Washington Center

PurposeA patient-centered approach to clinical care is related to improved outcomes. Patient -centered communication (PCC) includes eliciting the patient’s agenda, active listening, partnering with patients and expressing empathy. Clinicians’ implicit bias is associated with low quality PCC.Materials and MethodsWe explored whether brief health equity/implicit bias education improves academic clinicians’ PCC and if implicit and explicit race and gender bias are associated with PCC improvement. This mixed methods online survey of clinical teaching faculty included tests of implicit and explicit race and gender bias, demographic and practice characteristics, a brief online health equity implicit bias educational intervention, and a pre-and-post course simulated clinical interaction using case vignettes. Emotional elements (empathy, reassurance, concern and partnering) of PCC were assessed to determine the impact of the course on PCC.ResultsOf 103 participants, 70.9% were female, 71.8% were White and 57.3% were MDs. We found that participants held moderate implicit bias favoring White People versus Black people (Cohen’s d = 0.66) and a strong implicit association of males rather than females with the concept of “career” (Cohen’s d = 1.15). Overall, brief implicit bias education did not significantly change participant PCC, however, early career clinicians and those who identified as medical doctors showed significantly greater post-course PCC improvement. Implicit and explicit bias were not associated with PCC scores.ConclusionThe impact of brief health equity/implicit bias education may go beyond knowledge acquisition and influence PCC if tailored to a specific discipline and stage of career, regardless of clinicians’ personal biases.

Healthcare systems worldwide face mounting challenges, including shortages of primary and specialty care providers, escalating direct and indirect medical costs, and limited access to high-quality diagnostic and interventional services—burdens that disproportionately affect patients in rural or medically underserved areas. Because timely, reliable, and affordable diagnostic and interventional services are essential to comprehensive, lifelong care, the expanding role of physiotherapists as autonomous, first-contact providers represents a critical and timely innovation. This article underscores the value of electrodiagnostic (EDX) testing and ultrasound imaging (USI) as instrumented point-of-care diagnostic tools available to physiotherapists through recognized pathways of training and credentialing and argues for their greater integration into contemporary practice. The authors contend that expanding training opportunities in both entry-level physiotherapy curricula and post-graduate programs will increase physiotherapist utilization of these technologies, strengthen the evidence-based rationale for physiotherapy as a primary care profession, and solidify the discipline's role as an indispensable member of the interdisciplinary healthcare team. By broadening access to EDX testing and USI, physiotherapists can deliver timely and cost-effective diagnostic and interventional services, mitigate barriers created by provider shortages, and help modernize healthcare systems to better meet the demands of strained populations worldwide.

ABSTRACTPurposeThe present study aims to evaluate whether differences in accuracy of the implant positions exist for static computer‐aided implant placement based on the manufacturing process of surgical guides and the inclusion or not of metal sleeves.MethodsSeventy‐two implants (6 per model) were placed in 12 models simulating a partially edentulous maxilla using 12 dentally supported surgical guides anchored with 2 anchor pins. The surgical guides were divided into three groups: additive manufactured with a metal sleeve (Group PS), additive manufactured without a metal sleeve (Group PNS), and subtractive manufactured without a metal sleeve (Group MNS). The internal drilling diameter was standardized for all groups (4.85 mm). Deviations between the planned virtual implant positions and the scanned postoperative models were assessed in three parameters: 3D deviations at the crest, 3D deviations at the apex, and angular deviations in the implant insertion axis. The Shapiro–Wilk test was applied to analyze the normality of the sample distribution. Kruskal–Wallis and Mann–Whitney tests were used to analyze the deviations among the groups (α = 0.05).ResultsStatistical differences were reported among the groups in the parameters: 3D deviations at the crest, 3D deviations at the apex, and angular deviations in the implant insertion axis (p < 0.05). At the crest, the smallest 3D deviation was recorded in the MNS group (0.498 ± 0.337 mm) followed by the PNS group (0.660 ± 0.572 mm) and the PS group (1.028 ± 0.424 mm) (p < 0.05). At the apex, as well, the lowest deviation was observed in the MNS group (0.810 ± 0.544 mm) followed by the PNS group (0.840 ± 0.620) and the PS group (1.360 ± 0.990 mm) (p < 0.05). Regarding angular deviations, the best results were obtained by the PNS group (1.44° ± 1.57°) with statistically significant differences with both the MNS group (2.90° ± 2.35°) and the PS group (3.88° ± 2.85°) (p < 0.05).ConclusionsThe accuracy of the implant position was affected by the inclusion or absence of metal sleeves and the manufacturing method. Overall, non‐sleeved guides deliver better accuracy by reducing crestal and apical deviations, as well as angular errors. Differences between the groups without metal sleeves, 3D printed and milled, were found in the implant angulation, where the 3D printed group obtained more accurate results.

