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Background: Deep learning techniques can accurately detect and grade inflammatory findings on images from capsule endoscopy (CE) in Crohn's disease (CD). However, the predictive utility of deep learning of CE in CD for disease outcomes has not been examined., Objectives: We aimed to develop a deep learning model that can predict the need for biological therapy based on complete CE videos of newly-diagnosed CD patients., Design: This was a retrospective cohort study. The study cohort included treatment-naïve CD patients that have performed CE (SB3, Medtronic) within 6 months of diagnosis. Complete small bowel videos were extracted using the RAPID Reader software., Methods: CE videos were scored using the Lewis score (LS). Clinical, endoscopic, and laboratory data were extracted from electronic medical records. Machine learning analysis was performed using the TimeSformer computer vision algorithm developed to capture spatiotemporal characteristics for video analysis., Results: The patient cohort included 101 patients. The median duration of follow-up was 902 (354-1626) days. Biological therapy was initiated by 37 (36.6%) out of 101 patients. TimeSformer algorithm achieved training and testing accuracy of 82% and 81%, respectively, with an Area under the ROC Curve (AUC) of 0.86 to predict the need for biological therapy. In comparison, the AUC for LS was 0.70 and for fecal calprotectin 0.74., Conclusion: Spatiotemporal analysis of complete CE videos of newly-diagnosed CD patients achieved accurate prediction of the need for biological therapy. The accuracy was superior to that of the human reader index or fecal calprotectin. Following future validation studies, this approach will allow for fast and accurate personalization of treatment decisions in CD., Competing Interests: UK: research support – Medtronic, Janssen, Takeda. Speaker/advisory fees – AbbVie, BMS, Janssen, Pfizer, Takeda, MSD, Rafa. RE: Speaker for Takeda, Janssen, and Medtronic. SBH: received consulting and advisory board fees and/or research support from AbbVie, MSD, Janssen, Takeda, Pfizer, GSK, and CellTrion. EK, SheS, RMY, OB, and EZ: no competing interests. RK, AB, EA, and ShiS: employees of Intel Inc., (© The Author(s), 2023.)

Introduction: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic., Methods: A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t -test, χ 2 , adjusted odds ratio, and immersion-crystallization methods were used to analyze the data., Results: The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020; P ≤ .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86; 95% CI, 1.00 to 3.57; P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87; 95% CI, 1.31-2.66; P ≤ .01), report higher levels of anxiety (aOR = 1.53; 95% CI, 1.04-2.24; P = .013), and higher levels of stress (aOR = 1.39; 95% CI, 1.17-1.66; P ≤ .001)., Conclusion: As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

Introduction: Many medical schools overestimate the percentage of their graduates who enter the primary care workforce based on the "first-certificate" residency their graduates enter. To rectify this problem, Deutchman and colleagues proposed a new method of estimation. The objective of this study was to compare results from the traditional residency match and Deutchman methods to the actual percentage of University of Kansas School of Medicine (KUSM) graduates who practice primary care after completing medical school and all residency and subspeciality fellowship training., Methods: A retrospective study was conducted using a convenience sample of KUSM graduates from 2003-2014. Percentages of graduates classified as primary care by the traditional Residency Match Primary Care Method (RMPCM) and the percentages of graduates identified as primary care by Deutchman's Intent to Practice Primary Care Method (IPPCM) were compared with the actual percentage of graduates who eventually entered the primary care workforce., Results: Of the 1,944 KUSM graduates identified during the study period, the RMPCM predicted a 48.1% primary care output rate. The Deutchman's IPPCM predicted a 22.8% primary care output rate. The actual known percentage of graduates practicing primary care was 34.2%., Conclusions: Neither the RMPCM nor the Deutchman's IPPCM performed well in predicting the percentage or number of KUSM graduates who eventually practiced primary care. Due to predictions for the shortage of primary care physicians, there is a need to identify a method that more accurately predicts the medical schools' contribution to the primary care workforce., (© 2022 The University of Kansas Medical Center.)

