Impact of quality indicators on variability of keratometry measurements using a swept-source OCT based optical biometer.

PURPOSE: To characterize the variability of keratometry measurements on the IOLMaster 700, and relate it to device image quality indicators (QI). SETTING: Two academic centers and one private practice. DESIGN: Multicenter, retrospective consecutive case series. METHODS: Measurements from three sites, obtained between December, 2015 and July, 2023 were included. Surgery-naïve phakic eyes with same-day sequential measurements on the same eye were identified. Repeat measurement pairs were grouped by IOLMaster QIs (success vs. warning), and changes in mean standard (∆Kmean) and total (∆TKmean) keratometry as well as standard (∆Kastig) and total (∆TKastig) astigmatism vectors were calculated. RESULTS: Analysis was performed on 3,222 eyes of 1,890 patients. Measurement 'success' was associated with a smaller ΔKmean (0.09 ± 0.14 D) and ΔTKmean (0.11 ± 0.16 D) when compared to pairs in which both measurements had a 'warning' [0.25 ± 0.32 D and 0.14 ± 0.17 D, respectively; (p < 0.0001)]. A similarly smaller ∆Kastig (0.26 ± 0.28 D) and ∆TKastig (0.28 ± 0.30 D) was observed with measurement 'success' versus 'warning' [0.77 ± 0.79 D and 0.42 ± 0.41 D, respectively (p < 0.0001)]. Even when both measurements were successful, the proportion of measurement pairs that had a ∆Kastig > 0.50 D increased from 14% to 24% to 32% when Kmean standard deviation (SD) was ≥ 0.01, 0.05, and 0.10 D, respectively. CONCLUSIONS: When measurement quality is poor, total keratometry varies less than standard keratometry measurements. Clinicians may use the SD of Kmean/TKmean to estimate the repeatability of measurements and balance this against their tolerance for performing repeat measurements.

Association Between Resident In-Service Exam Scores by Post-Graduate Year and Subsequent Board Qualifying Exam.

INTRODUCTION: Prior work notes the AUA in-service exam (ISE) percentile ranking of chief residents correlates with qualifying exam (QE) performance. We present a 5-year analysis of resident performance on the ISE and subsequent QE to determine if earlier time points in training may identify those needing additional educational support. METHODS: Participant ISE scores over a 5-year period from 2014 to 2018 and subsequent QE scores in 2019 were recorded. Pearson's correlation coefficient measured the association between percentage questions correct for each ISE year and QE. Youden Index calculated the optimal cut-point for yearly ISE percentage correct that would predict scoring greater than the lowest quartile and decile on the QE. RESULTS: Median percent questions correct on ISE increased over PGY1 (47%), PGY2 (56.5%), and PGY3 (70%) years but remained stable thereafter (PGY4-5) at approximately 70%. Median QE percent correct in 2019 was 66% (Std Dev 7.6%). Correlation of percent questions correct between ISE and QE improved from 0.31 to 0.53 over training duration. The lowest decile and quartile percent correct scores on the QE were 56% and 60%, respectively. Percent correct ISE score predicting performance above the lowest decile 2019 QE score increased from 38% PGY1, 57% PGY2, and leveled off after PGY3 year (∼70%). Similar observations were noted with lowest quartile QE score. CONCLUSIONS: Scoring approximately 70% of questions correct on the ISE during PGY3 and later years was associated with low risk of failing the QE. Such information provides benchmarks for residency programs to offer targeted educational content for at-risk candidates.

Impact of the Graphic Memoir "My Degeneration: A Journey Through Parkinson's" on Patients With Parkinson's Disease: A Mixed Methods Study.

