ResearchPad - testing Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Genuine cross-frequency coupling networks in human resting-state electrophysiological recordings]]> Genuine interareal cross-frequency coupling (CFC) can be identified from human resting state activity using magnetoencephalography, stereoelectroencephalography, and novel network approaches. CFC couples slow theta and alpha oscillations to faster oscillations across brain regions.

<![CDATA[The utility of simple questions to evaluate cognitive impairment]]> As the population of patients with cognitive decline grows, physicians and caregivers need brief screening tools. Comprehensive neurocognitive batteries require special training and time for evaluation. We focused on accessibility and compared the diagnostic power of several easy questions.Design“Attended With” (AW) and “Head-Turning Sign” (HTS) factors and participants’ replies to following questions were recorded: “Do you feel that you have more difficulties in your daily life than you used to?”, [no consciousness (C-) or consciousness+ (C+)], “Could you tell me about your daily pleasures or pastimes?” [no pleasure (P-) or pleasure + (P+)], “What are notable current/recent news/topics?” [no news (N-) or news+ (N+)].SettingThis took place in our Memory Clinic between May 2016 and July 2019.ParticipantsWe enrolled 162 consecutive cases (44 cognitive normal (CN), 55 amnestic mild cognitive impairment (aMCI), and 48 Alzheimer’s disease (AD)).MeasurementsThe sensitivity and specificity of each battery were calculated, and on account of those numbers, the population attributable risk percent % (PAR%) of (AW and HTS+), (C- and P-), (C- and N-), (P- and N-) as analysis of combination of questions, respectively, were calculated.ResultsAW had high sensitivity, 87.4, 95.8% (CN vs aMCI + AD, CN + aMCI vs AD) but the sensitivity of HTS was only 46.4, 57.7%, and HTS showed high specificity, 100.0, 71.8%. C- had high sensitivity, 80.6, 87.5%, whereas P- and N- had high specificity, both 83.9% in CN vs aMCI + AD, 88.1% and 75.9% in CN + aMCI vs AD, respectively. In combination analysis, the PAR% of (C- and N-) were as high as (AW and HTS+).ConclusionsThe combination of (C- and N-) is as powerful as (AW and HTS+) in screening AD. Our findings provide novel insights for screening utility of brief questions “Consciousness of Impairment” and “Recent News.” ]]> <![CDATA[Senegal to trial $1 speedy test for covid-19]]> <![CDATA[How accurate is self-testing?]]> The UK has embarked on a programme of self-testing for coronavirus, but can swabs taken at home be trusted? Michael Brooks reports

<![CDATA[Rethinking testing]]> Instead of just testing people with symptoms, many countries could benefit from weekly testing of all key workers, reports Michael Le Page

<![CDATA[MON-137 Evaluation of the Timeliness of Serial Denosumab Administrations at the University of Colorado Hospital]]> BACKGROUND:

Denosumab is an antiresorptive medication commonly used in the treatment of osteoporosis that works by slowing bone loss. This medication should not be delayed or interrupted without initiation of an alternative treatment (i.e. bisphosphonates) as studies have shown that this can lead to rapid bone loss, very high markers of bone turnover, and increased vertebral fracture (VF) risk. It is unknown how frequently dosing is delayed in practice settings and how best practices can ensure timely dosing. Our study aimed to (1) evaluate the frequency and causes of delayed denosumab doses at our institution and (2) compare the incidence of delayed doses before and after implementation of a new electronic ordering process.


We performed a retrospective chart audit for all patients receiving two or more denosumab doses at our institution between 1/1/16-8/11/18 and categorized those whose doses were >/=214 days (7 months) as delayed. We reviewed notes, imaging, and labs in a subset of this population to assess reasons for the delay. On 8/11/18, a new outpatient infusion center (OIC) therapy plan went into place. This plan bundled a one-year denosumab order (2 doses) with an automatic referral to the OIC along with physician reminders for renewal. We compared rates of delayed denosumab dosing before and after implementation of this new order process.


Between 1/1/16-8/11/18, 385 patients received 1295 doses of denosumab, with 160 (41.6%) receiving 193 instances of delayed doses. We reviewed the charts of 98 individuals who received 111 instances of late doses between 7/6/16-8/11/18. The most prevalent reasons for delays were: delays in follow-up by the patient (27.9%), delays in the provider placing an order for the drug and OIC referral simultaneously (27.9%), and delays in OIC scheduling (18%). During the 14 months after implementation of the new ordering process, 347 patients received 614 instances of denosumab, of which 123 (35.4%) received 128 instances of delayed dosing. This is a relative decrease of 17.5% (p=0.09) for the proportion of patients with a late dose.


Nearly half of the patients on denosumab in our hospital received delayed denosumab dosing. Delays were often due to a lack of coordination between subsequent dose order placement and referral to the OIC. Our institution successfully implemented a bundled therapy plan to improve timely dosing. By March 2020, we expect to reassess the post-intervention group to further describe reasons for dosing delays. We also will compare rates of VFs associated with delayed denosumab dosing pre- and post-intervention periods.