Inflammatory bowel diseases (IBDs) comprise a group of conditions thought to be caused by a dysregulated host immune response to the gut microbiome. IBDs, which affect 1.3% of Americans, include Crohn disease (CD), ulcerative colitis (UC), and microscopic colitis. UC and microscopic colitis are limited to the colon, but CD can occur anywhere along the gastrointestinal tract. Gastrointestinal symptoms typically predominate, including diarrhea and abdominal pain, along with systemic symptoms of weight loss, fatigue, night sweats, and fever. However, many patients have extraintestinal symptoms, often in the joints, skin, or eyes; extraintestinal symptoms can appear before gastrointestinal symptoms. Colonoscopy with biopsy is the test of choice for diagnosing UC and microscopic colitis. Diagnosing CD typically requires ileocolonoscopy and also may require esophagogastroduodenoscopy. Traditionally, therapy involved mesalamine for UC, thiopurines or methotrexate for CD, and budesonide for microscopic colitis. However, recently, biologic drugs targeting tumor necrosis factor alpha and other inflammatory drugs have revolutionized care of IBD. Surgery (complete resection of involved colon) can be curative in UC. In CD, surgery typically is only used for complications or refractory disease., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Malabsorption syndromes are a heterogenous group of conditions that can cause distressing gastrointestinal symptoms. Celiac disease is most common and is triggered by exposure to gluten. Tissue transglutaminase immunoglobulin A is the diagnostic test of choice; management is gluten avoidance. Lactose intolerance is caused by absence or declining levels of the enzyme lactase. Diagnosis typically is clinical, but breath tests can be helpful if diagnosis is uncertain. Management is lactose avoidance. Bile acid malabsorption results in unabsorbed bile acids in the colon, leading to diarrhea. The 75selenium homotaurocholic acid test is most accurate but is not widely available. Therefore, a trial of bile acid sequestrants (typically cholestyramine) is a reasonable alternative when the diagnosis is suspected. Exocrine pancreatic insufficiency is caused by decreased production of pancreatic enzymes, typically occurring in patients with preexisting pancreatic damage from alcohol, surgery, radiation, diabetes, or cystic fibrosis. Diagnosis involves fecal fat or fecal elastase-1 tests. Management is pancreatic enzyme replacement. Small intestinal bacterial overgrowth is caused by pathologic overgrowth of the small bowel microbiome. Diagnosis is by jejunal biopsy or, more commonly, breath tests. Antibiotics (typically rifaximin) are the initial management. Other options include dietary changes, probiotics, and prokinetic drugs.

Occult gastrointestinal (GI) bleeding is bleeding from the GI tract that is not noticeable to patients or physicians. Patients with unexplained anemia (ie, not attributable to another cause such as menstrual bleeding), particularly iron deficiency anemia, should be evaluated for occult GI bleeding. Similarly, if fecal blood is detected during routine colorectal cancer screening, an evaluation for occult bleeding is indicated. Direct visualization with colonoscopy or esophagogastroduodenoscopy are the initial tests of choice; which one is conducted first depends on a patient's risk factors for upper versus lower GI bleeding. If initial endoscopy is negative, repeat endoscopy may identify the bleeding source. If still negative, other tests, typically capsule endoscopy, can be used to evaluate for small bowel bleeding. Management of identified lesions varies, but they often are amenable to endoscopic intervention or medical management. The need for transfusion is uncommon in occult GI bleeding. Rarely, a surgical approach to visualization and resection may be undertaken. If no bleeding source is identified, or even if it is identified and successfully treated, patients should be evaluated for conditions or treatments that might increase the risk of rebleeding (eg, nonsteroidal anti-inflammatory drug use, antiplatelet/anticoagulant therapy). Need for these treatments should be reevaluated., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. CRC screening reduces CRC deaths. Although the median age at diagnosis is 67 years, the incidence in younger individuals has been increasing, and younger patients are more likely to present with more advanced disease. In the past, guidelines recommended initiating screening at age 50 years. However, guidelines from multiple organizations now recommend initiating screening at age 45 years. Screening should start even earlier in individuals with genetic risks for CRC. Recommendations about when to discontinue screening vary, but all guidelines recommend continuing at least to age 75 years. After age 75 years, screening should be based on patients' life expectancy, medical status, and values and goals. Colonoscopy is considered the gold standard screening test, but many patients decline colonoscopy because of its invasive nature and associated bowel preparation. Other tests recommended in guidelines include guaiac-based fecal occult blood test, fecal immunochemical and DNA tests, flexible sigmoidoscopy, and computed tomography colonography. Recommended screening intervals vary for each of these tests. Two newer screening tests, not yet included in guidelines, are Epi proColon (methylated septin DNA) assay (which detects methylation of the SEPT9 gene associated with CRC) and capsule colonography. All patients also should be informed about lifestyle and diet-related interventions that can decrease CRC risk., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Introduction The novel coronavirus infectious disease (COVID-19) has spread rapidly with vast global implications. This study assessed how family physicians in Kansas responded to COVID-19 and the effects of the pandemic on the physicians' well-being. Methods. The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 18-item survey assessing family physicians' concerns about being exposed to COVID-19, levels of personal depression, anxiety, stress, and burnout in addition to demographic information. Results. There was a 45.6% response rate, with 50.4% (n=57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared to those who did not, were more likely to report at least one manifestation of burnout (odds ratio[OR]=3.96; 95% confidence interval [CI], 1.38-11.36; P = .011), experience emotional exhaustion (OR=3.21; 95% CI, 1.01-10.10; P<.05), and feel a higher level of personal stress (OR=1.13; 95% CI, 1.01-1.27; P=.011). Conclusion. Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes such as burnout, depression, anxiety, and stress, to determine the need for interventions, and influence the implementation of programs to support physician wellness. These data can help drive wellness and mental health support initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians., Competing Interests: Authors report none, (© 2021 Annals of Family Medicine, Inc.)

