Physician Experience of Discrimination in a Leadership and Well-Being Program.

Family Physicians Sue to Shine Light on RUC Deliberations, Claim Specialists Skew Reimbursement Against Primary Care

One Stop Health Care Shopping? The Rise of “McClinics” and Their Impact on Emergency Care

This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of North American (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists, and dermatologists in North America. It is important to realize that guidelines cannot always account for individual variation among patients. They are assessments of current scientific and clinical information provided as an educational service; are not continually updated and may not reflect the most recent evidence (new evidence may emerge between the time information is developed and when it is published or read); should not be considered inclusive of all proper treatments methods of care, or as a statement of the standard of care; do not mandate any particular course of medical care; and are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Whether and the extent to which to follow guidelines is voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances. Although IDSA, AAN, and ACR make every effort to present accurate, complete, and reliable information, these guidelines are presented “as is” without any warranty, either express or implied. IDSA, AAN, and ACR (and their officers, directors, members, employees, and agents) assume no responsibility for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with these guidelines or reliance on the information presented. The guidelines represent the proprietary and copyrighted property of IDSA, AAN, and ACR. Copyright 2020 Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology. All rights reserved. No part of these guidelines may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of IDSA, AAN, or ACR. Permission is granted to physicians and healthcare providers solely to copy and use the guidelines in their professional practices and clinical decision-making. No license or permission is granted to any person or entity, and prior written authorization by IDSA, AAN, or ACR is required, to sell, distribute, or modify the guidelines, or to make derivative works of or incorporate the guidelines into any product, including but not limited to clinical decision support software or any other software product. Except for the permission granted above, any person or entity desiring to use the guidelines in any way must contact IDSA, AAN, or ACR for approval in accordance with the terms and conditions of third party use, in particular any use of the guidelines in any software product. Summarized below are the 2020 recommendations for the prevention, diagnosis, and treatment of Lyme disease. The panel followed a systematic process used in the development of other Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text (http://onlinelibrary.wiley.com/doi/10.1002/acr.24495/abstract). A. Personal protective measures B. Repellents to prevent tick bites C. Removal of attached ticks A. Diagnostic tick testing B. Diagnostic testing of asymptomatic patients following tick bites Supplementary data. Supplementary materials (in addition to the full guideline) are available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24495/abstract. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. Conflict of interest statement. See the Methodology section in the full guideline (on the Arthritis Care & Research website at http://online​library.wiley.com/doi/10.1002/acr.24495/abstract) for approach to conflict of interest (COI) by the IDSA/AAN/ACR COI review group. The following list is a reflection of what has been reported to the IDSA/AAN/ACR COI review group. To provide thorough transparency, the IDSA/AAN/ACR requires full disclosure of all relationships, regardless of relevancy to the guideline topic. The assessment of disclosed relationships for possible COI is based on the relative weight of the financial relationship (i.e., monetary amount) and the relevance of the relationship (i.e., the degree to which an association might reasonably be interpreted by an independent observer as related to the topic or recommendation of consideration). The reader of these guidelines should be mindful of this when the list of disclosures is reviewed. Dr. Lantos has received research funding from the National Cytomegalovirus Foundation and from the NIH and educational funding from Duke University; and has served as a consultant and reviewed trial protocol for Frederick O’Connor Medical Consultants, LLC. Dr. Bockenstedt has received research funding from the NIH and the Gordon and Llura Gund Foundation; has received remuneration from L2 Diagnostics for investigator-initiated NIH-sponsored research; and was awarded an endowed professorship as the Harold W. Jockers Professor of Medicine at Yale University. Dr. Falck-Ytter serves as director of the Evidence Foundation and the GRADE Network; conducts GRADE workshops with the Evidence Foundation; has served as the chair of the Guidelines Committee for the American Gastroenterological Association; and has received research funding from the Cleveland VA Medical Research and Education Foundation. Dr. Aguero-Rosenfeld serves as a council member for the New York City chapter of the American Society of Microbiology (ASM) and as a Board member of the American Lyme Disease Foundation; has provided legal testimony and consultation regarding Lyme disease and tick-borne diseases; and has received research grants from the NIH, BioFire, New York State Department of Health, and ViraMed. Dr. Auwaerter receives research funding from the Fisher Center for Environmental Infectious Diseases and the NIH; serves on the Board of Directors of the American Lyme Disease Foundation and as the Vice Chair of the Infectious Diseases Society of America (IDSA) Foundation; serves as a scientific advisor for DiaSorin, Adaptive Technologies, and Shionogi; provides legal expert opinion testimony regarding Lyme disease; had stock in Johnson & Johnson; has served as an editor for Johns Hopkins POC-IT ABX Guide, an advisor for the Food and Drug Administration (FDA), Genentech, Dynavax, Aradigm, Cempra, BioMérieux, Cerexa, and Medscape; has received research funding from Cerexa; has served on the FDA Advisory Board, the Medscape Advisory Board, and the IDSA Board of Directors; and his spouse has equity interest in venture capital–funded