INTRODUCTION: Understanding the lived experience of illness is important for empowering patients and informing health care practitioners. This study investigated the impact of a book-length comic memoir, My Degeneration: A Journey Through Parkinson's, by Peter Dunlap-Shohl, on patients' mental health, knowledge, and attitudes about living with Parkinson's disease (PD). The authors further explored which patients found the book to be beneficial and why. METHODS: In this convergent mixed methods study, patients with PD were recruited from a multidisciplinary movement disorders clinic in 2019-2020 and were eligible if cognitively intact; English-speaking; had stage I, II, or III PD; and < 12 months had elapsed since diagnosis. Participants received My Degeneration to read at home, measures were obtained pre- and postintervention, and participants were interviewed within approximately 1 month. RESULTS: Thirty participants completed the study (13 males and 17 female; mean age = 59 years). Four qualitative themes emerged: Reading My Degeneration 1) validated the experience of living with PD, 2) reinforced practical behaviors that support well-being, 3) provided insight about the illness experience, and 4) was emotionally and physically taxing. There were no statistically significant pre-/postintervention changes in knowledge, self-efficacy, hope, or emotional distress. Book "endorsers" appreciated Dunlap-Shohl's dark humor and resonated with his experience; "detractors" found the book to be blunt and sometimes frightening. DISCUSSION/CONCLUSION: Participants who liked the book-the "endorsers"-revealed that it deeply resonated with them and helped them realize they were not alone with the disease. Many commented that Dunlap-Shohl's story was in some ways their story-and that this was both practically and emotionally reassuring. My Degeneration has the potential to benefit patients who appreciate comics, enjoy dark humor, and are not overly pessimistic.

Practice Readiness? Trends in Chief Resident Case Logs vs Subsequent Case Log Data in Clinical Practice.

INTRODUCTION: Limited information exists regarding the association between resident surgical case experience and subsequent case mix in practice. We compare the case log distribution residents completed during their chief year to those completed by these graduates in their first 2 years in independent practice. METHODS: Resident chief year case logs from 10 institutions were analyzed across 4 categories of index procedures: (1) general urology, (2) endourology, (3) reconstructive urology, and (4) urologic oncology. Current Procedural Terminology codes for associated index procedures were used to query case log data during their first 2 years in practice collected by the American Board of Urology. Interactions were tested between the trends of chief year case logs relative to trends in practice case logs. RESULTS: Amongst 292 residents, a total of 104,827 cases were logged during chief year and 77,976 cases in the first 2 years as an attending. Most cases completed during chief year were in oncology followed by general urology, endourology, and reconstructive urology. As attendings, most cases completed were in general urology, followed by endourology, reconstructive urology, and oncology. Chief year case logs showed decreasing trends in the median number of case logs in reconstructive urology, endourology, and general urology, while case logs in independent practice noted increasing trends in all index procedure categories over time. CONCLUSIONS: Urology residents perform more cases during their chief year compared to their first 2 years of independent practice. Case types completed as chief residents vs subsequent clinical practice also differ significantly. These observations may have implications for residency training, particularly regarding curriculum design.

Implementation of COVID-19 infection control best practices in nursing homes amid the pandemic.

BACKGROUND: The COVID-19 pandemic has claimed around 170,000 lives among nursing home residents and staff in the United States through April 2023. In a cluster randomized controlled trial (RCT) with 136 nursing homes, we delivered training to improve COVID-19 infection control best practices. We sought to assess the implementation of infection control practices in participating nursing homes. METHODS: Concurrent with the delivery of the RCT (January-November 2021), we surveyed nursing home administrators (NHAs, n = 38) at baseline and 6-month follow-up. Using validated items from the Centers for Disease Control and Prevention (CDC), the surveys inquired about 80 infection control best-practice activities (yes/no). The survey also asked seven scales corresponding to inner setting factors that may have impacted implementation. We assessed changes in infection control practices and inner setting factors between baseline and 6-month follow-up. RESULTS: Overall, the implementation of 11 best practices changed over time. NHAs reported an increase in the availability of informational materials for residents and families (84% vs. 100%, p = 0.031), the use of alcohol-based hand sanitizer over soap (76% vs. 97%, p = 0.008), and the development of contingency plans for increased postmortem care (53% vs. 82%, p = 0.013). The implementation of four best-practice visitation policies and three communal restrictions decreased between baseline and 6-month follow-up (all p < 0.05). Regarding inner setting factors, only culture stress (perceived strain, stress, and role overload) increased between surveys (mean scores: 3.14 vs. 3.58, p = 0.004). CONCLUSION: This study was among the first to report changes in implementing COVID-19 infection control best practices in nursing homes amid the pandemic. Culture stress was an important inner setting factor that may have impacted implementation activities. TRIAL REGISTRATION: NCT04499391 DATE OF REGISTRATION: August 3rd, 2020.