Background and Objectives: Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics., Methods: This study was part of the 2020 Council of Academic Family Medicine's Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States., Results: The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use., Conclusions: SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.

Introduction: This study was conducted to assess family physicians' perception of the US Food and Drug Administration-approved mRNA Coronavirus disease 2019 (COVID-19) vaccines, their plans to be vaccinated with an approved mRNA COVID-19 vaccine, and their support for vaccination of patients and family members., Methods: The authors conducted a cross-sectional survey of 307 practicing family physicians, full-time faculty physicians, and resident physicians in Kansas from December 14, 2020, to December 31, 2020. The study participants completed an anonymous, 20-item survey assessing family physicians' concerns about exposure to COVID-19 and their perceptions of the mRNA COVID-19 vaccines to control SARS-CoV-2. A mixed-method approach was used to collect, analyze, and interpret the data., Results: There was a 51.1% response rate. The proportion of family physicians who reported their intentions to be vaccinated for COVID-19 was significantly higher than those who were hesitant to receive the mRNA vaccines (90.6% vs 9.4%; χ 2 [1, n = 307] = 201.9.1; P < .0001). Among those who were willing to be vaccinated with an approved mRNA COVID-19 vaccine, the main reasons were to prevent COVID-19 infection; protect self, family, and community; contribute to herd immunity; inspire confidence that the vaccines are safe and end the pandemic and bring life back to normal., Conclusion: Our findings suggest a significantly positive association between a physician's concerns and their willingness to be vaccinated with an approved mRNA COVID-19 vaccine. With the authorization of 2 new mRNA COVID-19 vaccines, future studies should investigate the number of physicians in our study who received the vaccine., Competing Interests: Conflict of interest: None., (© Copyright 2021 by the American Board of Family Medicine.)

Introduction: COVID-19 has spread rapidly, with vast global implications. This study assessed how family physicians in Kansas were responding to COVID-19 and the effects of the pandemic on their well-being., Methods: The authors conducted a cross-sectional survey of 113 family physicians in Kansas between May 22, 2020 and June 25, 2020. The study participants completed an anonymous, 36-item survey assessing their concerns about being exposed to COVID-19 and levels of personal depression, anxiety, stress, and burnout in addition to demographic information., Results: There was a 45.6% response rate, with 50.4% (n = 57) of the respondents reporting manifestations of burnout. The physicians who personally treated any presumptive or confirmed COVID-19 patient, compared with those who did not, were more likely to report at least 1 manifestation of burnout, experience emotional exhaustion, and feel a higher level of personal stress., Conclusion: Our findings demonstrate that the COVID-19 pandemic may be taking an emotional toll on family physicians in Kansas. This study provides a baseline from which to continue further monitoring of outcomes. Data can help drive initiatives at local, state, and national levels to help diminish the negative impact of the COVID-19 pandemic on physicians., Competing Interests: Conflict of interest: None., (© Copyright 2021 by the American Board of Family Medicine.)