<![CDATA[MON-130 Improving the Accuracy and Reliability of Free Thyroxine (FT4) Measurements Through the CDC Clinical Standardization Programs (CSP)]]> Reliable free thyroxine (FT4) measurements are essential for assessing thyroid function and for correctly diagnosing and treating thyroid disorders. Thyroid hormones play an important role in normal brain development of the fetus, and abnormal FT4 during pregnancy is associated with adverse pregnancy outcomes. Standardization of FT4 measurements, is critical to improving the accuracy and reliability of current methods and thus to improve diagnosis, treatment and prevention of thyroidal illnesses. Currently, there are no serum-based reference materials available for FT4 to assess the accuracy and reliability of FT4 assays. CDC CSP is collaborating with the International Federation of Clinical Chemistry and Laboratory Medicine, and the Partnership for the Accurate Testing for Hormones to address these issues through development of an accurate and sensitive higher-order Reference Measurement Procedure (RMP) for FT4 that will be used to assign target value to serum-based materials. The CDC CSP FT4 reference method is using equilibrium dialysis in combination with liquid chromatography tandem mass spectrometry (LC-MS/MS). FT4 in serum is isolated from the binding proteins in 1 mL equilibrium dialysis cells for 4 hours at 37oC. FT4 is further isolated by extractions prior to LC-MS/MS analysis. To determine the concentration of FT4 in serum, certified primary reference materials are used to prepare calibration materials. Chromatographic separation is achieved using a C18 reverse phase column with a gradient of methanol and water with 0.1% formic acid. Quantification by selective reaction monitoring is performed in the positive mode using electrospray ionization. Two transitions are monitored for each analyte and internal standard, and triplicate injections are used to minimize instrument instability. The within- and between-day imprecision for the CDC RMP are 2.2–3.9% and 1.8–2.6%, respectively. By comparisons with the RMPs at Ghent University in Belgium, Radboud University Medical Center in the Netherlands, and the Reference Material Institute for Clinical Chemistry Standards in Japan, the CDC RMP reported a bias within +2.5% of the mean for all labs. Factors affecting measurement accuracy were investigated, to maximize recovery for optimum performance of the method. FT4 was detectable in all samples, and thus, suitable for analysis of hypo-, eu-, and hyperthyroid patients. A comparison among hypo-, eu-, and hyperthyroid patients of a commercially available immunoassay and the CDC RMP indicated a mean bias of -37.7%. The CDC CSP has also evaluated the RMP for accurate measurement of FT4 in pregnant individuals. This candidate reference method for FT4 in serum demonstrates good accuracy and precision, and can be used as a viable base for accuracy to which routine methods for FT4 can be compared. 1. Van Houcke, S.K., et. al. Clin. Chem. Lab. Med. 2011, 49, 1275–1281.

<![CDATA[MON-131 Mortality and Glycemic Control Among Patients with Leukemia and Diabetes Mellitus: A Case-Control Study]]> Background: Unlike with solid organ cancers, little data is available on how diabetes mellitus (DM) and hematologic malignancies interact to affect survival and glycemic control. We examined the impact of DM on survival in patients with leukemia and the effect of leukemia on glycemic control. Materials and Methods: Patients with leukemia with and without DM were matched 1:1 (2007–2017), 70 matched pairs (total N=140 pts) were included in the analysis. We compared characteristics between cases and controls and assessed survival with the Kaplan-Meier method and Cox proportional hazards model. Mixed models compared hemoglobin A1c (HbA1c) and glucose levels over time. Results: The median age of patients at diagnosis was 56 (18–94); 60% were male and 89% had acute leukemia. Among those with DM, HbA1c was only recorded in 25 of 70 patients during the year following cancer diagnosis and was 6.8%. There was no change in HbA1c values over time in these DM patients. Mean glucose was significantly different between DM and non-DM patients (p<0.001). Time (days since leukemia diagnosis) was significant (p<0.001) and there was a significant interaction effect (p=0.01). Glucose values increased in the DM patients during the year following diagnosis, while remaining stable in those without DM. Median follow-up time was 23.2 months. Three-year survival was estimated at 46% for DM patients versus 45% in non-DM pts by Kaplan Meier method (p=0.79). Hazard ratio (stratification for matched pairs) was 1.05 (95% CI: 0.57 - 1.94; p=0.88). Three-year relapse-free survival was estimated at 34% for DM patients versus 43% for non-DM patients (p=0.58). Hazard ratio (stratification for matched pairs) = 1.10 (95% CI: 0.61–1.98; p=0.76). Conclusions: DM did not adversely impact survival in patients with leukemia. Leukemia and its treatment did not affect glycemic control. This should be reassuring to hematologists and endocrinologists who treat patients with leukemia and diabetes.

