Engaging in advocacy during medical training: assessing the impact of a virtual COVID-19-focused state advocacy day.

PURPOSE: The physician voice is crucial to shaping health policy and public health guidelines, particularly during COVID-19. However, there are gaps in health policy and advocacy education within graduate medical education. This study sought to characterise the impact of a virtual COVID-19 focused advocacy day among medical trainees in Massachusetts. STUDY DESIGN: The half-day event featured speakers drawn from government relations experts, physician advocates, and state and federal legislators as well as breakout discussions among attendees. A 25-question Redcap survey and list of resources/opportunities for continued advocacy was administered to all participants at event's conclusion on 19 May 2020. RESULTS: There were 60 responses from 141 participants (43% response rate). One-third reported no prior formal health policy instruction, and over half reported getting information from news publications, social media and peers. 58% believed physician involvement in advocacy to be 'extremely important' prior to COVID-19; 83% believed the same after onset of COVID-19 (p<0.0001). The most common barriers to advocacy engagement were lack of time and knowledge. Most attendees felt participation increased their knowledge and likelihood to engage in the COVID-19 response, imparted useful skills/knowledge for continued advocacy, increased their interest in future similar events, and that such events should be available to all trainees. CONCLUSIONS: Trainees recognise the importance of health policy and advocacy and value opportunities to gain the necessary skills/knowledge to effect tangible change. Virtual advocacy days can be replicated nationwide to help trainees learn about advocacy efforts and find their legislative voices during COVID-19 and beyond.

Older Age is Associated with a Higher Incidence of Melanoma Death but a Lower Incidence of Sentinel Lymph Node Metastasis in the SEER Databases (2003-2011).

PURPOSE: Elderly melanoma patients are known to have lower survival rates than younger patients with melanoma. Paradoxically, a few recent studies have shown a lower frequency of sentinel lymph node (SLN) positivity in older individuals. This is the first analysis of a large national sample to examine the relationship between SLN metastasis and melanoma death across all age groups. METHODS: The U.S. Surveillance Epidemiology and End Results (SEER) Databases were queried to examine SLN biopsy and mortality outcomes in 158,813 melanoma cases reported from 2003 to 2011, the most current data available in SEER. RESULTS: In bivariate analyses of the 47,577 cases with coded tumor depths and nodal surgery, increasing age varied directly with melanoma death and inversely with SLN positivity, for tumor depths >1 mm (P < 0.001). In multivariate regression analyses, 60-79 year-olds were more likely to die of melanoma compared with 20-39 year-olds [odds ratio (OR) 1.83, 95 % confidence interval (CI) 1.64-2.05], but they were less likely to be SLN-positive (OR 0.62, 95 % CI 0.57-0.68). The inverse association between melanoma mortality and SLN positivity was most pronounced at the extremes of age. DISCUSSION: The finding that increasing age is associated with a higher incidence of melanoma death but a lower incidence of SLN metastasis highlights the need for further study into age-related differences in melanoma biology, immunological surveillance, and host response. It also questions whether the 5- and 10-year survival rates associated with the current melanoma staging system should be stratified by age to predict outcomes more accurately for melanoma patients.

Who exceeds ATP-III risk thresholds? Systematic examination of the effect of varying age and risk factor levels in the ATP-III risk assessment tool.

OBJECTIVE: We sought to determine the levels of risk factors required to exceed threshold values of intermediate (> or = 10%) or high (> 20%) predicted 10-year risk for coronary heart disease using the Adult Treatment Panel III (ATP-III) Risk Assessment Tool. METHODS: Continuous risk factor values were entered into the risk assessment tool to examine levels of predicted 10-year risk. Both individual risk factors and the joint effects of varying multiple risk factors were systematically examined. RESULTS: Women only exceed 10% risk at ages > or = 70 with single risk factors of HDL-cholesterol levels < 30 mg/dL or systolic blood pressure > 170 mm Hg. Women < or = 65 only exceed 10% risk if they are smokers with low HDL-cholesterol levels. In contrast, single risk factors can cause men over 45 to exceed 10% or 20% predicted 10-year risk. Combinations of only modestly elevated risk factors cause many men to exceed 10% risk at ages > or = 45, and to exceed 20% risk at ages > or = 55. CONCLUSIONS: Because such high-risk factor levels are required for men < 45 years and women < 65 years to exceed ATP-III risk thresholds, additional means for risk communication may be needed for individuals with elevated risk factors in these age ranges.