Humor in parenting: Does it have a role?

BACKGROUND: Despite the widespread use of humor in social interactions and the considerable literature on humor in multiple fields of study, the use of humor in parenting has received very little formal study. The purpose of this pilot study was to gather preliminary data on the use of humor in the raising of children. MATERIALS AND METHODS: We developed and administered a 10-item survey to measure people's experiences being raised with humor and their views regarding humor as a parenting tool. Responses were aggregated into Disagree, Indeterminate, and Agree, and analyzed using standard statistical methods. RESULTS: Respondents (n = 312) predominantly identified as male (63.6%) and white (76.6%) and were (by selection) between the ages of 18-45 years old. The majority of participants reported that they: were raised by people who used humor in their parenting (55.2%); believe humor can be an effective parenting tool (71.8%) and in that capacity has more potential benefit than harm (63.3%); either use (or plan to use) humor in parenting their own children (61.8%); and would value a course on how to utilize humor in parenting (69.7%). Significant correlations were found between the use of humor and both i) the quality of respondents' relationships with their parents and ii) assessments of how good a job their parents had done. CONCLUSIONS: In this pilot study, respondents of childbearing/rearing age reported positive views about humor as a parenting tool.

Time-Dependent Variation in Immunoparalysis Biomarkers Among Patients with Sepsis and Critical Illness.

Immunoparalysis is a significant concern in patients with sepsis and critical illness, potentially leading to increased risk of secondary infections. This study aimed to perform a longitudinal assessment of immune function over the initial two weeks following the onset of sepsis and critical illness. We compared ex vivo stimulated cytokine release to traditional markers of immunoparalysis, including monocyte Human Leukocyte Antigen (mHLA)-DR expression and absolute lymphocyte count (ALC). A total of 64 critically ill patients were recruited in a tertiary care academic medical setting, including 31 septic and 33 non-septic patients. Results showed that while mHLA-DR expression significantly increased over time, this was primarily driven by the non-septic subset of critically ill patients. ALC recovery was more prominent in septic patients. Ex vivo stimulation revealed significant increases in TNF and IL-6 production over time in septic patients. However, IFNγ production varied with the stimulant used and did not show significant recovery when normalized to cell count. No significant correlation was found between mHLA-DR expression and other immunoparalysis biomarkers. These findings suggest the need for more nuanced immune monitoring approaches beyond the traditional 'sepsis' versus 'non-sepsis' classifications in critically ill patients. It also provided further evidence of a potential window for targeted immunotherapeutic interventions in the first week of critical illness.

Bariatric surgery and COVID-19 outcomes: results from the PaTH to Health: Diabetes study.

BACKGROUND: Obesity and type 2 diabetes mellitus (T2DM) are risk factors for severe COVID-19 infection. Bariatric surgery (BSG) is an effective treatment of obesity through weight loss and may reduce COVID-19 severity. OBJECTIVES: We examined the effect of BSG on COVID-19 outcomes in patients with or at risk of T2DM. SETTING: Electronic health record data from the PaTH Clinical Data Research Network, a partnership of 5 health systems reviewed from March 1, 2020, to December 31, 2020. METHODS: Ambulatory and in-hospital patient encounters with COVID-19 diagnosis and obesity were identified. We constructed 2 patient groups: BSG and non-BSG (NBSG). The BSG group included patients with at least 1 encounter for the BSG procedure code and/or 1 BSG diagnosis code; the NBSG group included patients with no procedure or diagnosis code for BSG with body mass index (BMI) ≥40 or BMI ≥35 and at least 2 obesity-related co-morbidities. We matched 1 patient in the BSG group to 2 patients in the NBSG group based on age, gender (sex defined at birth), race and ethnicity, group (T2DM and at risk of T2DM), and site. The primary outcome was 30-day outcomes of COVID-19 severity. RESULTS: After matching, we found that patients with BSG had lower odds of respiratory failure (41%) and ventilation/intensive care unit (ICU) admission/death (52%). Patients in the BSG group had lower odds of hospitalization, pneumonia, respiratory failure, and the most severe COVID-19 outcomes combined (ventilation/ICU admission/death). T2DM was identified as a risk factor for COVID-19 severity in the BSG group. CONCLUSIONS: This retrospective, matched-cohort analysis found BSG to have a protective effect against severe COVID-19 outcomes.

