Annual Exam Research Articles

Improving Access and Timeliness of Employee Annual Exams.

Access to preventive healthcare improves health outcomes and reduces risk of chronic disease. Annual examinations were integrated into an underutilized clinic at the University of Utah to improve access to preventive care. Nurse practitioners conducted these examinations, which included history, physical examination, age-based screenings, and immunizations. The service was part of a wellness program offering health premium discounts for participants. With employee permission, visit documentation was shared with primary care providers (PCPs) or used to help establish a PCP. Human resources received monthly reports of participating employees identification numbers, validating participation in order to receive premium discount. In 2023, 373 examinations were performed, including 719 preventive services and screenings, with 143 referrals for specialty and primary care. Patient satisfaction remained high throughout implementation. This initiative effectively increased access to preventive care for employees, demonstrating the feasibility of offering annual examinations in worksite clinics. The program addresses common barriers to preventive care such as long wait times, PCP shortages, and travel time to appointments.

Changes in diabetes care and management practices during the COVID-19 pandemic.

We examined changes in diabetes care and management practices before and during the COVID-19 pandemic. Population-based data regarding four diabetes-related healthcare engagement and four self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups in 2019 (before the pandemic) and 2021 (during the pandemic). Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp; 95% confidence interval: -4.8, -0.4), from 75.4% to 73.1%, and prevalence of annual eye exams fell by 4.0pp (-6.2, -2.8), from 72.2% to 68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5pp (-5.9, -1.1), from 44.9% to 41.9%. Of self-management behaviors, avoidance of smoking increased by 2.0pp (0.4, 3.6) from 84.7% to 87.1%. The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.

Test Smart, Treat Smart-using clinician feedback to adapt a catheter-associated urinary tract infection intervention for spinal cord injury.

Catheter-associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision-making challenge when determining whether antibiotic treatment is appropriate. To conduct preimplementation SCI-focused adaptations to the evidence-based practice (EBP) "Kicking CAUTI"-to develop a guide for SCI providers surrounding testing and treatment of CAUTI. Four 1-hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process. The clinical algorithm was simplified, a urinary symptom assessment added, and provider- and patient-facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention. Traditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.

Racial/ethnic disparities in cost-related barriers to care among near-poor beneficiaries in Medicare Advantage vs traditional Medicare.

To compare racial and ethnic disparities in cost-related medical care and dental care barriers and use of vision care among near-poor Medicare beneficiaries in Medicare Advantage (MA) vs traditional Medicare (TM) overall and stratified by supplemental insurance enrollment. Cross-sectional analysis of 2015-2019 data from the nationally representative Medicare Current Beneficiary Survey. Propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM among near-poor Medicare beneficiaries with incomes between 101% and 250% of the federal poverty level. We assessed differences in cost-related medical care barriers and cost-related dental care barriers as well as receipt of annual eye exams in MA vs TM. For cost-related barriers to medical care, Hispanic-White disparities were narrower by 8.8 (95% CI, -14.0 to -3.6) percentage points in MA relative to TM but differences in Black-White disparities were not statistically significant. MA was not associated with narrower differences in Hispanic-White or Black-White disparities in dental care access. Higher proportions of Black and Hispanic beneficiaries in MA received an annual eye exam vs White beneficiaries in both MA and TM. MA was associated with narrower racial disparities primarily compared with TM without supplemental insurance. Among near-poor Black and Hispanic Medicare beneficiaries, MA was associated with greater use of vision care and narrowing of some disparities in cost-related access barriers vs TM. However, MA did not uniformly narrow racial/ethnic disparities in access and use. These findings highlight the importance of maintaining and enhancing features of Medicare coverage that may promote equitable access to care, including additional benefits and lower cost sharing.

Successful Neoadjuvant Chemotherapy and Surgical Removal of a Nonmetastatic Testicular Round Cell Tumor in a Solomon Island Eclectus Parrot (Eclectus roratus solomonensis).

An intracoelomic mass was palpated on an annual exam of a 24-year-old male Solomon Island eclectus parrot (Eclectus roratus solomonensis). The initial diagnostic workup included a complete blood count, plasma biochemistry panel, and coelomic ultrasound. Computed tomography was highly suggestive of a testicular mass. Tamoxifen and the gonadotropin-releasing hormone agonists leuprolide and deslorelin were administered as neoadjunctive endocrine therapies. Biopsy and histologic examination confirmed a testicular mass consistent with a round cell tumor. Four doses of carboplatin 15 mg/kg IV were administered as neoadjunctive chemotherapy, and testicular size decreased by approximately 95%. The remaining gross tumor was removed via orchidectomy with clean but narrow margins. Seven months following surgery, a contrast CT scan did not show any evidence of recurrence of or metastasis from the original mass. This is the first report of successful treatment of a testicular tumor in a psittacine with neoadjuvant chemotherapy and orchidectomy.