<![CDATA[MON-117 Reducing Unnecessary Repeat Vitamin D Testing at a Large Ambulatory Hospital: A Quality Improvement Initiative]]> Background:

With the increasing interest in the importance and potential benefits of vitamin D, there has been a significant rise in unnecessary vitamin D testing.

The aim of the project was to reduce unnecessary repeat vitamin D testing at Women’s College Hospital by 50% by May 30th 2020.


The Model for Improvement framework was used in the design of the quality improvement project to reduce unnecessary repeat vitamin D testing. Problem characterization was conducted to design the intervention to address root causes and iterative Plan-do-Study-Act cycles were used to develop an intervention that incorporated a best practice advisory (BPA). The primary outcome measure was unnecessary vitamin D testing. Unnecessary repeat testing was defined as: repeat 25-hydroxyvitamin D testing within 3 months or repeat 25-hydroxyvitamin D testing after a normal result (>75 mmol/L) in the preceding 12 months.

Secondary outcomes which included BPAs generated, as well as the number of BPAs that resulted in no test being ordered were tracked. Paper-based orders were also tracked as a balancing measure.


It was identified that 12.7% of vitamin D testing (n= 289/2276) between July 2017 and July 2018 was related to unnecessary repeat testing. Following our cause and effect analysis and problem characterization, it was noted that providers ordered repeat vitamin D testing due to being unaware of prior normal results, as well as due to a knowledge gap of current testing recommendations. If the 25-hydroxyvitamin D order was identified as unnecessary at the time of order entry, a BPA was generated at the point of care. The BPA was implemented on February 4th, 2019. As of August 31st, 2019 based on the analysis of the number of BPAs generated and the number of tests not ordered as a result, there has been a 26% reduction in the number of inappropriate repeat vitamin D orders.


Based on the preliminary data, a best practice advisory alert for vitamin D testing can be an appropriate QI intervention to reduce unnecessary vitamin D testing. Ongoing data analysis will be conducted to assess the long-term impact and sustainability of this intervention. Next steps include consideration of implementation of force function to reduce inappropriate repeat vitamin D testing.

<![CDATA[MON-116 Metabolic Parameters in Cancer Patients with and Without Diabetes Mellitus]]> Background: We have previously examined the link between diabetes mellitus (DM) and malignancy with respect to mortality, but little is known about how the cancer affects glycemic control. Therefore, the aim of this study was to evaluate metabolic parameters in patients with cancer with and without DM. Methods: We selected 1404 patients with newly diagnosed prostate, breast, lung, colorectal, and pancreatic cancer from the institutional cancer registry from 2010–2015. Records were selected and matched 2:1 cancer without DM (n=936) and cancer and concurrent DM patients (n=468). Patients were matched by year of diagnosis, age, gender, and cancer type. Metabolic parameters during the year after cancer diagnosis were examined using linear mixed models with fixed effects for time, cancer type, DM status and individual-specific random effect allowing each patient to have a different intercept. Results: Prostate cancer accounted for the majority of cases (n=199), followed by lung cancer (n=91), breast cancer (n=71), colorectal cancer (n=54), and pancreas cancer (n=53). Mean overall hemoglobin A1c (HbA1c) was 6.9 (1.2)%. Pancreas cancer patients had higher HbA1c overall (p=0.02). There was no change in HbA1c one year post cancer diagnosis (p=0.28). Mean glucose in non-DM was 108(18) mg/dL and 146 (45) mg/dL in DM pts. Lung and pancreas cancer patients had higher glucose values overall (p<0.001). Time (p<0.001), DM (p<0.001) and time * DM (p=0.02) were significant in a mixed model. A decrease in glucose over the year was observed in DM patients across all cancer types. Conclusions: A diagnosis of malignancy does not worsen glycemic control within the first year of cancer diagnosis. This should be reassuring to endocrinologists and oncologists who treat patients with DM and cancer. Longer term studies, and analysis in larger and more diverse patients groups are needed.

<![CDATA[MON-136 Reducing Unnecessary Inpatient Adrenocorticotropin Stimulation Tests]]> Background:

Outpatient adrenocorticotropin (ACTH) stimulation tests can be challenging to interpret due to heterogeneously reported cut-offs. Inpatient stimulation tests present additional challenges due to the presence of acute illness and unreliable coordination of dynamic function testing on a busy inpatient service. This study aims to characterize the use of ACTH stimulation tests in hospitalized patients to determine necessity of testing.


We conducted an inpatient audit of ACTH simulation tests done to rule out adrenal insufficiency between April 2018 to March 2019 at our institution. Normal post-ACTH response was defined as peak cortisol ≥500 nmol/L. Testing was considered inappropriate in patients with normal post-ACTH response who had a serum cortisol ≥250 nmol/L drawn during the same admission prior to stimulation testing. Cut-offs were based on previous analysis of 195 outpatient stimulation tests.