Leadership Perspectives on Nursing Home Operations From Crisis to Control: A Mixed Methods Study.

OBJECTIVES: Nursing home (NH) leaders remain challenged to deliver quality care, despite the COVID-19 transition to an endemic phase. This study describes NH leadership perspectives on preparing and maintaining quality care during times of diminishing resources as experienced through the COVID-19 pandemic to gain insight on how best to support NHs moving forward. DESIGN: This was a cross-sectional, parallel convergent mixed methods study. SETTING AND PARTICIPANTS: This study reports quantitative data from N = 5001 NHs across 12 states along with qualitative data from a subsample of NH leaders (N = 15). METHODS: Publicly reported survey data were analyzed using descriptive statistics. Individual in-depth interviews with NH leaders conducted at 12-month follow-up were analyzed using inductive thematic coding organized by a guiding framework. Data were integrated using convergent analysis and a joint display. RESULTS: NH leaders (licensed administrators, clinical directors, and managers) reported resident and staff infection rates, and access to resources (such as personal protective equipment and testing supplies) that aligned with national trends. Leaders described their NHs (n = 14; 43% rural; 71% not for profit) to be in varied states of operational readiness (standard, contingency, crisis) to support quality infection prevention and control (IPC) at the transition to the endemic COVID-19 phase. Leadership reported continued challenges in addressing resident and staff vaccinations, securing testing supplies, obtaining financial resources to maintain acceptable levels of personal protective equipment, continued staffing shortages, and issues in implementing isolation practices in current facilities. CONCLUSION AND IMPLICATIONS: NH leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas. Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC-related metrics and adequate funding to account for the long-term financial burden NHs face.

Getting it Across the Finish Line - Publication Rates of Abstracts Presented at a Major Urologic Conference.

OBJECTIVE: To identify characteristics of published manuscripts following a regional American Urological Association (AUA) meeting and recognize trends of publication rates over a 13-year timeframe. METHODS: Abstract submissions to the Mid-Atlantic AUA (MA-AUA) conference from 2008 to 2020 were collected. Manuscripts were searched using abstract titles and authors in a standard fashion using PubMed, Google Scholar, and Google. Characteristic data was collected, including abstract type (podium or poster), abstract category, first author gender, manuscript publication date, and journal of publication. Univariate and multivariate analysis determined association of these variables with manuscript publication. RESULTS: 1257 abstracts were presented between 2008 and 2020, of which 458 (36%) were published as manuscripts and 799 (64%) were not published. Of the published manuscripts, 55 (12%) were published prior to the conference date and 403 (88%) were published after. Our analysis was limited to the 403 manuscripts published post-meeting and the 799 abstracts that were not published, with N=1202. Amongst the 403 published post-meeting, the mean time to publication was 14.8 months ± 13.2 months. Podium presentations had a higher proportion of publications than those of posters (39.4% vs 30.5%, p=0.002). There was a statistically significant difference in proportion of publications between years (p=0.002). No association was noted between abstract first author gender and publication (38.7% male vs. 39.2% female, p=0.899). CONCLUSIONS: Approximately one-third of presented abstracts from a major urologic conference were published with an average time to publication of 15 months. Publication percentage varied significantly between different years. Podium presentations had a higher publication rate compared to non-podium abstracts.