6635 A Call for High-Value Diabetic Retinopathy Screening and the Introduction of a Novel Predictive Model

Abstract Disclosure: P.J. Williams: None. C. Kim: None. K. Ziadeh: None. E. White: None. C.S. Chen-Milhone: None. L.D. Lugo: None. K.B. Ellis: None. M.S. Juzych: None. Introduction: Diabetic retinopathy (DR) remains one of the leading causes of preventable blindness in middle-aged and older populations. Late-stage DR is often visually symptomatic; however, early DR is generally asymptomatic and requires screening. For type 2 diabetes mellitus (T2DM), the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases recommend an initial dilated eye exam with follow-up every 1-3 years, or annually if diabetic retinopathy is detected. Despite these guidelines, providers and insurers in the United States routinely recommend annual screening regardless of other factors. Methods: A cross-sectional analysis with prospective data verification was done for new diabetic eye exam referrals from August 2021 through July 2022 to address screening discrepancies. Established patients and referrals unrelated to hyperglycemia were excluded. Data collection included duration of diabetes, last hemoglobin A1c (HbA1c), maximum HbA1c, age, race, gender, BMI, relevant medication use, and imaging, as well as the presence of hypertension, hypercholesterolemia, diabetic peripheral neuropathy (DPN), diabetic nephropathy, diabetic amputation, and DR and data was verified against objective records up to 2 years later. Logistical multivariate analysis was conducted by a trained statistician. Results: 474 consecutive patients were referred over 1 year. Among all referrals, 2.11% (10/474) of patients were prediabetic. Among the patients with diabetes, 5.39% (25/464) were type 1 and 94.6% (439/464) were type 2. Among patients with T2DM, the average age was 57.64±11.52 (range = 25-98) and females made up 52.16% (229/439). The average diabetes duration among T2DM patients with DR was 19.39±8.45 years (range = 11-51) compared to 6.12±5.77 years (range = 0-31 years) without DR. Maximum lifetime HbA1c (p=0.0016), duration of diabetes (p<0.0001), and presence of DPN (p = 0.0047) were the strongest predictors of DR in patients with T2DM. A predictive model for DR was created utilizing these variables and hypercholesterolemia (p=0.048) with a predictive accuracy of 89.5% (chi-squared value (4)=121.451, p<0.001, Nagelkerke R2=57%). Sensitivity and specificity measured 92.31% and 87.99% respectively. The area under the ROC curve measured 0.952 (CI 0.925 to 0.972, p<0.0001). Conclusion: Duration of diabetes, maximum HbA1c, and DPN are strongly associated with DR among patients with T2DM and should be tracked to guide screening. Among T2DM patients with a well-documented recent onset of diabetes, maximum HbA1c less than 8, and benign initial eye exam, annual diabetic eye exams are unlikely to reveal DR in the first 10 years after onset. Based on our data, annual diabetic screening exams are unnecessary for many patients, and upper limits of screening intervals should be considered in low-risk patients to increase high-value care. Presentation: 6/2/2024

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice

BackgroundDiabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams. ObjectiveThe objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved. Practice descriptionThis study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist and manages diabetes through a collaborative practice agreement. Practice innovationA regional Medicaid plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted. Evaluation methodsThe rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics. ResultsA total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam. ConclusionThis pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

Artificial intelligence in orthopaedic education: A comparative analysis of ChatGPT and Bing AI's Orthopaedic In‐Training Examination performance

