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BackgroundProviders’ adoption of electronic health records (EHRs) is increasing and consumers have expressed concerns about the potential effects of EHRs on privacy and security. Yet, we lack a comprehensive understanding regarding factors that affect individuals’ perceptions regarding the privacy and security of their medical information. ObjectiveThe aim of this study was to describe national perceptions regarding the privacy and security of medical records and identify a comprehensive set of factors associated with these perceptions. MethodsUsing a nationally representative 2011-2012 survey, we reported on adults’ perceptions regarding privacy and security of medical records and sharing of health information between providers, and whether adults withheld information from a health care provider due to privacy or security concerns. We used multivariable models to examine the association between these outcomes and sociodemographic characteristics, health and health care experience, information efficacy, and technology-related variables. ResultsApproximately one-quarter of American adults (weighted n=235,217,323; unweighted n=3959) indicated they were very confident (n=989) and approximately half indicated they were somewhat confident (n=1597) in the privacy of their medical records; we found similar results regarding adults’ confidence in the security of medical records (very confident: n=828; somewhat confident: n=1742). In all, 12.33% (520/3904) withheld information from a health care provider and 59.06% (2100/3459) expressed concerns about the security of both faxed and electronic health information. Adjusting for other characteristics, adults who reported higher quality of care had significantly greater confidence in the privacy and security of their medical records and were less likely to withhold information from their health care provider due to privacy or security concerns. Adults with higher information efficacy had significantly greater confidence in the privacy and security of medical records and less concern about sharing of health information by both fax and electronic means. Individuals’ perceptions of whether their providers use an EHR was not associated with any privacy or security outcomes. ConclusionsAlthough most adults are confident in the privacy and security of their medical records, many express concerns regarding sharing of information between providers; a minority report withholding information from their providers due to privacy and security concerns. Whether individuals thought their provider was using an EHR was not associated with negative privacy/security perceptions or withholding, suggesting the transition to EHRs is not associated with negative perceptions regarding the privacy and security of medical information. However, monitoring to see how this evolves will be important. Given that positive health care experiences and higher information efficacy were associated with more favorable perceptions of privacy and security, efforts should continue to encourage providers to secure medical records, provide patients with a “meaningful choice” in how their data are shared, and enable individuals to access information they need to manage their care.

BACKGROUND & AIMS: The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. METHODS: Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. RESULTS: A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death. CONCLUSIONS: Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.

Background: The FACE‐Q Aesthetics is used extensively to measure patient reported outcomes for minimally invasive and surgical facial aesthetic treatments. We recently developed a new FACE‐Q scale to assess satisfaction with the appearance of the temples. Aim: The aim of this study was to field test the FACE‐Q Satisfaction with Temples scale to examine its psychometric properties. Methods: The FACE‐Q Satisfaction with Temples scale was administered to 171 adults (22 years or older) seeking minimally invasive treatment to improve temple hollowing as part of a clinical trial. The severity of temple hollowing was established through the clinician‐reported Allergan Temple Hollowing scale (clinician‐rated). The psychometric properties of the FACE‐Q Satisfaction with Temples scale were established by testing Rasch Measurement Theory (RMT) assumptions and model fit; unidimensionality by principal component analysis; and construct validity by hypothesis testing. Results: The study sample consisted of 171 adults (mean age 54.7 ± 9.9, range, 25–82 years). RMT analysis provided evidence for the scientific soundness of a 12‐item Satisfaction with Temples scale. The data fit the Rasch model (χ2 = 20.47, df = 24, p = 0.67), all items had ordered thresholds, and good item fit. Scale reliability was high, with Person Separation Index and Cronbach alpha values with and without extremes ≥0.93. Principal component analysis revealed a single component with high factor coefficients. Construct validity was established as scores for the Satisfaction with Temples and Face Overall scales were correlated (r = 0.623, p < 0.001). Conclusion: The FACE‐Q Satisfaction with Temples scale is a reliable and valid measure that can be used in clinical practice and research to measure outcomes following treatment for temple hollowing. [ABSTRACT FROM AUTHOR]