During the one-year study period there were 40 inpatients who had an ACTH stimulation test. Nineteen (48%) were considered unnecessary because patients either had a pre-ACTH serum cortisol ≥250 nmol/L and/or a 0-minute cortisol value just prior to the ACTH stimulation test ≥250 nmol/L. Except for a single instance where the patient was inappropriately on prednisone when basal cortisol was tested, all patients with any pre-ACTH cortisol ≥250 nmol/L had a normal post-ACTH response


Institutions may avoid unnecessary inpatient ACTH stimulation tests by implementing protocols which ensure that basal cortisol levels are drawn and below locally determined cut-offs before proceeding to dynamic testing. To characterize further, a three-year analysis of inpatient ACTH stimulation tests is underway.

<![CDATA[MON-114 Patient Perceptions of Obesity: African American vs. Caucasian Adults in an Urban Endocrinology Clinic]]> Introduction: The prevalence of obesity in the U.S. is highest in non-Hispanic black adults (38.4%) and Hispanic adults (32.6%) compared to non-Hispanic white adults (28.6%). Despite known racial disparities in obesity, not much is known about why these differences exist.

Objective: This study evaluated awareness of obesity, perceptions of obesity management, and barriers to adequate care in African American and Caucasian patients.

Methods: A 48-question survey was administered in 2018–2019 to an urban Endocrinology clinic’s adult patients with a body-mass index (BMI) ≥ 30 kg/m2. Chi-squared or Fisher’s exact tests were used to compare variables between groups.

Results: Of 137 respondents, 98 were African American and 39 were Caucasian. Most respondents were female (59–63.9%), had some college education (61.2–71.8%), and an annual income ≤ $50,000 (51.3–63.2%). Comorbidities included hypertension (64–66%), diabetes (73–79%), and arthritis (47–51%). Significantly more Caucasians than African Americans were aware of their BMI (65.8% vs 40%, p=0.0071). Both African Americans and Caucasians perceived their weight to be less than their actual BMI (African Americans: 23.2% perceived “obese” vs. 72.5% BMI 30–39.9 kg/m2 [p<0.001] and 6.3% perceived “extremely obese” vs. 27.6% BMI > 40 kg/m2 [p<0.001]; Caucasians: 37.8% perceived “obese” vs. 66.6% BMI 30–39.9 kg/m2 [p=0.02] and 8.1% perceived “extremely obese” vs. 33.3% BMI > 40 kg/m2 [p=0.01]). Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death, and 100% considered obesity treatable. Most (72.2–73.7%) recalled their health care provider (HCP) discussing obesity in the past year. Weight loss options discussed were similar between groups. Most discussed diet (70–82%) and exercise (59–62.2%) with HCPs, but few discussed formal weight loss programs (16.3–20.5%), anti-obesity medications (10%), or bariatric surgery (7–10.3%). Barriers were similar for both groups. Top barriers to diet were cost and lack of time and knowledge. Barriers to exercise were lack of time and inability to exercise. Top reasons for not discussing anti-obesity medications and bariatric surgery included concern for side effects or complications, lack of knowledge of the medications/procedures, and cost with surgery.

Conclusions: This study found similar perceptions of obesity management among African American and Caucasian patients with obesity. Despite excellent awareness of obesity as a health problem, decreased awareness of BMI and misperception of weight status were present in both groups. Discussion of diet and exercise was frequent, but discussion of formal weight loss programs, anti-obesity medications, and bariatric surgery was poor. These findings suggest a need for greater patient education and discussion of BMI and treatment beyond diet and exercise for patients with obesity.

<![CDATA[MON-129 Analysis of Omega3 PUFAs Status Among the Female and Male Population of the Moscow Region]]> INTRODUCTION:

All humans have levels of EPA+DHA that if methodologically correctly assessed in erythrocytes, are optimal more than 8%. Omega-3 polyunsaturated fatty acids (PUFAs), namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are permanent subjects of interest not only in relation to the protection of cardiovascular health and the prevention of the incidence of both ventricular and atrial arrhythmias, but also many serious health issues that can be prevented by optimal levels.

OBJECTIVE: The aim of this study was to assess in a retrospective study the omega-3 PUFAs status at Moscow region according age and sex.


In this retrospective study, the records of 1349 patients who presented with various complaints in the period from 2013 to 2017 aged 1 to 91 were examined. Fatty acids within the red blood cell membranes were analyzed as methyl ethers after trans-esterification with sodium methylate using GC-MS followed by omega-3 index calculation.


Deficiency of omega-3 PUFAs was found in 68.5% of patients. The most severe deficiency was noted in children and adolescents aged 0 to 17 years (in girls to a greater extent). In age groups of 18–44 and 45–59 years, the prevalence of severe (<4%) and moderate (4–8%) deficiency was comparable in males and females: among 18–44-year-old men severe deficiency was noted in 5.6%, moderate – in 29.4%, at the age of 45–59 years – in 7 and 23%, respectively; among women – 6.4, 24.4, 8.4 and 20%, respectively. In the age group of 60-74 years, prevalence of severe deficiency was significantly higher in men, who had severe deficiency in 9.2% of cases, whereas in women of the same age it was found only in 4.8% of cases, the prevalence of moderate deficiency is 23 and 23.8%, respectively.