<b>Discussion:</b> These data highlight differences in treatment engagement and receipt of an adequate dose of treatment based on intervention-level factors within an active PTSD specialty clinic, which can aid decision-making for patients and providers. Future research is needed to investigate predictors of treatment engagement and outcomes.

Abstract Background Prolonged viral replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunocompromised (IC) hosts has raised questions about whether treatment duration with nirmatrelvir/ritonavir (nirmatrelvir/r) should be longer than the authorized 5-day course. Data describing nirmatrelvir/r treatment outcomes are limited in the IC population. The primary objective of this study was to assess the efficacy of a nirmatrelvir/r 5-day course as treatment for coronavirus disease 2019 (COVID-19) in IC patients. Methods A retrospective chart review was conducted at Fred Hutchinson Cancer Center (FHCC) of patients ≥ 18 years old with an active hematologic malignancy who received nirmatrelvir/r under Emergency Use Authorization between 12/22/21 - 5/25/23. Patients with an active oncology treatment plan within 3 months (before or after) their nirmatrelvir/r prescription date were included. Patients who received nirmatrelvir/r under Investigational New Drug authorization were excluded. The primary outcome was a composite of all-cause mortality or COVID-19 related hospitalization within 30 days of nirmatrelvir/r. A secondary outcome, persistent COVID-19 infection, was defined as a positive SARS-CoV-2 polymerase chain reaction test 30-90 days after initial positive test. Results Among 928 patients who received nirmatrelvir/r at FHCC, 399 patients were included. Median age was 63 years, 55% of patients were male, and lymphoma was the most common malignancy, 48% (Table 1). Thirty-day all-cause mortality or COVID-19 related hospitalization occurred in 39/399 (9.8%) of patients. Thirteen patients (3.3%) had persistent COVID-19 infection; 8 had persistent symptoms and 5 required additional treatment. Early discontinuation of nirmatrelvir/r due to adverse effects, most commonly gastrointestinal, occurred in 11 (2.8%) patients (Table 2). Conclusion Incidence of the primary outcome was higher in our population compared to rates in nirmatrelvir/r phase 3 trial data and driven by hospitalization rather than all-cause mortality. Persistent infection requiring further treatment occurred in only 1.3% of patients. Additional studies are needed to define optimal treatment duration, including potential indications for use &amp;gt; 5 days in IC hosts. Disclosures Frank Tverdek, PharmD, Merck: Advisor/Consultant Catherine Liu, MD, Pfizer: Grant/Research Support

Despite widespread advances in DNA sequencing, the functional consequences of most genetic variants remain poorly understood. Multiplexed Assays of Variant Effect (MAVEs) can measure the function of variants at scale, and are beginning to address this problem. However, MAVEs cannot readily be applied to the ~10% of human genes encoding secreted proteins. We developed a flexible, scalable human cell surface display method, Multiplexed Surface Tethering of Extracellular Proteins (MultiSTEP), to measure secreted protein variant effects. We used MultiSTEP to study the consequences of missense variation in coagulation factor IX (FIX), a serine protease where genetic variation can cause hemophilia B. We combined MultiSTEP with a panel of antibodies to detect FIX secretion and post-translational modification, measuring a total of 44,816 effects for 436 synonymous variants and 8,528 of the 8,759 possible missense variants. 49.6% of possible F9 missense variants impacted secretion, post-translational modification, or both. We also identified functional constraints on secretion within the signal peptide and for nearly all variants that caused gain or loss of cysteine. Secretion scores correlated strongly with FIX levels in hemophilia B and revealed that loss of secretion variants are particularly likely to cause severe disease. Integration of the secretion and post-translational modification scores enabled reclassification of 63.1% of F9 variants of uncertain significance in the My Life, Our Future hemophilia genotyping project. Lastly, we showed that MultiSTEP can be applied to a wide variety of secreted proteins. Thus, MultiSTEP is a multiplexed, multimodal, and generalizable method for systematically assessing variant effects in secreted proteins at scale.

Introduction: A diverse health care workforce can better serve diverse patient populations. This study characterizes the experience of sexual minority medical students, particularly those with multiple marginalized identities, to determine how these are related to intended specialty and satisfaction with medical education.

We evaluated 249 asymptomatic patients receiving antibiotics for urinary infection: 222 had asymptomatic pyuria and/or nitrituria (ASPN) and 133 had asymptomatic bacteriuria (ASB, growth ≥105 colony forming units/ml). ASPN identified 40% more cases of unnecessary antibiotics compared to ASB and may be a more comprehensive measure of unnecessary antibiotic use.