

Background: Cotesting with the Papanicolaou (Pap) and human papillomavirus tests detects most precancerous and cancerous lesions and increases the sensitivity for detecting high-grade precancerous and invasive cervical cancers compared with human papillomavirus testing alone. Objective: To compare the use of the Papette brush (hereafter Papette) to the traditional spatula with endocervical brush (cytobrush) for cervical cancer screening. Design: Pragmatic observational study. Methods: Adult women aged 21–64 years who were eligible for a Papanicolaou test at a Midwest Community Internal Medicine practice underwent cervical cancer screening using the Papette or spatula with cytobrush from 18 August 2021 through 1 February 2022. Cluster sampling was used across the practice. Pathology reports were then analyzed to compare the number of satisfactory versus unsatisfactory results between the two collection techniques. Results: We collected results for 756 Pap tests. The test results were satisfactory with the Papette 93.8% of the time compared with 93.0% for the spatula with cytobrush. Conclusion: The Papette is not inferior to a spatula with cytobrush as a collection method for Pap tests.

Objective: The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare professionals (HCP). Methods: A total of 40 HCP were invited to participate in an open-label pilot study. Participants were asked to use a brain sensing wearable device (MUSE-S™) on a daily basis to reduce their stress, for a total of 90 days. Total study participation duration was 180 days. Study enrollment began in August 2021 and ended December 2021. The exploratory outcomes included stress, depression, sleep, burn-out, resilience, quality of life, and cognition. Results: Among the 40 HCP in study, the majority were female (85%), white (87.5%) and with an average age of 41.3 ± 11.0 years (SD). Participants used the wearable device an average of 23.8 times over a 30-day period with a mean duration of 5.8 min with each use. Study results demonstrate the positive impact of guided mindfulness using the wearable device MUSE-S™ and its accompanying application (APP). A statistically significant improvement was found for a reduction in stress ( P < .001) and improvement in resilience ( P = .02), quality of life ( P = .003), and cognition ( P < .001). The majority (91.9%) of the participants indicated they felt more relaxed after using the device, and 73% indicated they would continue to use this device at end-of-study. No adverse effects were reported. Conclusion: Study results show that 3 to 10 min of guided meditation during work hours through the use of a brain sensing wearable device is safe and acceptable, with associated health benefits for HCP.

Introduction/Objectives: A culture of joy in the workplace supports well-being, but less is known about the effect of a shared experience on well-being and burnout in a health care setting. This pilot study investigated personal well-being and occupational burnout among primary care staff who participated in a 3-month virtual book club. Methods: In December 2021, health care workers from a primary care practice were invited to participate in a 3-month virtual book club. Participants were emailed a preintervention survey with questions regarding well-being and burnout, the pandemic’s influence on emotional health, and demographic information. The book club met virtually every month from January 2022 through March 2022. After the March 2022 book club meeting, a paired postintervention survey was sent to participants with additional questions regarding their participation in the book club. Well-being and burnout were measured with the 11-point Well-Being Index, and the pandemic’s influence on emotional health was assessed with the 64-point Pandemic Emotional Impact Scale. Results: Of 12 book club participants, 9 participants (6 physicians and 3 nurses) completed surveys before and after the intervention. Postintervention improvement in the median score of the Pandemic Emotional Impact Scale was significant (7 points, P = .04). Although Well-Being Index results uniformly favored improved well-being after book club participation, the median improvement of 1 point was not significant ( P = .69). Conclusions: Social connection through a virtual workplace activity such as a book club may contribute to well-being and may decrease occupational burnout.

<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.

Abstract Objectives People with dementia often have high care needs at end of life. We compared care delivery in the last year of life for people living with dementia in the community (home/assisted living facilities, ALF) to those in skilled nursing facilities (SNF). Methods This was a retrospective study of people who died with a diagnosis of dementia in the community compared with SNF between 2013 and 2018. Primary outcomes of hospitalizations/ED visits in the last year of life were measured. Secondary outcomes included advance care planning (ACP) completion, hospice enrollment, provider visits and ICU admissions. Results Of 1203 people with dementia, 581 (48.3%) were living in a SNF and 622 (51.7%) in the home/ALF. At least one hospitalization was recorded for 70.7% in the home/ALF compared with 50.8% in the SNF (p&lt; 0.01), similar to ED visits (80.2% versus 58% in home/ALF and SNF groups, respectively, p&lt; 0.01). People in the SNF had more provider visits (median 9 (IQR 6, 12) compared with 5 (IQR 3,9) in the home/ALF group (p&lt; 0.01). There was no ACP for 12% of those in the home/ALF, compared with 4.6% in the SNF(p&lt; 0.01). Approximately half (56.5%) in the SNF were enrolled in hospice compared with 68.3% in the home/ALF group (p&lt; 0.01), Median time in hospice was 26.5 days in the SNF versus 30 days in the home/ALF (p=0.67). Conclusions People living with dementia have frequent acute care utilization in the last year of life. Hospice care was more common in the home/ALF. Time in hospice was short.

The COVID-19 pandemic has disrupted medical care worldwide and caused delays in care for many illnesses and procedures unrelated to COVID-19; however, less clear is how it may have affected diagnosis of conditions that present with similar symptoms, such as primary pulmonary coccidioidomycosis (PPC). We conducted an observational cohort study of patients diagnosed with PPC between March 1 and December 1 in 2 years: 2019 (before COVID-19) and in 2020 (after COVID-19) to compare the time from symptom onset to PPC diagnosis. Relevant demographic and clinical variables were collected, and statistical analyses were performed with the χ 2 test, Wilcoxon rank sum test, and Cox proportional hazards regression analysis. During 2019, 83 patients were diagnosed with PPC. During 2020, 113 patients were diagnosed with PPC. For both groups, the median time from symptom onset to diagnosis of PPC was 14 days (P = .13). No significant differences in time to diagnosis existed between the 2 years for location of diagnosis (outpatient clinic, emergency department, or in hospital), for computed tomographic imaging performed before diagnosis, or for number of COVID-19 tests received before PPC diagnosis. In addition, there were no differences in the 2 years between the total number of clinical visits before diagnosis. However, patients in the post-COVID-19 group who had fever were diagnosed with PPC earlier than those without fever (hazard ratio, 1.77; 95% confidence interval, 1.15–2.73; P = .01). Contrary to what we expected, no significant delay in diagnosis of PPC occurred during the COVID-19 pandemic.