Background and Objectives: Faculty shortages are a significant concern in family medicine education. Many family medicine residency programs need to recruit faculty in the coming years. As a result, family medicine faculty and resident physicians will be interviewing candidates to fill these vacancies. Little is known about the characteristics valued in a family medicine residency faculty candidate., Methods: Using a cross-sectional survey of family medicine faculty and resident physicians in family medicine residency programs in Kansas, we attempted to define which characteristics are most valued by current faculty members and resident physicians in family medicine residency programs during the faculty hiring process., Results: Of 187 invited respondents, 93 completed the survey (49.7% response rate). Twenty-five characteristics, grouped into five domains of relationship building, clinical, teaching, research and administrative skills, were rated as either not important, important, or very important. Building and maintaining healthy relationships was the most important characteristic for faculty, residents, males, and females. Administrative characteristics were the lowest ranked domain in our survey., Discussion: These results provide an important snapshot of the characteristics valued in faculty candidates for family medicine residency programs. Understanding the paradigm used by existing faculty and resident physicians in family medicine residency programs when considering new faculty hires has an important impact on faculty recruitment and faculty development programs.

Introduction: Given the recent reports of e-cigarette, or vaping, product use-associated lung injury (EVALI) and harm of e-cigarettes, the authors evaluated changes in the use and perception of e-cigarettes as tobacco use cessation tools in 2019 relative to 2016. The authors also evaluated the sources family physicians most commonly use to receive information regarding e-cigarettes., Methods: A cross-sectional online survey of 248 community family physicians in Kansas was conducted from October 2019 to December 2019. An 11-item questionnaire measured the participants' perceptions of recommending e-cigarettes to patients for tobacco cessation. A mixed method approach was used to collect, analyze, and interpret the data. Standard descriptive statistics, Likelihood-Ratio/Fisher's exact tests, and immersion-crystallization methods were used to analyze the data., Results: The response rate was 59.3% (147/248). The proportion of the family physicians who did not recommend e-cigarettes for tobacco use cessation was significantly higher in 2019 than in 2016 (86% vs. 82%; χ 2 [1, n = 261] = 12.31; p < 0.01). Several reasons regarding respondents' perceptions of e-cigarettes as tobacco use cessation tools were reported. The medical literature and news media were the top sources where family physicians accessed e-cigarettes information., Conclusion: Most family physicians did not recommend e-cigarettes for tobacco cessation. Opinions regarding the efficacy and safety of e-cigarettes were influenced by information sources. Future, larger studies would be beneficial to further determine family physicians' beliefs and practices regarding e-cigarettes as tobacco use cessation products., (© 2020 The University of Kansas Medical Center.)

Introduction: Loneliness has been linked to clinician burnout and other types of emotional distress. Research assessing the prevalence of loneliness among physicians is growing. Little is known, however, about how loneliness relates to other types of emotional distress among practicing physicians. The objectives of the study were to determine the prevalence of loneliness, and to explore the relationship between loneliness, burnout, depressive symptoms, and suicidal ideation among active member physicians of the Medical Society of Sedgwick County (MSSC)., Methods: The study involved a convenience sample of 197 practicing physicians who were active members of the MSSC. The 3-item University of California, Los Angeles Loneliness Scale, the Abbreviated Maslach Burnout Inventory, and 2-item Primary Care Evaluation of Mental Disorders Patient Health Questionnaire were used to measure prevalence of loneliness, manifestations of burnout, and symptoms of depression, respectively., Results: Using an email survey, 442 practicing physicians received an invitation to participate; 197 (44%) completed the survey. The prevalence of loneliness was 43%. Loneliness prevalence was associated positively with age (p = 0.017) and more likely in those who reported manifestations of burnout (p < 0.01) or screened positive for depression (p < 0.01). Depression (OR = 2.24; 95% CI, 0.97-5.19) and emotional exhaustion (OR = 1.05; 95% CI, 0.39-2.84) were significantly associated with loneliness, including when adjusted for participants' sex, age, and duty hours., Conclusion: Loneliness is prevalent among active member physicians of the Medical Society of Sedgwick County. Given that loneliness is associated with burnout and other emotional distress, there is an important need to understand its implications better., (© 2020 The University of Kansas Medical Center.)