Background and Aim: Quantification of body compartments, particularly the interaction between adipose tissue and skeletal muscle, is emerging as novel a biomarker of metabolic health. The present study evaluated the impact of liver transplant (LT) on body compartments. Methods: Totally 66 adult LT recipients were enrolled in whom body compartments including visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), muscle fat infiltration (MFI), fat‐free muscle volume (FFMV), and liver fat (LF) were quantified via whole body magnetic resonance imaging (MRI). To provide non‐LT comparison, each LT recipient was matched to at least 150 non‐LT controls for same sex, age, and body mass index (BMI) from the UK Biobank registry. Results: LT recipients (vs matched non‐LT controls) had significantly higher subcutaneous (13.82 ± 5.47 vs 12.10 ± 5.10 L, P < 0.001) and visceral fat (7.59 ± 3.75 vs 6.72 ± 3.06 L, P = 0.003) and lower LF (5.88 ± 7.14 vs 8.75 ± 6.50%, P < 0.001) and muscle volume (11.69 ± 2.95 vs 12.12 ± 2.90 L, P = 0.027). In subgroup analysis, patients transplanted for metabolic dysfunction‐associated steatohepatitis (MASH) cirrhosis (vs non‐MASH cirrhosis) had higher ASAT, VAT, and MFI. A trend toward higher LF content was noted; however, this did not reach statistical significance (6.90 ± 7.35 vs 4.04 ± 6.23%, P = 0.189). Finally, compared with matched non‐LT controls, patients transplanted for MASH cirrhosis had higher ASAT and VAT; however, FFMV and MFI were similar. Conclusion: Using non‐LT controls, the current study established the higher‐than‐expected adiposity burden among LT recipients, which is even higher among patients transplanted for MASH cirrhosis. These findings provide data needed to design future studies developing radiomics‐based risk‐stratification strategies in LT recipients. [ABSTRACT FROM AUTHOR]

Objective To identify impacts of different survey methodologies assessing primary care physicians' (PCPs') experiences with electronic health records (EHRs), we compared three surveys: the 2022 Continuous Certification Questionnaire (CCQ) from the American Board of Family Medicine, the 2022 University of California San Francisco (UCSF) Physician Health IT Survey, and the 2021 National Electronic Health Records Survey (NEHRS). Materials and Methods We evaluated differences between survey pairs using Rao-Scott corrected chi-square tests, which account for weighting. Results CCQ received 3991 responses from PCPs (100% response rate), UCSF received 1375 (3.6% response rate), and NEHRS received 858 (18.2% response rate). Substantial, statistically significant differences in demographics were detected across the surveys. CCQ respondents were younger and more likely to work in a health system; NEHRS respondents were more likely to work in private practice; and UCSF respondents disproportionately practiced in larger academic settings. Many EHR experience indicators were similar between CCQ and NEHRS, but CCQ respondents reported higher documentation burden. Discussion The UCSF approach is unlikely to supply reliable data. Significant demographic differences between CCQ and NEHRS raise response bias concerns, and while there were similarities in some reported EHR experiences, there were important, significant differences. Conclusion Federal EHR policy monitoring and maintenance require reliable data. This test of existing and alternative sources suggest that diversified data sources are necessary to understand physicians' experiences with EHRs and interoperability. Comprehensive surveys administered by specialty boards have the potential to contribute to these efforts, since they are likely to be free of response bias. [ABSTRACT FROM AUTHOR]

Drugs with prolonged on-target residence times often show superior efficacy, yet general strategies for optimizing drug-target residence time are lacking. Here we made progress toward this elusive goal by targeting a noncatalytic cysteine in Bruton's tyrosine kinase (BTK) with reversible covalent inhibitors. Using an inverted orientation of the cysteine-reactive cyanoacrylamide electrophile, we identified potent and selective BTK inhibitors that demonstrated biochemical residence times spanning from minutes to 7 d. An inverted cyanoacrylamide with prolonged residence time in vivo remained bound to BTK for more than 18 h after clearance from the circulation. The inverted cyanoacrylamide strategy was further used to discover fibroblast growth factor receptor (FGFR) kinase inhibitors with residence times of several days, demonstrating the generalizability of the approach. Targeting of noncatalytic cysteines with inverted cyanoacrylamides may serve as a broadly applicable platform that facilitates 'residence time by design', the ability to modulate and improve the duration of target engagement in vivo.