Such high prevalence of severe omega-3 PUFA deficiency in girls under 17 is likely due to girls’ and their parents’ concerns about weight, diet and veganism, and requires the inclusion of omega-3 index analysis in adolescent girls’ screening. Thus, during the most important period – the period of puberty – 25% of girls have metabolic and hypoxic disorders due to deficiency of omega-3 PUFA and are at risk of not only diseases associated with metabolic disorders, but also reproductive disorders (infertility, miscarriage, fetal malformations). The obtained data is indicative of the necessity to choose dosages of omega-3 PUFAs, considering not only the patients age, but also their gender.

<![CDATA[MON-139 Development of a Culturally Competent Skills and Knowledge Assessment Tool for Patients with Diabetes]]> Training of diabetes (DM) skills is critical to assure competency of DM survival skills (e.g. glucose testing) for immediate self-care. While DM assessments exist, we sought to develop a culturally acceptable DM Skills and Knowledge Assessment (DM-SKA) tool. A systematic search of Pubmed/Medline and Scopus (1980-2017) of assessments for DM knowledge was performed. 24 studies were identified, only 33% reported minority populations. Studies were classified by topic: measurement of DM skills, objectives of DM training, assessments of DM education, and other non-patient assessments. Content from existing assessments was adapted to create a 12 question DM-SKA to address 6 domains: DM, blood glucose and self-monitoring, support services, identification management of hypo and hyperglycemia, and insulin administration. To assess cultural acceptance, cognitive evaluations were conducted in individual user sessions and focus groups. The DM-SKA had a baseline Flesch reading score of 81.3 (low complexity language) and Flesch-Kincaid reading grade level of 5.3. Of 39 approached, 85% (N=33) participated (6 inpatients refused, feeling “overwhelmed”). Participants were diverse, including 8 clinicians, 10 patients/caregivers, and 15 laypersons; 46% were non-Hispanic whites, 33% non-Hispanic blacks, 12% Hispanics, and 9% Asian Americans. Mean age of patient/caregiver/laypersons was 57.8±17 (44% > age 65) and 40.1±12 years for clinicians (12.5% > age 65). All clinicians reported that appropriate DM skill domains were included and felt patients would complete the tool. All patients/caregivers and laypersons (N=25) verbalized adequate comprehension of each question; 96% reported willingness to complete the DM-SKA if provided and 88% reported their family, friends or someone in their community would be willing to complete it. However, both providers (N=2) and patients (N=2) reported concerns about assessment format and delivery [e.g. “testing” or “quiz”]. Some younger (<65 years) patients/caregiver/laypersons (N= 4) reported concerns about potential willingness of elderly family members to complete the tool. However, acceptability of the DM-SKA was noted from all participants >65 years. Vision problems and older age were identified as potential barriers. Of those offered the assessment (N = 25), 5 (20%) participants needed assistance [N=2 vision, N=3 English as second language]. Mean DM-SKA score was 10.2±1.7 of 12. Incorrect answers mostly occurred for questions with multiple correct answers. The DM-SKA has acceptable literacy characteristics, cognitive validity, and cultural acceptability by racial/ethnic minority populations, including elderly persons. Future work includes integration into clinical workflows and incorporation of patient preferences.

<![CDATA[MON-119 Osteoporosis Practice: A Pilot Survey of Primary Care Medical Residents]]> Background: Patients with osteoporosis are not adequately managed. This pilot study was aimed at evaluating primary care medical residents’ confidence and knowledge to diagnose and treat osteoporosis.

Methods: A 16-item, a paper-based de-identified survey was administered to all participating primary care medical residents at two independent University programs. Questions collected information on resident demographics, prior endocrinology exposure through a rotation or a didactic in osteoporosis, future career plan, and assessed confidence and knowledge about screening, diagnosis, and management of osteoporosis. Wilcoxon rank-sum tests were used to compare mean ranks and tetrachoric correlations were used to assess the correlation between variables.

Results: A total of 66 (24.4%) residents completed the survey with 59% being male, 64% were in the 1st and 2nd year of training (junior residents) and 36% were in their 3rd and 4th year of training (senior residents). Forty-eight percent had completed endocrinology rotation and 74% had attended a didactic in osteoporosis.

Residents who had an endocrine rotation had significantly higher confidence (p= 0.003) and knowledge (p= 0.04) to diagnose and treat osteoporosis. Residents who attended endocrine didactics had significantly higher confidence (p=0.04) but no difference in knowledge (p= 0.1). Senior residents had a positive correlation between confidence and knowledge (rho= 0.4, p=0.02). There was no difference in confidence level between males and females. Senior residents who had completed an endocrinology rotation were more likely to respond that they feel confident to obtain osteoporosis history and perform a physical exam compared to those who had not completed an endocrinology rotation (p=0.04). Female junior residents who attended didactics were more likely to respond that they have a higher confidence level to screen (p=0.02) and diagnose (p=0.007) osteoporosis compared with female junior residents who did not attend didactics. There was a strong positive correlation between confidence and knowledge for osteoporosis screening among senior residents who attended didactics (rho=0.8, p<0.0001) and for female residents overall (rho=0.75, p<0.0001). Confidence and knowledge for management of osteoporosis were highly correlated among junior residents who had completed endocrine rotation (rho=1, p<0.0001).

