Minnesota HealthSolutions (United States)

The shift toward virtual interviews in physician assistant/associate (PA) admissions accelerated during the COVID-19 pandemic, yet little is known about applicants' modality preferences. This study aimed to determine whether personal characteristics were associated with applicants' choice of interview format and to assess whether interview type was associated with admission outcomes and first-semester academic performance. This multicenter retrospective study included 405 interviewees to 3 private PA programs during the 2023 to 2024 admission cycle. Applicants chose either in-person or virtual interviews. Data were extracted from Centralized Application Service for Physician Assistants and institutional records and included demographics, academic metrics, and interview outcomes. Bivariable analyses and logistic regression were used to explore associations between interview type, admission status, matriculation, and grade point average (GPA). Of 405 interviewees, 270 chose in-person and 135 virtually. Those who chose virtual interviews were older, more likely to be male, lived farther from campus, had more patient care experience, and were more likely to identify as underrepresented in medicine (URiM). Among matriculants, those who interviewed virtually were more likely to report economic and environmental disadvantage. The proportion of interviewees offered admission and the proportion that matriculated were higher for those who chose in-person interviews than for those who chose to interview virtually. Interview type was not associated with first-semester GPA. Logistic regression identified URiM status and geographic distance as significant predictors of virtual interview choice. Offering virtual interviews may promote greater access and diversity without compromising academic outcomes. Applicants with URiM backgrounds or greater geographic/economic constraints were more likely to choose virtual formats. These findings support continued offering of virtual interviews as a strategy to reduce barriers in PA admissions.

Abstract BackgroundBlack/African Americans (B/AA) are nearly twice as likely as White/European Americans (W/EA) to have Alzheimer’s or other dementias and are more likely to provide care for persons with dementia (PwD). Evidence indicates that B/AA desire having someone to talk with who understands their caregiving challenges, yet are less likely than W/EA to ask for support. Further, community resources supporting caregivers’ ability to maintain health and well‐being developed with input from B/AA are lacking. We aimed to determine how a technology‐assisted caregiver matching service designed with user input could address diverse caregiver needs.MethodsFor this Phase I project, 32 caregivers of PwD (31% B/AA) participated in semi‐structured focus groups and completed surveys to provide input regarding characteristics deemed valuable in someone they would choose to be connected with for emotional support. Through an iterative process as new information emerged, a web‐based prototype and matching algorithm were developed.ResultsAge and sex distribution were similar between B/AA and W/EA (71 and 68 yrs; 90% and 86%, respectively). W/EA were most likely caring for a spouse/significant other (73%) whereas B/AA were caring for spouse/significant other (30%), a parent (30%;18% W/EA), a sibling (10%; 0% W/EA), or other (30%; 9%W/EA). Level of emotional support was rated “poor” (50% B/AA, 18% W/EA); “average” (0% B/AA, 14% W/EA); “good” (40% B/AA, 41% W/EA); and “excellent” (10%, 27% W/EA). Characteristics B/AA deemed “very important” or “absolutely essential” for a supportive match included living in close proximity, same ethnicity, similar lifestyle, and common values. Alternatively, W/EA selected similar age, living in close proximity, same sex, similar lifestyle, common values and interests, having the same caregiving relationship, and having the same diagnosis in their PwD (see chart).ConclusionIn this cohort, B/AA reported poorer levels of emotional support than W/EA. B/AA were equally likely to be supporting a spouse/significant other as a parent or other acquaintance, whereas W/EA provided support primarily for a spouse/significant other. Characteristics B/AA and W/EA consider important in a supportive caregiver match show important differences that should be considered when optimizing caregiving resources. Phase II will explore further in a much larger sample.