AbstractBackgroundThis study evaluated the performance of generative artificial intelligence (AI) models on the Orthopaedic In‐Training Examination (OITE), an annual exam administered to U.S. orthopaedic residency programs.MethodsChatGPT 3.5 and Bing AI GPT 4.0 were evaluated on standardised sets of multiple‐choice questions drawn from the American Academy of Orthopaedic Surgeons OITE online question bank spanning 5 years (2018–2022). A total of 1165 questions were posed to each AI system. The performance of both systems was standardised using the latest versions of ChatGPT 3.5 and Bing AI GPT 4.0. Historical data of resident scores taken from the annual OITE technical reports was used as a comparison.ResultsAcross the five datasets, ChatGPT 3.5 scored an average of 55.0% on the OITE questions. Bing AI GPT 4.0 scored higher with an average of 80.0%. In comparison, the average performance of orthopaedic residents in national accredited programs was 62.1%. Bing AI GPT 4.0 outperformed ChatGPT 3.5 and Accreditation Council for Graduate Medical Education examinees, and analysis of variance analysis demonstrated p < 0.001 among groups. The best performance was by Bing AI GPT 4.0 on OITE 2020.ConclusionGenerative AI can provide a logical context across answer responses through its in‐depth information searches and citation of resources. This combination presents a convincing argument for the possible uses of AI in medical education as an interactive learning aid.

Comparing Vision-Capable Models, GPT-4 and Gemini, With GPT-3.5 on Taiwan's Pulmonologist Exam.

Introduction The latest generation of large language models (LLMs) features multimodal capabilities, allowing them to interpret graphics, images, and videos, which are crucial in medical fields. This study investigates the vision capabilities of the next-generation Generative Pre-trained Transformer 4 (GPT-4) and Google's Gemini. Methods To establish a comparative baseline, we used GPT-3.5, a model limited to text processing, and evaluated the performance of both GPT-4 and Gemini on questions from the Taiwan Specialist Board Exams in Pulmonary and Critical Care Medicine. Our dataset included 1,100 questions from 2012 to 2023, with 100 questions per year. Of these, 1,059 were in pure text and 41 were text with images, with the majority in a non-English language and only six in pure English. Results For each annual exam consisting of 100 questions from 2013 to 2023, GPT-4 achieved scores of 66, 69, 51, 64, 72, 64, 66, 64, 63, 68, and 67, respectively. Gemini scored 45, 48, 45, 45, 46, 59, 54, 41, 53, 45, and 45, while GPT-3.5 scored 39, 33, 35, 36, 32, 33, 43, 28, 32, 33, and 36. Conclusions These results demonstrate that the newer LLMs with vision capabilities significantly outperform the text-only model. When a passing score of 60 was set, GPT-4 passed most exams and approached human performance.

A Review of Abnormal Pap Smear Follow Up in the Resident Clinic

Introduction: The pap smear is a screening tool designed to reduce the incidence of invasive cervical cancer. The incidence of cervical cancer diagnosis has decreased by 50% from 1970 to 2010. This is largely accredited to pap smear screening, follow up colposcopy appropriate surgical treatment. The pap smear was performed annually for many years; however, in 2012 the guidelines changed to spaced screening pap smears. In our resident clinic we serve patients with barriers to health care. These barriers limit follow up for abnormal pap smears. This study aimed to identify the follow up rate after abnormal pap with colposcopy among resident continuity clinic patients. Methods: The patients with annual exams from resident clinic were collected from Jan 1st, 2023 to Jan 1st, 2024. Study Design: The pap smear results and follow up were reviewed. Results: During the year 2023, 402 patients presented to the resident continuity clinic for annual exams. Pap smears were obtained in 82% of our annuals and 12% had an abnormal pap result. Of these patients, only 62% had appropriate follow up colposcopy. Discussion: The results from our study revealed a low rate of follow up from abnormal pap smear. Conclusion: This study allowed us to better understand the abnormal pap smear follow up in our resident clinic population. Future area of study includes how shorter interval follow up after abnormal pap smear screening may affect colposcopy follow up rates.

Improving OBGYN resident CREOG scores

Background: OBGYN residents take an annual in-service training exam from the Council on Resident Education in Obstetrics and Gynecology (CREOG). The CREOG exam is used within the residency program to identify areas of improvement in education and to help residents prepare for passing the written boards. Introduction: This study’s aim was to improve knowledge and preparation for the CREOG exam through an improved didactic schedule and more focused test preparation strategy. This included incorporating a question bank and CREOG preparation throughout the year. Methods: The average standardized scores per resident class year for Corewell Health East- Dearborn were reviewed from 2019 to 2024. Study Design: The didactic schedule emphasized areas of weakness identified in the prior year, a question bank gamified, and CREOG preparation was initiated at the beginning of the academic year. Residents were also given a personal analysis with areas of improvement from prior years and a faculty liaison. Results: From 2019 to 2024, scores of each class year increased. In the PGY1 class year, the score increased from 54% in 2019 to 60% in 2024. In the PGY2 class year, the score increased from 57% in 2019 to 69% in 2024. In the PGY3 class year, the score increased from 55% in 2019 to 70% in 2024. In the PGY4 class year, the score increased from 58% in 2019 to 71% in 2024. The overall score has increased from 56% in 2019 to 67% in 2024. Discussion: Over six years, our residency didactic schedule and learning environment was revamped by our residents and faculty which resulted in improved scores in the CREOG exam. Conclusion: The improvement in CREOG scores will continue to guide future changes in our didactic schedule.