Background: Plasma-derived (pd) or recombinant (r) therapeutic factor VIII proteins (FVIIIs) are infused to arrest/prevent bleeding in patients with hemophilia A (PWHA). However, FVIIIs are neutralized if anti-FVIII-antibodies (inhibitors) develop. Accumulating evidence suggests that pdFVIIIs with von Willebrand factor (VWF) are less immunogenic than rFVIIIs and that distinct rFVIIIs are differentially immunogenic. Since inhibitor development is T-helper-cell-dependent, human leukocyte antigen (HLA)-class-II (HLAcII) molecules constitute an important early determinant., Objectives: Use dendritic cell (DC)-protein processing/presentation assays with mass-spectrometric and peptide-proteomic analyses to quantify the DP-bound, DQ-bound, and DR-bound FVIII-derived peptides in individual HLAcII repertoires and compare the immunogenic potential of six distinct FVIIIs based on their measured peptide counts., Patients/methods: Monocyte-derived DCs from normal donors and/or PWHA were cultured with either: Mix-rFVIII, a VWF-free equimolar mixture of a full-length (FL)-rFVIII [Advate ® (Takeda)] and four distinct B-domain-deleted (BDD)-rFVIIIs [Xyntha ® (Pfizer), NovoEight ® (Novo-Nordisk), Nuwiq ® (Octapharma), and Afstyla ® (CSL Behring GmBH)]; a pdFVIII + pdVWF [Beriate ® (CSL Behring GmBH)]; Advate ± pdVWF; Afstyla ± pdVWF; and Xyntha + pdVWF., Results: We showed that (i) Beriate had a significantly lower immunogenic potential than Advate ± pdVWF, Afstyla - pdVWF, and Mix-rFVIII; (ii) distinct FVIIIs differed significantly in their immunogenic potential in that, in addition to (i), Afstyla + pdVWF had a significantly lower immunogenic potential than Beriate, while the immunogenic potential of Beriate was not significantly different from that of Xyntha + pdVWF; and (iii) rFVIIIs with pdVWF had significantly lower immunogenic potentials than the same rFVIIIs without pdVWF., Conclusions: Our results provide HLAcII peptidomic level explanations for several important clinical observations/issues including the differential immunogenicity of distinct FVIIIs and the role of HLAcII genetics in inhibitor development., (© 2019 International Society on Thrombosis and Haemostasis.)

Background: The medical literature reports that many medical trainees experience burnout. The primary goal of this study was to determine how the prevalence of burnout and other forms of emotional distress among the University of Kansas School of Medicine (KUSM) medical students compared to the previously published data., Methods: We conducted a cross-sectional survey of 379 medical students. Between July and September 2018, we surveyed 872 KUSM medical students on the three campuses (Kansas City, Salina, and Wichita) of KUSM. The survey included items on demographic information, burnout, symptoms of depression, fatigue, quality of life, and self-reported general health. The authors used standard descriptive summary statistics, Kruskal-Wallis test/one-way analysis of variance, chi-square test, correlation, and multivariate logistic regression model to analyze the data., Results: The overall response rate was 43.5% with 48% of the students reporting manifestations of burnout. Burnout, depression, and fatigue were lowest during the first year of training and increased as year in training progressed. In multivariate models, only year in training was associated with increased odds of burnout, symptoms of depression, and fatigue. Nearly 46% of the students screened positive for depression, and 44.6% reported high levels of fatigue in the past week., Conclusion: Even though KUSM students have a lower prevalence of burnout than the national rate (48% vs. 55.9%), this prevalence is high enough to warrant new interventions. Because burnout and other emotional distress increase over the course of medical school no matter what campus the students attend, interventions should be both longitudinal and global across all campuses., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© International Association of Medical Science Educators 2019.)

Introduction: Missed outpatient appointments are a common problem for academic residency clinics, and reducing their rate improves office efficiency, income, and resident education. Identifying specific reasons why some patients miss outpatient appointments may provide insight into developing targeted approaches to reducing their rates. This study sought to find reasons associated with patients' missed appointments at two family medicine residency clinics., Methods: The study utilized a qualitative research design involving patients at two urban, university-affiliated family medicine residency outpatient clinics. Twenty-five randomly selected patients who were dismissed from the clinics for missing three or more scheduled appointments during a five-year span (July 2012 to July 2017) were interviewed over the phone about reasons they did not keep their scheduled clinic appointments. The authors, individually and as a group, used an immersion-crystalization approach to analyze the content of the interviews., Results: Responses from 25 participants (21 females and four males) are presented. Fifty-two percent of patients were Caucasian, 32% Black, 12% Hispanic, and 4% Asian. Five themes emerged from the data analysis as major reasons the patients missed their scheduled outpatient appointments: forgetfulness, transportation issues, personal health issues, family and employer obligations, and other issues, such as anticipated long clinic wait times, bad weather, and financial problems., Conclusions: The findings showed there are several logistical, situational, and clinical reasons for patients' missed scheduled outpatient appointments.