Abstract BackgroundCaregiving for persons with dementia negatively impacts physical and mental health, including increased risk for chronic loneliness and isolation. This Phase I study aimed to recruit former and current dementia caregivers as engaged partners in the design of a unique, technology‐assisted pairing platform to match caregivers to one another for meaningful connection and support based on characteristics chosen by the caregivers themselves.MethodWe recruited thirty‐two caregivers to participate in two semi‐structured focus groups (audio recorded for qualitative analyses) and complete a survey to understand the characteristics desired in another caregiver for the purpose of emotional support. Participants interacted with a website prototype on their personal device and completed a user experience feedback form. An iterative process was used to design the website and matching questionnaire allowing participants to validate preferences and concerns. Website analytics were captured (e.g. time to answer each question, total time spent on the website).ResultThe efforts culminated in a website ‘look and feel’ that addressed the preferences and criticisms of study participants. Figure 1 shows the home page slider inviting caregivers to join (images 1‐3) and describes the matching process (4); the caregiver answers up to 34 questions to create a profile (5‐7) and the website provides a list of caregivers that best match criteria (8). Overall, 87% of study participants rated a high level of comfort with completing the personal profile questions; 82% felt confident the questions asked would lead to a good match. An algorithm to match caregivers was created using the profile questions which asked participants to self‐select and then rank the characteristics of highest importance. Good and poor matches are scored by the algorithm, with 1 being a “perfect” match (Figure 2). In the current cohort, each participant had at least one match that scored 0.708 or higher.ConclusionOur study established interest in a technology assisted peer‐to‐peer caregiver matching program that is a potential low‐cost, high‐impact resource. The study resulted in a set of matching characteristics and an algorithm prototype within a user influenced website and will be further tested in Phase 2. Research supported from NIA of the NIH.

‘Clinical epidemiology’ is the application of rigorous logic and statistics to the study of diagnosis, prognosis, and therapy [1]. ‘Evidence-based medicine’ provides a hierarchical framework for evaluating clinical evidence [2]. The importance of the word, ‘clinical,’ cannot be overstated. ‘Clinic’ and ‘clinical’ refer to ‘doctors and patients,’ ‘the bedside’, ‘those hospitalized with sickness.’ Clinical research, therefore, is solely applicable to people (humans). Historically, many clinical discoveries have been a result of the observation of something happening in one person: an anecdote. A control group or power calculation was not necessary when the first patient survived meningitis after receiving penicillin, or when insulin and cortisol were given to those with insulin deficiency or adrenal insufficiency. In instances of extraordinary technical achievements, uncontrolled research has led to renal dialysis to reduce uremia, and organ transplantation. Of course, initial descriptive studies are not sufficient to generalize to other individuals or create practice policies and guidelines. But they might represent the beginning of a fruitful line of research and clinical care. Without access to the funding required to conduct expensive outcomes-based trials, the ‘state-of-the-art’ of the knowledge about carbohydrate restriction is not found by searching the published medical literature. Individuals and groups are organizing and studying themselves [3]. The ‘state-of-the-art’ of carbohydrate restriction is found in self-experimentation, clinical practices, and independent research that crosses traditional disciplines. SELF-EXPERIMENTATION In the paper by Dikeman (pp. 437–440), observations by physicians and patients with Type 1 diabetes mellitus have provided the pilot data to propose controlled clinical research. The paper by Reason (pp. 441–445) describes a group of individuals affected by an uncommon condition called McArdle's Disease who found improvement by using a carbohydrate-restricted diet. Now they are influencing the funded researchers of McArdle's Disease. In the paper by Feltham (pp. 446–452), his n-of-1 self-experiment to address the time-honored belief that a “calorie is a calorie” resulted in dramatically different weight gain on diets with the same amount of calories, providing provocative pilot evidence that a calorie is NOT a calorie. In a similar fashion, the paper by Lake (pp. 453–462) shatters the notion that high levels of exercise can only be accomplished while consuming dietary carbohydrate: his group traveled 100 miles over 5 days on their own power while only consuming water. CLINICAL PRACTICE REVIEWS Translating randomized controlled trials into clinical practice is typically accomplished through outcomes studies or health services research. The paper by Foley (pp. 463–468) outlines the metabolic effects of carbohydrate-restricted dietary patterns, and how they could be integrated into disease prevention and/or treatment programs. In the papers by Unwin (pp. 469–479) and Mitchell (pp. 480–487), clinic data are reviewed to address one of the unsubstantiated concerns about low carbohydrate diets: impaired renal function. Panayotti (pp. 488–495) describes a clinical program that incorporates a carbohydrate-restriction dietary option in a Pediatric obesity program. In the paper by Oliver (pp. 496–502), a brief intervention using carbohydrate restriction led to weight loss in a clinical practice. INDEPENDENT INTER-DISCIPLINARY RESEARCH There is also a growing number of independent researchers who are facilitating the connections across disciplines exploring the possible use of carbohydrate-restricted diets. In the paper by O’Hearn (pp. 503–508), the potential for using a ketogenic diet for sleep disorders is reviewed. The potential regarding carbohydrate-restricted dietary patterns for disease prevention and treatment is just beginning to be explored. It is my hope that the early investigations in this issue will be transferred from the ‘bedside’ to the ‘bench,’ and stimulate organizations that are interested in treating or preventing human illness to study or use carbohydrate-restricted dietary patterns. Acknowledgements None. Financial support and sponsorship No financial support or sponsorship has been given. Conflicts of interest E.C.W. receives royalties for the sale of diet books, and has equity in Adapt Your Life, Inc., a company based on low-carbohydrate concepts.