Limitation: Limitations of this study include its small sample size and lack of generalizability.

Conclusion: This pilot study provides important insights into the confidence and knowledge among in-training primary care medical residents in two independent University programs. Curriculum development should focus on practical and measurable modules to improve resident knowledge. Findings from this survey need to be replicated in a larger sample size study.

<![CDATA[MON-121 Pain Is a Major Driver of Quality of Life and Psychoemotional Health in Lipodystrophy Syndromes]]> Background Lipodystrophy is a group of heterogeneous syndromes characterized by selective loss of adipose tissue and metabolic abnormalities. The severity of pain and its possible relation to measures of quality of life (OoL) and psychoemotional and metabolic health have never been studied in-depth previously. Methods LD-Lync study is an international multi-center study collecting data on the natural history of different lipodystrophy syndromes. We have completed phase 1 of the study where only a single site (University of Michigan) entered data (n = 79 patients, M/F: 16/63, mean age: 46.13 ± 14.60, 56 with familial partial lipodystrophy). In this study, we sought to investigate the relationship of pain perception on QoL, psychoemotional and metabolic aspects of the disease. Brief Pain Inventory (BPI) was used to calculate pain severity (BPI-SS) and pain interference scores (BPI-IS). Results From the 77 who completed the questionnaires, 56 (72.73%) patients reported pain at different levels. Out of the 56, 29 (51.79%) patients had moderate/severe pain (BPI-SS ≥ 4). Patients with moderate/severe pain had “more impaired” QoL scores: physical functioning: 20 (15-50) vs. 80 (45-95), p = 0.002; limitation to physical health: 0 (0-25) vs. 75 (0-100), p = 0.002; energy/fatigue 15 (10-30) vs. 45 (20-60), p = 0.032; emotional well-being: 48 (32-60) vs. 72 (48-84), p = 0.029; social functioning: 33 (20-38) vs. 58 (35-70), p = 0.002; general health: 15 (10-25) vs. 35 (20-55), p = 0.005). Severe depression (PHQ-9 > 14) was more frequently detected among patients with moderate/severe pain (63.2% vs. 36.9%, p = 0.008). PHQ-9 score measuring depression was positively correlated with BPI-SS (r = 0.53, p < 0.001), and BPI-IS (r = 0.63, p < 0.001). Emotional burden score was also higher in patients reporting moderate/severe pain (4.0 (2.6-5.0) vs. 2.7 (1.6-3.3), p = 0.015). BPI-SS/BPI-IS scores correlated positively with disease distress (r = 0.33, p < 0.001, and r = 0.31, p = 0.010) and GAD7 scores measuring anxiety (r = 0.52, p < 0.001, and r = 0.50, p < 0.001). Anxiety (GAD7 > 10) was more prevalent among patients with moderate/severe pain (58.6% vs. 23.4%, p = 0.002). The presence of diabetes was associated with higher BPI-SS scores: 3.50 (1.50-5.00) vs. 0 (0-3.25), p = 0.030). Also, patients with HbA1c > 6.5% exhibited higher BPI-SS scores than those with an HbA1c less than 6.5%: 3.38 (1.38-5.00) vs. 1.25 (0-3.50), p = 0.030). Conclusion Our study reveals a high frequency of pain perception among patients with different types of lipodystrophy. Pain severity contributes to worsening in QoL, affects physical and emotional function, and relates to psychoemotional state in patients with lipodystrophy. In addition, the presence of diabetes and higher HbA1c may potentially modulate pain in patients with lipodystrophy. Further work is needed to elucidate the pathways that regulate pain in these patients and to address it effectively.

<![CDATA[MON-LB309 Prevalence and Characteristics of Patients With Primary Severe Hypercholesterolemia in a Multidisciplinary Healthcare System in the Midwest]]> Background

Severe hypercholesterolemia (SH) phenotype includes all subjects with LDL-c of 190 mg/dL or more regardless of cause. Those with SH have up to 5-fold long-term risk for coronary artery disease (CAD).


To assess prevalence, characteristics & different aspects of clinical care for patients with primary SH in a multidisciplinary healthcare system in the Midwest.

Subjects & methods

A retrospective, record-based, cross-sectional study was conducted using datasets from unique electronic health records of living patients presenting at a U.S. metropolitan healthcare system from 01/01/2013 until 08/31/2019. Cases were identified as SH if maximum LDL-c during the timeframe was 190 mg/dL or more. Subjects not meeting this criterion were used as controls. Comorbidities considered included CAD, congestive heart failure (CHF), diabetes mellitus (DM), hypertension (HTN), obesity & smoking. Lipid lowering therapies including statin, ezetimibe, & PCSK9I use were also assessed. Statistical analyses, including t-tests & logistic regression, were conducted to identify differences between cases & controls.