Introduction: The medical literature suggests disturbingly high rates of burnout among US physicians. The objective of this study was to determine the rates of burnout, other forms of distress, and overall quality of life among physicians in Sedgwick County., Methods: The study involved a convenience sample of 197 physicians who were active member physicians of the Medical Society of Sedgwick County (MSSC). Between July and August 2018, we surveyed 872 physicians who were active members of the MSSC. The survey assessed manifestations of burnout, symptoms of depression and suicidal ideation, fatigue, and quality of life. The authors used standard descriptive summary statistics, Mann-Whitney U test/independent samples t -Test, Fisher's exact test, and correlations to analyze the data., Results: The participation rate was 44.6%, with 49.5% of the respondents reporting manifestations of burnout. Although 85% of the participants rated their overall quality of life as good/very good, 45% screened positive for depression, 5% had thoughts of suicide during the past year, and 44% reported excessive fatigue during the past week. Those with manifestations of burnout were 2.13 (100% vs 46.9%, p < 0.01) times more likely to report thoughts of suicidal ideation, 2.43 (72.6% vs 30.4%; p < 0.001) times more likely to screen positive for depression, and 1.89 (67.5% vs 35.8%; p < 0.001) times more likely to have high degrees of fatigue. All of the participants who had suicidal ideation reported manifestations of burnout., Conclusions: Burnout was prevalent among active member physicians of the MSSC. Burnout among the participants was associated with symptoms of depression, fatigue, suicidal ideation, and intention of leaving the medical profession via early retirement and/or career change.

The immunogenicity of protein therapeutics is an important safety and efficacy concern during drug development and regulation. Strategies to identify individuals and subpopulations at risk for an undesirable immune response represent an important unmet need. The major histocompatibility complex (MHC)-associated peptide proteomics (MAPPs) assay directly identifies the presence of peptides derived from a specific protein therapeutic on a donor's MHC class II (MHC-II) proteins. We applied this technique to address several questions related to the use of factor VIII (FVIII) replacement therapy in the treatment of hemophilia A (HA). Although >12 FVIII therapeutics are marketed, most fall into 3 categories: (i) human plasma-derived FVIII (pdFVIII), (ii) full-length (FL)-recombinant FVIII (rFVIII; FL-rFVIII), and (iii) B-domain-deleted rFVIII. Here, we investigated whether there are differences between the FVIII peptides found on the MHC-II proteins of the same individual when incubated with these 3 classes. Based on several observational studies and a prospective, randomized, clinical trial showing that the originally approved rFVIII products may be more immunogenic than the pdFVIII products containing von Willebrand factor (VWF) in molar excess, it has been hypothesized that the pdFVIII molecules yield/present fewer peptides (ie, potential T-cell epitopes). We have experimentally tested this hypothesis and found that dendritic cells from HA patients and healthy donors present fewer FVIII peptides when administered pdFVIII vs FL-rFVIII, despite both containing the same molar VWF excess. Our results support the hypothesis that synthesis of pdFVIII under physiological conditions could result in reduced heterogeneity and/or subtle differences in structure/conformation which, in turn, may result in reduced FVIII proteolytic processing relative to FL-rFVIII.

Introduction: This study explored the prevalence of and the relationship between job satisfaction and burnout among obstetrics and gynecology residency program coordinators., Methods: This cross-sectional study involved members of the American Program Managers of Obstetrics and Gynecology. The Copenhagen Burnout Inventory and Spector's Job Satisfaction Survey were used to measure the participants' burnout and job satisfaction rates respectively. Data were collected between August 2017 and December 2017. The authors used Fisher's exact tests, Spearman's r correlations, and multiple linear regression to analyze the data., Results: There was an 83% (171/207) response rate. Thirteen percent of the coordinators reported high, 70% moderate, and 17% low job satisfaction scores. Thirty-nine percent of the coordinators reported high, 25% moderate, and 36% slight work-related burnout rates. Correlation coefficient showed a significantly negative relationship between job satisfaction and work-rated burnout, ( r s [169] = -0.402, p < 0.01). Regression analysis showed co-workers (β = -0.47) and supervision (β = -0.16) domains of the job satisfaction scale were significant predictors of work-related burnout ( R = 0.55; F [5, 195] = 11.05; p < .001)., Conclusions: The findings highlight the importance of job satisfaction factors, such as support from coworkers and supervisors, in dealing with work-related burnout among residency coordinators.