Examine the possible deficit of education, training, and confidence among physician assistants (PAs) for assisting patients who have been victims of sex trafficking and determine if there is support for a nationwide mandatory sex trafficking component in the PA curriculum. This quantitative study examined 184 United States PAs' predictors of confidence in assisting victims of trafficking using a modified PROTECT survey and used bivariable logistic regression to analyze data. This study identified a significant association between confidence in assisting in the care of sex trafficking patients and a nationwide curriculum requirement (OR = 5.389, p = .016) and past training (OR = .096, p = .000). Due to the majority of PAs not having the confidence or past training to assist in the care of patients who have been victims of sex trafficking, this study supports the need for a curriculum requirement dedicated to this topic in US PA programs.

The mammalian order primates contains wide species diversity. Members of the subfamily Colobinae are unique amongst extant primates in that their gastrointestinal systems more closely resemble those of ruminants than other members of the primate order. In the growing literature surrounding nonhuman primate microbiomes, analysis of microbial communities has been limited to the hindgut, since few studies have captured data on other gut sites, including the foregut of colobine primates. In this study, we used the red-shanked douc (Pygathrix nemaeus) as a model for colobine primates to study the relationship between gastrointestinal bacterial community structure and gut site within and between subjects. We analyzed fecal and pregastric stomach content samples, representative of the hindgut and foregut respectively, using 16S recombinant DNA (rDNA) sequencing and identified microbiota using closed-reference operational taxonomic unit (OTU) picking against the GreenGenes database. Our results show divergent bacterial communities clearly distinguish the foregut and hindgut microbiomes. We found higher bacterial biodiversity and a higher Firmicutes:Bacteroides ratio in the hindgut as opposed to the foregut. These gut sites showed strong associations with bacterial function. Specifically, energy metabolism was upregulated in the hindgut, whereas detoxification was increased in the foregut. Our results suggest a red-shanked douc's foregut microbiome is no more concordant with its own hindgut than it is with any other red-shanked douc's hindgut microbiome, thus reinforcing the notion that the bacterial communities of the foregut and hindgut are distinctly unique. OPEN PRACTICES: This article has been awarded Open Materials and Open Data badges. All materials and data are publicly accessible via the IRIS Repository at https://www.iris-database.org/iris/app/home/detail?id=york:934328. Learn more about the Open Practices badges from the Center for Open Science: https://osf.io/tvyxz/wiki.