Predicting Organ Dysfunction in Septic and Critically Ill Patients: A Prospective Cohort Study Using Rapid Ex Vivo Immune Profiling.

OBJECTIVES: While cytokine response patterns are pivotal in mediating immune responses, they are also often dysregulated in sepsis and critical illness. We hypothesized that these immunological deficits, quantifiable through ex vivo whole blood stimulation assays, may be indicative of subsequent organ dysfunction. DESIGN: In a prospective observational study, adult septic patients and critically ill but nonseptic controls were identified within 48 hours of critical illness onset. Using a rapid, ex vivo assay based on responses to lipopolysaccharide (LPS), anti-CD3/anti-CD28 antibodies, and phorbol 12-myristate 13-acetate with ionomycin, cytokine responses to immune stimulants were quantified. The primary outcome was the relationship between early cytokine production and subsequent organ dysfunction, as measured by the Sequential Organ Failure Assessment score on day 3 of illness (SOFAd3). SETTING: Patients were recruited in an academic medical center and data processing and analysis were done in an academic laboratory setting. PATIENTS: Ninety-six adult septic and critically ill nonseptic patients were enrolled. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Elevated levels of tumor necrosis factor and interleukin-6 post-endotoxin challenge were inversely correlated with SOFAd3. Interferon-gamma production per lymphocyte was inversely related to organ dysfunction at day 3 and differed between septic and nonseptic patients. Clustering analysis revealed two distinct immune phenotypes, represented by differential responses to 18 hours of LPS stimulation and 4 hours of anti-CD3/anti-CD28 stimulation. CONCLUSIONS: Our rapid immune profiling technique offers a promising tool for early prediction and management of organ dysfunction in critically ill patients. This information could be pivotal for early intervention and for preventing irreversible organ damage during the acute phase of critical illness.

Pilot Study Assessing the Effect of Exam Room Length on the Measurement of Strabismus.

PURPOSE: Our study aims to investigate the effect of decreasing distance from the patient to the fixation target on the measurement of strabismus with a known distance-near disparity. METHODS: Strabismus measurements were taken by one pediatric ophthalmologist at our standard distance of 18 feet and compared to those taken at 16, 14, 12, and 10 feet from the fixation target. A clinically meaningful difference was defined as >2.5 prism diopters (PD), since a difference of that magnitude may alter surgical planning. RESULTS: Thirty-nine subjects, including 22 exotropes and 17 esotropes, were included in this study. Mean prism diopter difference (PDD) in the exotrope group at lengths of 16, 14, 12, and 10 feet compared to 18 feet were 1.3 (SD 1.9, range 0-6), 1.3 (SD 2.2, range 0-8), 1.7 (SD 3.2, range 0-14), and 2.8 (SD 4.4, range 0-14), respectively. Among esotropes, the mean PDD at the same distances were 1.1 (SD 1.9, range 0-7), 2.1 (SD 2.6, range 0-7), 3.9 (SD 4.9, range 0-19), and 4.3 (SD 5.1, range 0-19). The percentages of exotropes with a PDD of >2.5 at 16, 14, 12, and 10 feet compared to 18 feet were 13.6% (n = 3), 13.6% (n = 3), 18.2% (n = 4), and 27.3% (n = 6), respectively. In the esotrope group, 11.8% (n = 2), 35.3% (n = 6), 47.1% (n = 8), and 47.1% (n = 8) had a PDD of >2.5 at the same distances, respectively. CONCLUSION: This pilot study is the first to investigate the change in measured angle of strabismus at various non-mirrored distances from the patient to the fixation target. Our methodology defines a framework that could be used in a higher-powered study to further our understanding of the effect of room length on strabismus evaluation.

Breast Implant Imaging Surveillance Practice: Survey of Breast Imaging Radiologists in the Society of Breast Imaging.