After exclusion of subjects with secondary dyslipidemia, 224,920 records were used for analysis. Of these, 3.0% (6755) had SH. Those with SH were older by an average of about 3.5 years as compared to the control group. The most populous age-gender subgroup was females aged 40-75 years (35.2%). In the absence of any of the 5 comorbidities (CAD, CHF, DM, HTN, obesity), patients with SH were more likely to have established care with primary care (95% CI = 65%-69%) compared to control (95% CI= 56.5% - 57.2%). Patients with SH had more comorbidities with overall comorbidity represented by their higher Hierarchical Condition Category (HCC) score (P=0.001). HTN (P=0.000), premature CAD (P=0.000) & obesity (P=0.017) were all slightly more prevalent in cases than control. Mean arterial BP, systolic BP, diastolic BP & lipid parameters (LDL-c, total cholesterol, HDL, TG & Lipoprotein(a)) were higher in patients with SH (P= 0.000) compared to control. Patients with SH were treated more with statins or ezetimibe compared to control (P=0.000). However, of SH subjects, only 61% were found to have been treated with statin & only 26% were treated with high intensity statin. In the absence of any of the 5 comorbidities, these are lower (52% & 16% respectively) for statin use & 3.5% for the use of Ezetimibe. Persistent elevation of LDL-c to 190 mg/dL or more was present in 31% (2102) of SH cases.


Prevalence of primary SH is 3% in our population. Patients with SH exhibit greater likelihood for comorbidities, including those related to CVD. Most patients with SH are seen in the primary care setting rather than by endocrinology or cardiology. The use of statins (generally), high intensity statins, and ezetimibe in those with SH is more than control but still below that recommended by guidelines.

<![CDATA[MON-135 Improving Thyroid Fine Needle Aspiration Education: Implementation of a Formal Clinical Procedure Assessment Tool for Teaching Thyroid FNA to Endocrinology Fellows]]> Fellows must demonstrate competence in the performance of thyroid biopsy (bx) from the 2019 ACGME Program Requirements for GME in Endocrinology, Diabetes, and Metabolism. During fellowship, trainees are often taught thyroid bx using an unstructured approach, through demonstration followed by supervised performance on patients. Concerns regarding patient safety, lack of readily available faculty & patients, and lack of competency checkpoints limit the utility of such an approach to teaching procedural skills (1). Application of Psychomotor Learning Theory to teaching procedural skills has modified prior philosophy to “learn, see, practice, prove, do, maintain.”  (2) Two phases exist: 1) cognitive- conceptualization and visualization of the procedure and 2) psychomotor- acquisition of procedural skills. Formal training has been shown to improve FNA diagnostic accuracy along with fewer surgical procedures for benign lesions.(2) There is no evidence to support any specific recommendations for training fellows on safe and efficient thyroid bx techniques further highlighting the need for a competency based approach.(3) Since the didactic lecture format is not well suited for the acquisition of complex manual operations, in our study, we seek to 1) create, implement, and standardize the thyroid FNA curriculum for Endocrine fellows at our institution by employing global learning objectives and a skill checklist to help guide competency, and 2) assess the impact of this curriculum on knowledge, performance, and comfort. The goal is to prepare fellows for unsupervised practice through clinical procedure assessment tools to guide practical learning in conjunction with didactic lectures. Curriculum could be implemented not only across the nation to other endocrine fellowships but widely across multiple disciplines such as otolarynology, radiology, pathology. To assess the nationwide need for a formal means of teaching and evaluating thyroid US/ FNA skills within fellowship programs, we will be administering a nationwide survey to all Endocrinology Program Directors and recently graduated Endocrinology Fellows.

1.Vogelgesang, S. A., Karplus, T. M., Kreiter, C. D. (2002). An instructional program to facilitate teaching joint/soft-tissue injection and aspiration. Journal of general internal medicine, 17(6), 441–445.

2. Ljung, B., Drejet, A., Chiampi, N., Jeffrey, J., Goodson, W. H., Chew, K, Miller, T. R. (2001). Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer, 93(4), 263-268. doi:10.1002/cncr.9040.

3. Pitman, B., Abele, J., Ali, S. Z., Elsheikh, T. M., Jeffrey, R. B., Scoutt, L. (2008). Techniques for thyroid FNA: A synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagnostic Cytopathology Diagn. Cytopathol., 36(6), 407-424. doi:10.1002/dc.20829.