Capricor. Dr. Belani reviews non-continuing medical education (CME) lectures for and received honoraria and travel reimbursement from Horizon Therapeutics; and has received research funding from the NIH and the Children’s Hospitals and Clinics of Minnesota. Dr. Bowie has provided expert testimony to the Canadian Senate Subcommittee on Bill C-442: An Act Respecting a National Lyme Disease Strategy on behalf of the Association of Medical Microbiology and Infectious Disease Canada; and has received research funding from GlaxoSmithKline, Pfizer Canada, the Canadian Institutes of Health Research, and Vancouver Coastal Health Research Institute. Dr. Branda receives research funding from the Lyme Disease Biobank Foundation and Zeus Scientific; serves as a scientific advisor and consultant to DiaSorin, Inc.; has served as a scientific advisor and consultant for T2 Biosystems; has served on the scientific advisory board of Roche Diagnostics and AdvanDx; has received research funding from Karius, Inc., Alere, Inc., T2 Biosystems, BioMérieux, TBS Technologies, Immunetics, Inc., DiaSorin, Inc., Kephera Diagnostics, Inc., and the Bay Area Lyme Foundation; has participated in unfunded research collaborations with Karius Inc. and Kephera Diagnostics; was a member of the editorial board of the Journal of Clinical Microbiology; was a co-inventor on an application for a patent to protect intellectual property; and his spouse is an employee of Informed DNA. Dr. Clifford receives research funding from the NIH and the Alzheimer’s Association; serves as scientific consultant to Inhibikase and Excision BioTherapeutics; serves on Data and Safety Monitoring Boards (DSMB) for Biogen, Genzyme/Sanofi, Genentech, EMD Serono, Shire, Wave Life Sciences, Pfizer, Atara, Mitsubishi Tanabe, and IQVIA (formerly Quintiles); serves on Progressive Multifocal Leukoencephalopathy (PML) adjudication committees for Amgen, GlaxoSmithKline, EMD Serono, Bristol Myers Squibb, Roche, and the Takeda Oncology (formerly Millennium) Adjudication Committee–FDA, as well as Dr. Reddy’s Laboratories; has previously received research funding from the NIH; and his spouse formerly held stock in Johnson & Johnson. Dr. DiMario has received research funding from Novartis. Dr. Halperin serves as an Editorial Board Member of Neurology, and Vice Chair of the American Academy of Neurology (AAN) Guideline Subcommittee; has stock in Abbott Labs, AbbVie, Merck, and Johnson & Johnson; provides and has previously provided legal expert testimony defending physicians in medical malpractice cases on various neurologic issues, including Lyme disease; has received research funding from NIH, the Centers for Disease Control and Prevention (CDC); and has served as a section editor of neuroinfectious diseases in Neurology & Neuroscience Reports. Dr. Krause receives research funding from the Yale Emerging Infections Program; receives remuneration from Gold Standard Diagnostics for a collaborative research project; has stock in Gilead Sciences and First Trust NASDAQ Pharmaceuticals ETF; has received research funding from the NIH, the Centers for Disease Control and Prevention (CDC), the Gordon and Llura Gund Foundation, and L2 Diagnostics for NIH-sponsored research; has served as a scientific consultant and provided medical education and training for Oxford Immunotec, Inc.; has a patent pending (Enhanced Chemiluminescent enzyme-linked immunosorbent assay for detection of antibodies against Babesia microti), for which US Provisional Patent Application No. 62/580,588, was filed on November 2, 2017; serves on the Board of Directors for the American Lyme Disease Foundation and the Editorial Boards of Pathogens and Plos Neglected Tropical Diseases and the Editorial Advisory Board of Clinical Infectious Diseases; was on the Editorial Board of Journal of Clinical Microbiology, and will be on the Editorial Board of Clinical Microbiology Reviews starting January 2021. Dr. Liang has stock in Johnson & Johnson; received research funding from the Veterans Health Administration, the Arthritis Foundation, and the NIH; has served on the FDA Advisory Panel, Institute of Medicine panels; served as a scientific reviewer for the Research Grant Council of Hong Kong and the NIH; served on the Board of the Lupus Clinical Trials Consortium, Beacon Hill Villages, and Rx Foundation and advised the Institute for Clinical and Economic Review and the China Medical Board; previously had stock in Sequenom; and his spouse has stock in Johnson & Johnson. Dr. Meissner is a current member of the CDC Workgroups and serves as a volunteer consultant on the American Academy of Pediatrics Committee on Infectious Diseases and the NIH DSMB. Dr. Nigrovic receives research funding from the NIH, Department of Defense, and the NIH Center for Research Resources and for Advancing Translational Sciences (NCATS), Global Lyme Alliance, and Peabody Foundation; serves on the Editorial Board for Annals of Emergency Medicine; has served as scientific consultant for Adaptive Technologies; has received research funding from the NIH, Provider and Payer Quality Initiative (PPQI) Research Foundation, Harvard Catalyst, Hood Foundation, Bay Area Lyme Foundation, CDC, Emergency Medical Services for Children (EMSC), the National Patient-Centered Clinical Research Network (PCORNet), Milton Foundation, and Boston Children’s Hospital. Dr. Nocton receives research funding from Bristol Myers Squibb; serves as a member of the Subboard of Pediatric Rheumatology of the American Board of Pediatrics; and has received research funding from AbbVie, NIH, and the Arthritis Foundation. Dr. Pruitt has received research funding from Teva Pharmaceuticals and has served on the AAN Editorial Board of Neurology Clinical Practice. Ms Rips has received research funding from the Center for AIDS Research, Biogen Idec, Hoffmann-LaRoche, Sun Pharmaceutical Industries Ltd., Genzyme, the Alzheimer’s Association, and the American College of Radiology; and has served as a speaker for Teva Pharmaceuticals. Dr. Rosenfeld serves as a Council Member of the American College of Cardiology; has stock in Abbott, Proctor & Gamble, and General Electric; has received Fellowship Support from Boston Scientific, Medtronic, and Abbott Laboratories (formerly St. Jude Medical); has received research funding from Boehringer Ingelheim Pharmaceuticals, Inc.; and has served on the Program Committee and the Patient and Caregivers Committee of the Heart Rhythm