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Persons living in long-term care facilities (LTCFs) have experienced disproportionate illnesses and deaths from the COVID-19 pandemic. By June 2020, >50,000 COVID-19 deaths had occurred in LTCF residents in the [...]

Introduction The optimal length of Family Medicine Residency is unknown. As part of the American Board of Family Medicine 4-year Length of Training (LoT) pilot project, Naval Hospital Jacksonville (NHJ) maintained a dual-track 3- and 4-year Family Medicine Residency, graduating seven 4-year residents over consecutive 4 years of the LoT program. One measure of success regarding the impact of 4-year residents on program outcomes is scholarly output during residency. Materials and Methods Cumulative scholarly activity points are tracked for all NHJ residents. Cumulative scholarly activity points, points per year per, and raw percentile USMLE/COMLEX scores from academic years 2016–17 to 2019–20 were compared between PGY3 and PGY4 graduates using one-way ANOVA to 95% confidence with post hoc Tukey honestly significant difference pairwise comparison to evaluate pairwise significance between groups where multi-group differences were found. Results During the 2016–17 through 2019–20 academic years, NHJ had 28 residents complete 3 years of training without interruption (3 Years), 11 residents complete 3 years of training interrupted by general medical officer tours (Resiterns), and 7 residents complete 4 years of training without interruption (4 Years). There were no significant differences in average raw USMLE and COMLEX scores between 3 Year (71%), Resitern (68%), and 4 Year (76%) residents (P  = .335). 4-Year residents had significantly more cumulative scholarly points (103) than 3-Year residents (32.6, P  < .001) and Resiterns (18.7, P  < .001) and also had more cumulative scholarly points per year of residency (27.8) than 3-Year residents (9.8, P  < .001) and Resiterns (7.0, P  < .001). Conclusions An observed benefit of a 4-year Family Medicine Residency was a marked increase in scholarly output at this program. [ABSTRACT FROM AUTHOR]

Background Altered sense of smell is a commonly reported COVID-19 symptom. The performance of smell testing to identify SARS-CoV-2 infection status is unknown. We measured the ability of formal smell testing to identify SARS-CoV-2 infection and compared its performance with symptom screening. Methods A convenience sample of emergency department patients with COVID-19 symptom screening participated in smell testing using an eight odor Pocket Smell Test (PST). Participants received a SARS-CoV-2 viral PCR test after smell testing and completed a health conditions survey. Descriptive analysis and receiver operating characteristic (ROC) curve models compared the accuracy of smell testing versus symptom screening in identifying SARS-CoV-2 infection. Results Two hundred and ninety-five patients completed smell testing and 87 (29.5%) had a positive SARS-CoV-2 PCR test. Twenty-eight of the SARS-CoV-2 positive patients (32.2%) and 49 of the SARS-CoV-2 negative patients (23.6%) reported at least one of seven screening symptoms (OR = 1.54, P = 0.13). SARS-CoV-2 positive patients were more likely to have hyposmia (?5 correctly identified odors) than SARS-CoV-2 negative patients (56.1% vs. 19.3%, OR = 5.36, P<0.001). Hyposmia was 52.9% (95% CI 41.9%-63.7%) sensitive and 82.7% (95% CI 76.9%-87.6%) specific for SARS-CoV-2 infection. Presence of ?1 screening symptom was 32.2% (95% CI 22.6%-43.1%) sensitive and 76.4% (70.1%-82.0%) specific for SARS-CoV-2 infection. The ROC curve for smell testing had an area under the curve (AUC) of 0.74 (95% CI 0.67-0.80). The ROC curve for symptom screening had lower discriminatory accuracy for SARS-CoV-2 infection (AUC = 0.55, 95% CI 0.49-0.61, P<0.001) than the smell testing ROC curve. Conclusion Smell testing was superior to symptom screening for identifying SARS-CoV-2 infection in our study. [ABSTRACT FROM AUTHOR]

Introduction: HIV‐associated Kaposi sarcoma (HIV‐KS) is the most common cancer in Malawi. In 2008, the non‐governmental organization, Partners In Health, and the Ministry of Health established the Neno Kaposi Sarcoma Clinic (NKSC) to treat HIV‐KS in rural Neno district. We aimed to evaluate 12‐month clinical outcomes and retention in care for HIV‐KS patients in the NKSC, and to describe our implementation model, which featured protocol‐guided chemotherapy, integrated antiretroviral therapy (ART) and psychosocial support delivered by community health workers. Methods: We conducted a retrospective cohort study using routine clinical data from 114 adult HIV‐KS patients who received ART and ≥1 chemotherapy cycle in the NKSC between March 2008 and February 2012. Results: At enrolment 97% of patients (n/N=103/106) had advanced HIV‐KS (stage T1). Most patients were male (n/N=85/114, 75%) with median age 36 years (interquartile range, IQR: 29–42). Patients started ART a median of 77 days prior to chemotherapy (IQR: 36–252), with 97% (n/N=105/108) receiving nevirapine/lamivudine/stavudine. Following standardized protocols, we treated 20 patients (18%) with first‐line paclitaxel and 94 patients (82%) with bleomycin plus vincristine (BV). Of the 94 BV patients, 24 (26%) failed to respond to BV requiring change to second‐line paclitaxel. A Division of AIDS grade 3/4 adverse event occurred in 29% of patients (n/N=30/102). Neutropenia was the most common grade 3/4 event (n/N=17/102, 17%). Twelve months after chemotherapy initiation, 83% of patients (95% CI: 74–89%) were alive, including 88 (77%) retained in care. Overall survival (OS) at 12 months did not differ by initial chemotherapy regimen (p=0.6). Among patients with T1 disease, low body mass index (BMI) (adjusted hazard ratio, aHR=4.10, 95% CI: 1.06–15.89) and 1 g/dL decrease in baseline haemoglobin (aHR=1.52, 95% CI: 1.03–2.25) were associated with increased death or loss to follow‐up at 12 months. Conclusions: The NKSC model resulted in infrequent adverse events, low loss to follow‐up and excellent OS. Our results suggest it is safe, effective and feasible to provide standard‐of‐care chemotherapy regimens from the developed world, integrated with ART, to treat HIV‐KS in rural Malawi. Baseline BMI and haemoglobin may represent important patient characteristics associated with HIV‐KS survival in rural sub‐Saharan Africa., Introduction Kaposi sarcoma (KS) is a major cause of morbidity and mortality in sub‐Saharan Africa (SSA), resulting in 25,000 deaths each year [1]. In Malawi, KS is the most common [...]