OBJECTIVE: The objectives of this Society of Breast Imaging (SBI)-member survey study were to assess the current imaging patterns for evaluation of symptomatic and asymptomatic breast implant integrity, including modalities used and imaging intervals. METHODS: A 12-question survey assessing the frequency of imaging modalities used to evaluate implant integrity, approximate number of breast implant integrity studies requested per month, intervals of integrity studies, and referring provider and radiology practice characteristics was distributed to members of the SBI. RESULTS: The survey response rate was 7.6% (143/1890). Of responding radiologists, 54.2% (77/142) were in private, 29.6% (42/142) in academic, and 16.2% (23/142) in hybrid practice. Among respondents, the most common initial examination for evaluating implant integrity was MRI without contrast at 53.1% (76/143), followed by handheld US at 46.9% (67/143). Of respondents using US, 67.4% (91/135) also evaluated the breast tissue for abnormalities. Among respondents, 34.1% (46/135) reported being very confident or confident in US for diagnosing implant rupture. There was a range of reported intervals for performing implant integrity studies: 39.1% (43/110) every 2-3 years, 26.4% (29/110) every 4-5 years, 15.5% (17/110) every 6-10 years, and 19.1% (21/110) every 10 years. CONCLUSION: For assessment of implant integrity, the majority of respondents (53.2%, 76/143) reported MRI as initial imaging test. US is less costly, but the minority of respondents (34.1%, 46/135) had confidence in US performance. Also, the minority of respondents (39.1%, 43/110) performed implant integrity evaluations every 2-3 years per the FDA recommendations for asymptomatic surveillance.

Evaluating the relationship between physical activity and quality of life in a racially diverse sample of breast cancer survivors.

PURPOSE: Physical activity (PA) has been shown to improve quality of life (QoL) in predominantly White cancer survivors. Very few studies have examined the association between PA and QoL among Black breast cancer survivors (BCS). We investigated the association between PA and multiple QoL domains and the effects of race on the proposed association in a racially diverse group of BCS. METHODS: This was an exploratory study using secondary data from a completed 12-month randomized controlled  trial (RCT). Mixed effects models were tested on a subset of participants in the control and exercise groups of the RCT. The primary outcomes were changes in the QoL domains (baseline to 12 months post baseline). RESULTS: There were 173 participants included in this analysis, averaging 59 years of age; about 33% of the participants were Black women. There were no significant differences in the QoL outcomes between the control and exercise groups at 12 months post baseline. Race was not a significant moderator. Exercise improved emotional/mental wellbeing and body image as it relates to social barriers at 12 months post baseline in Black and White BCS, but the changes in these outcomes were only statistically significant in White BCS (p < 0.05). CONCLUSIONS: Results show that exercise can improve multiple QoL domains over time in Black BCS. However, the significance of the effect on QoL was isolated to White BCS. The small sample size in Black women could constrain the statistical significance of observed effects. Future studies are warranted to assess associations between exercise and QoL in larger samples of Black women.

The addition of doxycycline to fluoroquinolones for bacterial prophylaxis in autologous stem cell transplantation for multiple myeloma.

BACKGROUND: Bacterial prophylaxis with a fluoroquinolone (FQ) during autologous stem cell transplant (ASCT) is common, although not standardized among transplant centers. The addition of doxycycline (doxy) to FQ prophylaxis was previously linked to reduced neutropenic fever and bacteremia in multiple myeloma (MM) patients undergoing ASCT although several confounders were present. We compared the incidence of neutropenic fever and bacteremia between MM patients variably receiving prophylaxis with FQ alone and FQ-doxy during ASCT. METHODS: Systematic retrospective chart review of MM patients who underwent ASCT between January 2016 and December 2021. The primary objective was to determine the effect of bacterial prophylaxis on neutropenic fever and bacteremia within 30 days of ASCT. Multivariable logistic regression for neutropenic fever and univariate logistic regression for bacteremia accounted for differences in subject characteristics between groups. RESULTS: Among 341 subjects, 121 received FQ and 220 received FQ-doxy for prophylaxis. Neutropenic fever developed in 67 (55.4%) and 87 (39.5%) subjects in the FQ and FQ-doxy groups, respectively (p = .005). Bacteremia was infrequent, with 5 (4.1%) and 5 (2.3%) cases developing in the FQ and FQ-doxy groups, respectively (p = .337). Among Gram-negative bacteremia events, 7/7 Escherichia coli strains were FQ-resistant, and 5/7 were ceftriaxone-resistant. CONCLUSION: The FQ-doxy prophylaxis group had fewer cases of neutropenic fever than the FQ group, however, there was no significant difference in bacteremia. High rates of antibiotic resistance were observed. An updated randomized controlled trial investigating appropriate prophylaxis for ASCT in the context of current oncology standards and changing antimicrobial resistance rates is warranted.