When the Family Medicine for America's Health (FMAHealth) Workforce Education and Development Tactic Team (WEDTT) began its work in December 2014, one of its charges from the FMAHealth Board was to increase family physician production to achieve the diverse primary care workforce the United States needs. The WEDTT created a multilevel interfunctional team to work on this priority initiative that included a focus on student, resident, and early-career physician involvement and leadership development. One major outcome was the adoption of a shared aim, known as 25 x 2030. Through a collaboration of the WEDTT and the eight leading family medicine sponsoring organizations, the 25 x 2030 aim is to increase the percentage of US allopathic and osteopathic medical students choosing family medicine from 12% to 25% by the year 2030. The WEDTT developed a package of change ideas based on its theory of what will drive the achievement of 25 x 2030, which led to specific projects completed by the WEDTT and key collaborators. The WEDTT offered recommendations for the future based on its 3-year effort, including policy efforts to improve the social accountability of US medical schools, strategy centered around younger generations' desires rather than past experiences, active involvement by students and residents, engagement of early-career physicians as role models, focus on simultaneously building and diversifying the family medicine workforce, and security of the scope future family physicians want to practice. The 25 x 2030 initiative, carried forward by the family medicine organizations, will use collective impact to adopt a truly collaborative approach toward achieving this much needed goal for family medicine.

Background and Objectives: Research into rates of burnout and job satisfaction among family medicine residency coordinators is nonexistent. Coordinators play a pivotal role in medical education, sometimes have multiple roles and titles, and often work in stressful environments. The goals of this study were to explore the prevalence of, and relationship between, burnout and job satisfaction among family medicine residency coordinators., Methods: This national wellness study involved 307 family medicine residency coordinators. Modified questions of the Professional Quality of Life Scale, Version 5 were used to measure participants' burnout and job satisfaction rates. The authors used chi-square tests, Pearson's r correlations, and multiple linear regression to analyze the data., Results: The response rate was 72% (307/429), with 24% of family medicine residency coordinators reporting high, 51% reporting moderate, and 26% reporting low rates of work-related burnout. Twenty-eight percent of the family medicine residency coordinators reported high, 46% moderate, and 26% low job satisfaction. There was a significantly negative relationship between job satisfaction and work-related burnout, r (306)=-.638, P&lt;0.001. Regression explained 42% of variance in job satisfaction, and showed that burnout (β=-.62) and years on the job (β=.15) were significant predictors of job satisfaction (R=0.64; F [5, 277]=40.28, P&lt;.001)., Conclusions: The results demonstrate that family medicine residency coordinators are generally satisfied with their work and reported moderate to high degree of burnout rates.

Background and Objectives: Research into the rates of burnout among nonclinical workers is nonexistent at medical education centers (MECs). The first goal of this study was to explore the prevalence of burnout among nonclinical faculty and staff working at a local MEC. The second goal was to identify predictors of burnout using job satisfaction dimensions-supervision, coworkers, contingency rewards, and nature of work., Methods: The study included a convenience sample of 95 nonclinical faculty and staff working at a local MEC. Data from these workers were collected between December 2016 and January 2017. The Abbreviated Maslach Burnout Inventory (AMBI) was used to measure burnout while a modified Spector's Job Satisfaction Survey (JSS) was used to measure participants' job satisfaction. The authors correlated the dimensions of the AMBI and JSS. They also conducted multiple regression analysis using the four dimensions of JSS to determine predictors of participant burnout., Results: The data showed that 1% of the 95 respondents reported high burnout and 35% reported medium burnout on the scale. Correlation coefficient showed that job satisfaction and burnout strongly and negatively correlated (r[93]=-.66; P&lt;.001). Multiple regression analysis showed that nature of work (β=-.49) and coworkers (β=-.30) were significant predictors of burnout (R=0.74; F[4, 90]=26.81; P&lt;.001)., Conclusions: Nonclinical workers at a local MEC were generally satisfied with their job and showed a moderate degree of burnout. Compared to the general population, our sample reported less burnout.