Society. Dr. Savoy serves on the American Academy of Family Physicians (AAFP) Board of Directors, as an ex-officio Board member of Delaware Academy of Family Physicians (DAFP), as the Chair of the Centers for Medicare and Medicaid Services (CMS) Advisory Panel on Outreach and Education, and as Secretary of the Board of Directors of the Association of Departments of Family Medicine; receives honoraria from AAFP, DAFP, CMS, and Merck; has served on an Advisory Council for Highmark Health and as an advisor to the AAFP Adolescent Immunization Project; has received honoraria from AAFP; has served as the President of DAFP, as Editor of DelFamDoc, and as a member of AAFP Commissions. Dr. Sood has received research funding from the NIH; and has provided expert testimony for Danaher Lagnese, PC. Dr. Steere receives research funding from the NIH and the Mathers Foundation; has received research funding from the NIH, the American College of Rheumatology, the Mathers Foundation, the English-Bonter-Mitchell Foundation, Immunetics, Inc., Zeus Diagnostics, and the Ounsworth-Fitzgerald Foundation; and has served as a scientific advisor for Baxter Bioscience Institute of Systems Biology, Immunetics, Inc., Roche Diagnostics, and Viramed. Dr. Strle receives research funding from the Slovenian Research Agency; serves as the Head of Health Counsel of the Ministry of Health of the Republic of Slovenia and as a member of the Steering Committee for the European Society of Clinical Microbiology and Infectious Diseases Study Group for Lyme Borreliosis; serves on the Roche Diagnostics Advisory Board on Lyme Disease Diagnostics; and has received honoraria from Roche Diagnostics. Dr. Sundel receives research funding from the NIH and AbbVie, Inc.; serves as a content author and editor for UpToDate; provides expert testimony to Chin-Caplan, PC; has provided expert testimony for Conway Homer, PC; has served as an advisor for Paul Hastings, LLC; has served as a content editor for SimulConsult and as a Medical Education Resources lecturer for CME-granting educational courses; has received remuneration from SimulConsult as a co-investigator for an NIH-sponsored grant; and has received research funding from the NIH. Dr. Tsao receives research funding from the National Science Foundation, NIH, CDC, the Michigan Lyme Disease Association, and the Michigan Department of Health and Human Services; serves as a Scientific Council Advisor Member for the Canadian Lyme Disease Research Network and as a scientific advisor for the American Lyme Disease Association; has received research funding from Michigan State University; has served as an Associate Editor for Ticks and Tick-Borne Diseases and on the Tick Vectors, Surveillance, and Prevention Subcommittee of the US Department of Health and Human Services Tick-Borne Disease Working Group; and has received remuneration for providing educational seminars for Boehringer Ingelheim (formerly Merial). Dr. Wormser receives research funding from Immunetics, Inc., Rarecyte, Inc., Institute for Systems Biology, and Quidel Corporation; serves on the Board of the American Lyme Disease Foundation; provides and has previously provided expert testimony in malpractice cases; has stock in AbbVie, Inc. and Abbott Laboratories; has received research funding from the CDC, NIH, BioMérieux, Bio-Rad Laboratories, and DiaSorin, Inc; has served as a scientific research advisor for Baxter International and as a Lyme disease advisor and expert for the Missouri Board of Registration for the Healing Arts; has a patent approved (US patent no. 10,669,567 B2) for High Sensitivity Method for Early Lyme Disease Detection; filed 2 patent applications related to early Lyme disease detection (application no: 62/277,252) and Lyme arthritis and post-treatment Lyme disease syndrome (application no: 62/725,745); and has served on the Editorial Boards for Clinical Infectious Diseases, Vector-Borne and Zoonotic Diseases, and Ticks and Tick-Borne Diseases. Dr. Zemel has served as an advisor for Novartis Promotional Speakers Bureau. No other disclosures relevant to this article were reported. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. The expert panel expresses its gratitude for thoughtful reviews of an earlier version to the external reviewers. The panel thanks the IDSA, AAN, and ACR for supporting the guideline development process. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr. Lantos had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rips, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Lantos, Rumbaugh, Bockenstedt, Falck-Ytter, Aguero-Rosenfeld, Auwaerter, Baldwin, Bannuru, Belani, Bowie, Branda, Clifford, DiMario, Halperin, Krause, Lavergne, Liang, Meissner, Nigrovic, Nocton, Osani, Pruitt, Rips, Rosenfeld, Savoy, Sood, Steere, Strle, Sundel, Tsao, Vaysbrot, Wormser, Zemel. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Approximately one in five Black students report cannabis use, which is associated with academic challenges, mental health, and interpersonal problems. Understanding motivators to use cannabis among Black students at predominantly White institutions (PWIs) warrants more research. Perceived racial discrimination (PRD), believing one is treated unjustly due to race, is related to substance use and variables associated with poor coping, such as depression and anxiety. Given that research is unavailable for Black college students on the factor structure of the Everyday Discrimination Scale (EDS) using chronicity-based coding, the first aim of the study is to examine the factor structure of the chronicity-based version of the EDS. The second aim is to investigate whether distressed coping is an intervening construct between PRD and cannabis use among Black college students. Participants, recruited from a midwestern PWI (N = 119), completed the EDS, the coping subscale of the Comprehensive Marijuana Motivations Measure, and reported past-year cannabis use. Factor analysis examined the measurement model of the EDS, while path analysis assessed the mediation models. A two-factor model assessing subtle and blatant PRD on the EDS fit the data. The path analysis revealed that distressed coping fully mediated the relationship between subtle PRD and cannabis use. Distressed coping did not mediate the relation between blatant PRD and cannabis use. Institutions might focus on reducing PRD and provide support to Black students to lessen its link to distressed coping and cannabis use.