The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. How can the desire to preserve flexibility be balanced against the desire of specialized PAs to distinguish themselves in their chosen specialty? This article reviews the issue of specialty certification in the context of contemporary PA practice and concludes that although specialty certification remains a threat to the flexibility of the PA model, it may be appropriate in some situations. In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.

This review discusses the most updated literature of muscle disease in scleroderma in the past year. In the past year, two studies have highlighted that fibrosis is a prevalent histopathologic feature in muscle biopsies of patients with scleroderma muscle disease. In addition, microangiopathy was a common co-feature on muscle biopsies. A fibrosing myopathy, or fibrosis predominance on muscle histopathology, is associated with a unique clinical phenotype in patients with scleroderma. When compared with those with an inflammatory myopathy, patients with a fibrosing myopathy tend to have diffuse scleroderma, lower muscle enzymes, nonirritable myopathy, and elevated cardiac enzymes. These patients are also reported to have a higher risk of cardiopulmonary complications and cardiac death when compared with those with an inflammatory myopathy. Although there are clear cases of overlap myositis, it is clear that muscle disease in scleroderma is being redefined, and it is crucial to start recognizing that the muscle is an organ that can directly be affected by scleroderma. Fibrosis can occur early in scleroderma muscle disease, and a unique histologic subtype of muscle disease, fibrosing myopathy, is associated with a higher risk of mortality.

ABSTRACTWe report two studies examining family interest in, and the feasibility of, technology-based treatment of childhood anxiety disorders and obsessive compulsive disorder (OCD). In the first study, 33 parents of children (51.5% boys; age 5–18 years) seen for anxiety or OCD completed a survey regarding access to technology, experience with the mental health system, and interest in technology-based tools. The majority of parents (76%) expressed high interest in electronic treatment options and preferred to use technology to facilitate, rather than replace, face-to-face treatment. In the second study, 10 youth (40% boys; age 6–17 years) and a parent completed an interactive online prototype to deliver psychoeducation for childhood anxiety disorders and OCD. User data supported the ability of the application to cover the breadth of symptom presentations, with most families able to identify multiple feared stimuli as well as related beliefs, avoidance behaviors, and potential exposures exercises. Only two entries, one fear stimuli and one exposure item, were made via free text. In addition, user experience was positive, with 80% of respondents rating the prototype highly. Overall, the results of both studies support and inform further development of electronic treatment tools for children with anxiety and OCD.

Pulmonary rehabilitation (PR) is an effective intervention for COPD. However, traditional center-based PR programs suffer from low uptake. Home-based PR is a viable solution, but few studies have shown the effectiveness of remote PR, as there is a scarcity of systems that can be easily adopted in clinical practice. The aim of this report is to communicate the development and feasibility of a home PR program that includes commercially available technology that allows the PR health coach to follow the patient through his or her PR process and to present the design of a prospective clinical trial. We developed a home PR system that includes a computer tablet, an activity monitor, and an oximeter connected to a cloud server. The home PR consists of 12 min of walking and 6 full-body exercises, to be completed 6 d/week, plus weekly telephone calls with the PR health coach. Two pilot studies were conducted in subjects with moderate-to-severe COPD. The first aimed to fine-tune the system development (N = 3), and the second tested the program feasibility of the 8-week program (N = 12). In pilot study 1, PR monitoring data from the subjects' home PR sessions were transmitted to the health coach application successfully. On a 10-point scale, participants rated the system as helpful (median = 8, interquartile range 8-9) and simple to use (median = 10, interquartile range 9-10). In pilot study 2, adherence ± SD for prescribed use was 87 ± 0.24%. Overall, participants gave the home PR system a rating of 6.2 ± 0.94 on a 7-point scale. A home PR program was developed that integrated health coaching and a home PR system that facilitated remote monitoring. Pilot testing indicated that the program is well-developed and feasible in a population of individuals with COPD. (ClinicalTrials.gov registration NCT02999685.).