<![CDATA[MON-132 Implementation of a Diabetes Prevention Program in the San Francisco Safety Net]]> Background: We examine the implementation of a DPP in the San Francisco Health Network, a safety net serving over 140,000 patients. We also evaluate the success of patients referred to a YMCA DPP, including the role of incentives (gym memberships and food vouchers). Methods: Overweight patients with prediabetes were referred, screened for eligibility and readiness, and invited to participate in a CDC-approved digital or in-person DPP. The YMCA’s DPP groups were led by a trained lifestyle coach, in English or Spanish, with 16 weekly core sessions followed by nine maintenance sessions over a year. Sessions were held at health care sites or at a YMCA (3 of 5 sites had gyms). Gym memberships were offered at no cost to all participants. Continued membership required meeting attendance metrics. Food vouchers became available to participants in Spring 2019. Results: From August 2017 to October 2019, 650 patients were referred to the DPP, 168 (25.8%) were reached, passed a readiness assessment and chose to participate. Of those, 110 patients expressed interest in the YMCA and 73 have registered for one of eight classes that are now past 16 weeks. Of those 73 patients, 64 officially enrolled (e.g. attended at least one session in the first four weeks). Enrolled patients were majority female (78.1%) and 45.3% reported a family history of DM. Average age was 47.9 ± 12.2 y, BMI 37.7 ± 8.4, A1c 5.8% ± 0.3. More than half (56.3%) were Hispanic/Latino, 17.2% Black, 9.4% Asian. Exactly half were English- and half Spanish-speaking. Of the 64 enrolled patients, 42 were retained in the DPP (e.g. attended four or more sessions). These patients attended an average of 11.8 ± 3.4 of the core 16 sessions. At wk 16, average weight loss was 2.2% ± 3.9 (N=40, range -4.4, 16.7); 20% of patients lost at least 5% of their initial body weight. Regarding incentives, 76% of the retained patients activated their gym membership. Average monthly gym attendance was 9.1 ± 9.1 visits with monthly visits maintained over 180 days. Gym visits positively correlated with weight loss (r2= 0.42) and there was a non-significant trend towards more frequent gym visits by patients enrolled at sites with a gym (11.8 ± 10.9 vs 6.5 ± 6.2). Comparison of Spanish-speaking participants who received food vouchers to those who did not showed a non-significant trend towards improved attendance (12.1 ± 3.0 vs 9.6 ± 3.7 of 16) and 16 wk weight loss (2.2% ± 3.4 vs 0.3% ± 2.4). Additional follow-up data at 36 wks available on 19 patients showed a sustained weight loss of 3.8% ± 6.6 compared to 2.4% ± 4.3 at 16 wks. Conclusion: While DPPs have been widely promoted, real-world implementation has been challenging. Understanding the delivery of DPPs in safety net populations is important given barriers to attendance. Our results show early modest weight loss in those enrolled in the YMCA DPP and suggest incentives such as gym memberships and food vouchers may improve attendance and weight loss.

<![CDATA[MON-120 The Implementation of a Scholarly Activity Curriculum: Impact Assessment]]> Introduction:

As detailed in the 2018 ACGME Common Program Requirements statement for fellowship institutions, “The physician is a humanistic scientist who cares for patients. This requires the ability to think critically, evaluate the literature, appropriately assimilate new knowledge, and practice lifelong learning.” Endocrinology fellowship programs are tasked with the expectation of creating an environment that fosters scholarly pursuit. It is under the discretion of each program to consider its institutional resources and community needs in order to meet this ACGME requirement.1

With the goal of enhancing trainee scholarly activity, our fellowship program created a Scholarly Activity Curriculum in 2017. The core curriculum pillars include delineating a yearly timeline of objectives and expectations, facilitating regular individual mentoring, permitting allotment of protected time, and advocating involvement in faculty scholarship and national conferences.


To assess the impact of the 2017 Endocrinology Fellowship Scholarly Activity Curriculum with respect to its ability to increase trainee scholarship.


The scholarly activities of the fellowship classes of 2017-2020 were extracted from archived Fellow Scholarly Activity Update presentations and exit-interview curricula vitae. The activities were categorized as conference presentations (oral/poster), basic scientific research, clinical scientific research, quality improvement, book chapters, review articles, case reports, and teaching activities. With the 2017 and 2018 classes representing the pre-curriculum study group and the 2019 and 2020 classes representing the post-curriculum study group, the number of activities per study group per scholarly category were tabulated and compared.


An increase in scholarly activity was noted in five of the delineated categories: conference presentations (80%), clinical scientific research (86%), review articles (100%), case reports (100%), and teaching activities (38%). The remaining three categories of basic scientific research, quality improvement, and book chapters showed no change.


The implementation of the 2017 Endocrinology Fellowship Scholarly Activity Curriculum was associated with a rise in trainee scholarly activity. Four of eight categories showed an 80% or more increase. Interestingly, the fellows involved in basic scientific research both pre and post-curriculum implementation were limited to those in the Specialty Training and Advanced Research (STAR) Program. Finally, identifying the need to increase involvement in quality improvement research, our program has implemented a 2019 Quality Improvement Curriculum.

1Common Program Requirements (Fellowship). ACGME. 2018. Accessed Nov 2019.