Going against medical advice: PCPs' role in reducing colonoscopy overuse.

9128 Background: Little is known about primary care physicians’ attitudes and knowledge regarding the health and long term follow-up (LTFU) of childhood cancer survivors (CCS). We sought to obtain family physicians’ (FPs) self-reported preferences and knowledge regarding this population. Methods: Following a pre-notification letter, surveys with a $2 bill were mailed to 1520 physicians from the AAFP membership directory in November 2010. A second mailing to non-responders is ongoing. Results: To date, 529 FPs have responded (35% response rate). Respondents have practiced a median of 25 years and see a median of 80 patients/week. In the last five years, 63% had seen at least one CCS in their practice; about half (54%) report almost never receiving a treatment summary. Among 3 specific cancer types, respondents’ discomfort in caring for CCS (1 = very uncomfortable; 7 = very comfortable) was greatest for osteosarcoma survivors (3.2 ± 1.7), less with ALL survivors (3.3 ± 1.7), and least with Hodgkin lymphoma (HL) survivors (mean ± SD 3.6 ± 1.7). The majority (82%) prefer to care for CCS in consultation with a cancer center based physician and/or LTFU clinic. A vignette of a 29-year-old female treated for HL with mantle radiation at age 16 was provided, participants were asked a series of follow-up monitoring questions. Concordance of responses to the Children’s Oncology Group LTFU Guidelines was: breast cancer surveillance, 18%; cardiac surveillance; 10%, and thyroid surveillance, 71%. Only 3% were concordant with all three of these questions. Concordance with breast cancer and cardiac questions was associated with reported familiarity with guidelines (OR=3.49, 95% CI 1.79-6.78; OR=3.73, 95% CI 1.73-8.04, respectively). In describing what would be most useful to care for CCS (1=not at all useful; 5=very useful), among 11 options, FPs reported the most preferred were access to LTFU guidelines (4.7 ± 0.6) and a patient-specific care plan (4.7 ± 0.6). Conclusions: While the majority of FPs are willing to follow CCS, they express some discomfort with this care, appear unfamiliar with the available LTFU guidelines and prefer to follow patients in collaboration with a cancer center.