Evaluating the Impact of Aevidum on Mental Health Knowledge, Attitudes, and Help-Seeking Behaviors in High School Students: A Mixed-Methods Study.

PURPOSE: To compare Aevidum's school mental health curriculum vs the curriculum plus Aevidum clubs in a mixed-methods study including pre/post surveys, a randomized clinical trial, and qualitative interviews. DESIGN: Concurrent mixed-methods: Aim 1) pre-post surveys evaluated curriculum only vs curriculum plus club schools separately regarding changes in knowledge, help-seeking, and school culture; Aim 2) randomized clinical trial compared curriculum only to curriculum plus club schools; Aim 3) qualitative school staff interviews enhanced understanding of school culture changes. SETTING: Curriculum delivered to 9th graders at ten Pennsylvania high schools; 5 schools randomized to start clubs. SUBJECTS: Students (surveys), staff (interviews). INTERVENTION: Aevidum curriculum plus/minus club. MEASURES: Aim 1, mixed effects linear and logistic regression models for longitudinal data were used to analyze survey items at each time point. Aim 2, the same regression models were used, except models included a fixed-effect for group and group by time interaction effect. Aim 3, interviews were transcribed; a codebook was developed followed by thematic analysis. RESULTS: Pre-survey 2557 respondents; 49% female, 86% non-Hispanic white. Post-survey 737 (29% response rate). Aim 1, pre-post (Likert responses, larger numbers favorable) demonstrated increased student knowledge to identify depression (4.26 [4.19-4.33] to 4.59 [4.47-4.71], P < .001) and help a friend access support (4.30 [4.21-4.38] to 4.56 [4.40-4.71], P = .001). Help-seeking increased for phone helplines (1.61 [1.57-1.66] to 1.78 [1.70-1.86], P < .001), crisis textlines (1.60 [1.55-1.64] to 1.78 [1.70-1.86], P < .001), internet/websites (1.80 [1.75-1.85] to 1.99 [1.90-2.08], P < .001), school counselors (P = .005) and teachers (.013). Aim 2, no significant differences in knowledge, help-seeking or culture between curriculum only vs curriculum plus club schools. Aim 3, staff (n = 17) interviews supported reduced stigma and increased mental health referrals. CONCLUSIONS: Aevidum's curriculum improved mental health knowledge and help-seeking; adding the club did not significantly change responses. Staff identified positive school culture impacts. Limitations include the lower post-survey response.

Interprofessional Education in a Psychiatry Clerkship.

OBJECTIVES: The purpose of this initiative was to encourage medical students to develop collaborative relationships with healthcare team members during a required psychiatry clerkship and reflect upon their demonstration of interprofessional competencies. METHODS: During the clerkship, third year medical students were required to complete two interprofessional activities (from a menu of 18 potential options) in conjunction with nurses, therapists, care coordinators, behavioral health specialists, peer specialists, unit secretaries, or unit managers during care of mutual patients. After completing these activities, students completed a reflection in which they self-reported how they had accomplished specific interprofessional competencies (quantitative and qualitative); the healthcare team members with whom the students collaborated also completed a corresponding reflection (quantitative) of students' interprofessional competence, based upon their interactions. RESULTS: Quantitative feedback from students and staff was paired to look for correlations. Paired responses produced a dataset that included 67 students' self-reflections and 110 feedback submissions from staff. Overall, there was much similarity between students' self-assessment ratings and ratings provided by staff members. Qualitative analysis of students' written feedback indicated they took initiative to take on new roles to support the care team and intentionally sought out healthcare teammates to learn about their roles and to better care for patients. Reflections highlight examples of student advocacy and empathy for patients they served. CONCLUSIONS: Results demonstrate that clerkship-based interprofessional education initiatives, designed with intentionality, promote interprofessional collaborative practices and prepare medical students for achieving residency milestones related to interprofessional collaboration.