Gastroesophageal reflux disease (GERD) is a gastrointestinal motility disorder that results from the reflux of stomach contents into the esophagus or oral cavity resulting in symptoms or complications. The typical symptoms of GERD are heartburn and regurgitation of gastric contents into the oropharynx. GERD affects quality of life and may cause erosive esophagitis, esophageal strictures, and Barrett esophagus, a precursor to esophageal adenocarcinoma. GERD is a clinical diagnosis and is most effectively treated with proton-pump inhibitors (PPIs). Long-term use of PPIs is associated with bone fractures, chronic renal disease, acute renal disease, community-acquired pneumonia, and Clostridium difficile intestinal infection., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The bacteria and fungi in the human gut make up a community of microorganisms that lives in symbiosis with humans, engaging in numerous diverse interactions that influence health. This article outlines the current knowledge on emerging topics in gastroenterology, including microbiome and probiotics, fecal microbiota transplantation, cyclic vomiting syndrome, eosinophilic esophagitis, and microscopic colitis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Recent support has been shown for physicians to recommend e-cigarettes to patients who are trying to quit smoking. Supporters of this recommendation argue that e-cigarettes are not combustible products and are less harmful and more effective cessation products than regular cigarettes, with less inherent risk. Those who oppose this idea argue that little reliable evidence suggests that e-cigarettes are better cigarette cessation devices than currently available nicotine replacement therapies, and that they pose as much risk as cigarettes. This study was conducted to explore family physicians' perceptions of recommending e-cigarettes as smoking cessation aids to patients who smoke cigarettes., Methods: The study used a mixed-methods approach whereby a 12-item survey was sent to 154 family physicians throughout the state of Kansas. Data were collected from 117, a 76% response rate. A multidisciplinary team used an immersion-crystallization approach to analyze the content of respondents' qualitative data; contingency table analysis was used to evaluate the quantitative data., Results: The results showed that family physicians have negative perceptions of e-cigarettes and do not recommend them for smoking cessation. Family physicians are concerned about the effectiveness of e-cigarettes and the uncertainty regarding safety., Conclusions: The results suggest that most family physicians do not recommend e-cigarettes for smoking cessation, citing lack of evidence on effectiveness and uncertainty regarding short- and long-term safety., Competing Interests: Conflict of interest: none declared., (© Copyright 2017 by the American Board of Family Medicine.)

Introduction: Kansas has a regionalized trauma system with formal mechanisms for review, however, increased communication with rural providers can uncover opportunities for system process improvement. Therefore, this qualitative study explored perceptions of family medicine physicians staffing emergency departments (ED) in rural areas, specifically to determine what is going well and what areas needed improvement in relation to the trauma system., Methods: A focus group included Kansas rural family physicians recruited from a local symposium for family medicine physicians. Demographic information was collected via survey prior to the focus group session, which was audiotaped. Research team members read the transcription, identified themes, and grouped the findings into categories for analysis., Results: Seven rural family medicine physicians participated in the focus group. The majority were male (71%) with the mean age 46.71 years. All saw patients in the ED and had treated injuries due to agriculture, falls, and motor vehicle collisions. Participants identified successes in the adoption and enforcement of standardized processes, specifically through level IV trauma center certification and staff requirements for Advanced Trauma Life Support training. Communication breakdown during patient discharge and skill maintenance were the most prevalent challenges., Conclusions: Even with an established regionalized trauma system in the state of Kansas, there continues to be opportunities for improvement. The challenges acknowledged by focus group participants may not be identified through patient case reviews (if conducted), therefore tertiary centers should conduct system reviews with referring hospitals regularly to improve systemic concerns.

Epistaxis, or nosebleed, is a common disorder that many patients will experience. Most patients go to the emergency room when they have an uncontrolled nosebleed, or they may present to an outpatient office. Most nosebleeds are not life-threatening and can be managed conservatively. Occasionally, hospital admission, referral to an otolaryngologist physician, and/or blood transfusion may be necessary. This article is an update on the latest information related to the prevention, causes, and treatment of epistaxis., (Copyright © 2014 Elsevier Inc. All rights reserved.)