Introduction: Encouraging resident scholarly activity has been a longstanding challenge for medical educators. The Accreditation Council for Graduate Medical Education (ACGME) has been increasing its emphasis on scholarly activity, forcing programs to evaluate their existing processes. This study sought to evaluate the impact of a scholarly activity point system on the resident scholarly productivity at multiple programs.Methods: Five military family medicine residencies evaluated resident outcomes 2 years before and 2 years after the introduction of a scholarly activity point system. Outcome measures included peer-reviewed publications with a resident as first author, peer-reviewed publications with a resident as any author, resident presentation of scholarship at a regional, national, and international conference, IRB-approved protocols with a resident as principal investigator, and IRB-approved protocols with a resident in any role.Results: Four of the five programs experienced substantial increases in nearly every outcome. The fifth program, which had a more robust culture of inquiry at baseline, did not experience an increase in resident scholarly productivity.Conclusions: A scholarly activity point system was associated with an increase in resident scholarly production in family medicine programs. It appears to work best in programs that start from a lower level of scholarly productivity at baseline. A point system appears to be a useful addition to scholarly activity curricula. [ABSTRACT FROM AUTHOR]

Background: Intensive lifestyle change programs effectively prevent or delay type 2 diabetes but are underutilized. We evaluated patient and clinician prediabetes attitudes and practices and implemented strategies to increase National Diabetes Prevention Program (DPP) referrals. Methods: The Tailored Implementation for Chronic Diseases framework guided data collection and the interventional approach of our cluster randomized implementation study across two large primary care clinics. Formative data came from clinician surveys, patient focus groups, and electronic health record (EHR) review. Thematic qualitative and descriptive quantitative analyses identified implementation opportunities. Intervention clusters (family medicine teams) received clinician detailing and EHR-guided prediabetes patient identification. All clusters (family medicine and internal medicine) had access to an electronic DPP referral process. The primary outcome was DPP referral. Results: Focus group participants (3 groups, 15 participants) had mixed perceptions of prediabetes risk and desired personalized behavior change guidance. Surveyed clinicians (31 respondents of 45 invited) viewed prediabetes care positively, but had low DPP awareness. Baseline pre-implementation EHR data for two years (15,520 adult patients) revealed A1c screening coverage of 75.9% per national guidelines. Documentation of prediabetes occurred in 50.7% (729/1,437) of patients meeting A1c criteria. Interim analysis of DPP referrals 8 months post-intervention found 4.8% (69/1,423) of diagnosed prediabetes patients received DPP referral in intervention clusters versus 0.7% (17/2,357) of diagnosed prediabetes patients in control clusters. Patients with prediabetes in intervention clusters had 3.32 (95% CI: 0.89, 12.35) odds of receiving DPP referral after covariate and clustered data adjustments. Conclusions: Clinician detailing and EHR patient identification increased DPP referrals. Disclosure: J.W. Keck: None. K.L. Roper: None. A. Thomas: None. L. Hieronymus: None. Funding: National Center for Research Resources; National Center for Advancing Translational Sciences (UL1TR001998) [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is a leading cause of hospitalization among young children. Historically, American Indian and Alaska Native (AI/AN) children have experienced high rates of RSV-associated hospitalization. In August 2023, a preventive monoclonal antibody (nirsevimab) was recommended for all infants aged <8 months (born during or entering their first RSV season) and for children aged 8-19 months (entering their second RSV season) who have increased risk for severe RSV illness, including all AI/AN children. This evaluation in Alaska's Yukon-Kuskokwim Delta region estimated nirsevimab effectiveness among AI/AN children in their first or second RSV seasons during 2023-2024. Among 472 children with medically attended acute respiratory illness (ARI), 48% overall had received nirsevimab ≥7 days earlier (median = 91 days before the ARI-related visit). For children in their first RSV season (292), nirsevimab effectiveness was 76% (95% CI = 42%-90%) against medically attended RSV illness and 89% (95% CI = 32%-98%) against RSV hospitalization. For children in their second RSV season (180), effectiveness against medically attended RSV illness was 88% (95% CI = 48%-97%). Nirsevimab is effective for preventing severe RSV illness among infants entering their first RSV season and children entering their second season with increased risk for severe RSV, including all AI/AN children., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. James W. Keck reports grant support from the National Institutes of Health (NIH) for the Alaska Native Center for Health Research Project and for the Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology; from the National Science Foundation for the Pandemic Environmental Surveillance Center for Assessing Pathogen Emergency Project; from NIH for the COVID-19 infection and diabetes incidence in Native American People project; from NIH for the Neqkiuryaraq – The Art of Preparing Food Project; from Greenwall Foundation for the developing stakeholder-engaged ethical guidance for public health wastewater surveillance project service; and as safety officer and chair of the Data Safety Monitoring Board for National Institute of Diabetes and Digestive and Kidney Diseases-funded study: Enhancing the Diabetes Prevention Program. No other potential conflicts of interest were disclosed.