The Impact of a Student-Led Health Education Clinic on the Health Literacy and Behaviors of a Rural Community in the State of Pennsylvania, USA.

Rural populations experience a number of disparities that place them at increased risk of morbidity and mortality related to chronic disease, including lower health literacy and greater distance to medical care. Community-based free healthcare education can offer targeted preventive care to these vulnerable populations; however, limited quantitative research exists measuring their impact, specifically on health literacy and likelihood for behavior change. To investigate this, a student-led health education clinic was held in January 2023 in the rural community of Lykens, Pennsylvania by the Student-run and Collaborative Outreach Program for Health Equity (SCOPE). Fifty-five pre- and post-clinic surveys using Likert-style questions measured the knowledge and likelihood of behavioral change for several preventive health topics, including hypertension, diabetes mellitus, cancer screenings, childhood vaccinations, skin cancer, mental health, addiction, and nutrition. From pre- to post-clinic, there was a significant increase in knowledge of hypertension (p = 0.023) and diabetes (p = 0.014), likelihood of attending cancer screenings (p = 0.038), and confidence in identifying cancerous moles (p = < 0.001). There was a non-significant increase in understanding of mental health and nutrition, and no change in understanding of addiction or childhood vaccinations. It is likely that the level of interaction in education provided and relevance of information to participants contributed to effective uptake of information. The results demonstrate an immediate impact on health literacy and likelihood of behavioral change for several important preventive health topics, and advocate for the use of student-run healthcare interventions in addressing the prevalence of chronic disease in rural communities.

Underuse of SARS-CoV-2-Neutralizing Monoclonal Antibodies in Skilled Nursing Facilities.

OBJECTIVE: Little is known about deployment of SARS-CoV-2-neutralizing monoclonal antibodies (mab) in skilled nursing facilities (SNFs), a high-risk population for COVID-19-related complications. We assessed the utilization of mabs in SNFs and identified facility characteristics associated with effective use. DESIGN: Retrospective cohort study assessing the correlation of SNF characteristics with increasing mab use. SETTING AND PARTICIPANTS: United States SNFs participating in Project ECHO (Extensions for Community Health Outcomes). METHODS: The primary outcome was percentage of total mabs per COVID-19 cases in SNFs. Facilities were divided into 3 groups based on the percentage of the administration of mabs per number of cases: 0%, >0% to 20%, >20%. Ordinal logistic regression was applied to assess whether facility characteristics-study group, state, location, type, size, rating at baseline, weekly average of residents vaccinated, weekly average of staff vaccinated, and total weeks short staffed-correlated with the primary outcome. A multivariable model was used to evaluate the independent effect of predictors. RESULTS: A total of 130 facilities were included. Between the weeks ending on May 30, 2021, and on May 29, 2022, mean mab use when accounting for the number of COVID-19 cases was 12.96% (±26.71%) and >50% of facilities administered 0 doses of mabs. Facility location was associated with mab use (P value .030), with micropolitan facilities having the highest percentage of facilities administering mabs (30.4% in >0% to 20%, and 39.1% in >20%, respectively). There was a nonsignificant trend toward increased mab use in facilities reporting fewer staffing shortages. When the multivariable ordinal logistic regression model was applied, location in a micropolitan vs metropolitan area was associated with higher odds [3.29 (1.30, 8.32), P value .012] of increasing percentage total mabs per cases. CONCLUSIONS AND IMPLICATIONS: COVID-19 mabs were underutilized in a high-risk population for COVID-19 hospitalization and death. Understanding the barriers to effective distribution is critical in shaping pandemic preparedness efforts for the future.