Primary care physician attitudes toward endoscopic screening for GERD symptoms and unsedated esophagoscopy

screening reports generated by 23andMe because there is confl icting evidence about BLM variants Indeed, 23andMe "would have to seek a different claim for reporting cancer risk," notes FDA Spokesperson Eric J. Pahon.

Few data are available regarding how patients view the role of primary care physicians as "gatekeepers" in managed care systems. To determine the extent to which patients value the role of their primary care physicians as first-contact care providers and coordinators of referrals, whether patients perceive that their primary care physicians impede access to specialists, and whether problems in gaining access to specialists are associated with a reduction in patients' trust and confidence in their primary care physicians. Cross-sectional survey mailed in the fall of 1997 to 12707 adult patients who were members of managed care plans and received care from 10 large physician groups in California. The response rate among eligible patients was 71%. A total of 7718 patients (mean age, 66.7 years; 32 % female) were eligible for analysis. Questionnaire items addressed 3 main topics: (1) patient attitudes toward the first-contact and coordinating role of their primary care physicians, (2) patients' ratings of their primary care physicians (trust and confidence in and satisfaction with), and (3) patient perceptions of barriers to specialty referrals. Referral barriers were analyzed as predictors of patients' ratings of their physicians. Almost all patients valued the role of a primary care physician as a source of first-contact care (94%) and coordinator of referrals (89%). Depending on the specific medical problem, 75% to 91% of patients preferred to seek care initially from their primary care physicians rather than specialists. Twenty-three percent reported that their primary care physicians or medical groups interfered with their ability to see specialists. Patients who had difficulty obtaining referrals were more likely to report low trust (adjusted odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5), low confidence (OR, 2.2; 95% CI, 1.6-2.9), and low satisfaction (OR, 3.3; 95% CI, 2.6-4.2) with their primary care physicians. Patients value the first-contact and coordinating role of primary care physicians. However, managed care policies that emphasize primary care physicians as gatekeepers impeding access to specialists undermine patients' trust and confidence in their primary care physicians.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Perceived Discrimination, Hypervigilance, and Visual Disabilities Among United States Adults: An Analysis of National Survey Data.

165 Background: Racial discrimination is a significant social determinant of health inequities. Ethnic disparities can indirectly result in different access to care, while healthcare provider ethnic bias can influence healthcare outcomes. National statistics show that Black patients have higher death rates when compared to those of other race and ethnicities. Our study aims to evaluate and compare self-reported and perceived discrimination in day-to-day life and healthcare experiences of patients who receive care at our cancer center. Methods: Cancer patients were surveyed in person at the Cancer Center at Medstar Washington Hospital Center between July 2022 and January 2023. The Everyday Discrimination Scale (EDS) by D.R. Williams and Discrimination in Medical Setting (DMS) questionnaire by M.E. Peek were used to collect data. Results: 100 patients following up at the clinic completed the paper survey. 74% were females and 26% males, 75% Black, 17% White and 8% Other Races (including Hispanic and Asian). The responses to the EDS and DMS were collected and coded as continuous variables, summed together, reported as medians, and compared across the various groups of interest. P-values between medians were reported using Kruskal Wallis test/Wilcoxon rank-sum test. Highest median scores on the EDS were found in Other Races, with a higher score representing higher self-perceived discrimination, followed by Black, and White (p<0.001). Lowest median scores on the DMS questionnaire were found in White, lower score representing lower self-perceived discrimination, followed by Other Races and Black (p<0.001). 30% of our total study population reported feeling that their quality of care was affected due to racial discrimination, out of which 83% were Black and 16% were Other Races, not including White (p= 0.006). Comparison of median scores for both the scales was not statistically different across age, gender, and cancer type. Conclusions: The results of our study demonstrate that self-reported and self- perceived racial discrimination extends to health care, and for some includes self-reported effects on the quality of health care received. Worse responses of the Other Races on the EDS and DMS scales could be explained by the low number of participants. Overall, the negative responses may have been affected by a variety of factors like varying stage of diagnosis, care received at other health-care centers, all of which would attribute to self-reported poorer experience regardless of race. There is a growing need to address these disparities to providing culturally sensitive care and addressing the root causes of systemic racism and inequality. This study is the first step in determining the day-to-day and healthcare experiences among patients at our center. We hope to follow with a prospective survey-based analysis of implicit bias among all healthcare workers.

Experiences of discrimination during pregnancy predict altered neonatal hair cortisol at birth.

Primary care physicians (PCPs) are well placed to provide holistic care to survivors of childhood cancer and may relieve growing pressures on specialist-led follow-up. We evaluated PCPs' role and confidence in providing follow-up care to survivors of childhood cancer. In Stage 1, survivors and parents (of young survivors) from 11 Australian and New Zealand hospitals completed interviews about their PCPs' role in their follow-up. Participants nominated their PCP for an interview for Stage 2. In Stage 2, PCPs completed interviews about their confidence and preparedness in delivering childhood cancer survivorship care. Stage 1: One hundred twenty survivors (36% male, mean age: 25.6 years) and parents of young survivors (58% male survivors, survivors' mean age: 12.7 years) completed interviews. Few survivors (23%) and parents (10%) visited their PCP for cancer-related care and reported similar reasons for not seeking PCP-led follow-up including low confidence in PCPs (48%), low perceived PCP cancer knowledge (38%), and difficulty finding good/regular PCPs (31%). Participants indicated feeling "disconnected" from their PCP during their cancer treatment phase. Stage 2: Fifty-one PCPs (57% male, mean years practicing: 28.3) completed interviews. Fifty percent of PCPs reported feeling confident providing care to childhood cancer survivors. PCPs had high unmet information needs relating to survivors' late effects risks (94%) and preferred a highly prescriptive approach to improve their confidence delivering survivorship care. Improved communication and greater PCP involvement during treatment/early survivorship may help overcome survivors' and parents' low confidence in PCPs. PCPs are willing but require clear guidance from tertiary providers. Childhood cancer survivors and their parents have low confidence in primary care physicians' ability to manage their survivorship care. Encouraging engagement in primary care is important to promote holistic follow-up care, continuity of care, and long-term surveillance. Survivors'/parents' confidence in physicians may be improved by better involving primary care physicians throughout treatment and early survivorship, and by introducing the concept of eventual transition to adult and primary services. Although physicians are willing to deliver childhood cancer survivorship care, their confidence in doing so may be improved through better communication with tertiary services and more appropriate training.