(062) IMPLEMENTING A VALIDATED SEXUAL DYSFUNCTION SCREENING TOOL AT AN INNER-CITY WOMEN’S HEALTH CLINIC

Abstract Introduction The American College of Obstetricians and Gynecologists (ACOG) reports 43% of American women experience sexual health problems, including Female Sexual Interest and Arousal Disorder, Female Orgasmic Disorder, Genito–Pelvic Pain and Penetration Disorder, and Substance or Medication-Induced Sexual Dysfunction. Objective At Women’s Ambulatory Health Services (WAHS), an inner-city clinic associated with Hartford HealthCare, at which UConn Health ObGyn residents work, there is no routine screening in place for sexual dysfunction. This project aimed to implement the Female Sexual Function Index (FSFI) for screening for sexual dysfunction at this clinic to identify patients who may benefit from treatment. Methods We implemented the FSFI-short version, a six-question screening tool for sexual dysfunction that has been validated in English and Spanish and utilized in many countries on July 1st, 2022. Patients presenting for a new gynecologic visit or an annual gynecologic exam were asked to complete the screening tool. Patients who scored equal to or less than 18 on the FSFI-short version were identified as at risk for female sexual dysfunction and were offered referral to a health psychologist specializing in sexual dysfunction. We utilized the RE-AIM framework for implementation science to guide the implementation evaluation. We collected data on patients from July 1 through December 1, 2022. We collected patient demographics and implementation outcomes, including rate of survey completion, candidacy for referral and referral completion. Results 196 surveys were reviewed between July 1st and December 1st of 2022. 44 surveys were excluded for various reasons, including not meeting study inclusion criteria or invalid responses. 152 screening forms were included and 45 patients screened positive. Subjective patient barriers were gathered from comments written directly onto the paper survey as well as quotes documented by their providers in the visit note. These subjective barriers included hesitancy to discuss sexual health and lacking knowledge that the gynecologist provider offers assessment and management for these disorders. Conclusions The introduction of the FSFI-sv at WAHS has both expanded the resources offered to patients, enhanced the environment surrounding topics of women’s health both between staff members as well as within the patient-provider relationship, and has unearthed multiple opportunities for improving the screening process, referral selection and work flow for sexual dysfunction amongst the patient population. Disclosure No.

RETROSPECTIVE HEMATOLOGY AND SERUM BIOCHEMISTRY OF RING-TAILED LEMURS (LEMUR CATTA) ON ST. CATHERINES ISLAND, GEORGIA, USA.

Annual health records were retrospectively analyzed for a colony of ring-tailed lemurs (Lemur catta) inhabiting St. Catherines Island, Georgia, USA to establish baseline hematological and serum biochemical parameters and determine sex- and age-related differences. Summarized complete blood count and serum biochemistry panel results are presented for 85 blood samples collected from 54 lemurs at annual health exams during 1998-2003. Within each of four age classes (infant, <1 yr; juvenile, 1-5 yr; adult, ≥ 6 yr), data were stratified and summarized based on sex. Lemur age was a significant positive predictor of mean corpuscular hemoglobin; absolute concentrations of neutrophils, monocytes, and band cells; serum concentrations of blood urea nitrogen (BUN), creatinine, globulins, lipase, and total protein; and gamma-glutamyl transferase (GGT) activity. Lemur age was a significant negative predictor of albumin:globulins ratio; alkaline phosphatase (ALP) activity; and serum concentrations of calcium, cholesterol, glucose, magnesium, phosphorus, potassium, and triglycerides. Neutrophil proportions increased with aging and lymphocyte proportions decreased with aging, particularly in females. Recent steep population declines of wild ring-tailed lemurs make their successful husbandry and medical care an increasingly pressing concern. These biomedical data will aid in clinical diagnosis and treatment of lemurs in human care, and support conservation efforts for this species.

Prevalence and Disparities in Telehealth Use Among US Adults Following the COVID-19 Pandemic: National Cross-Sectional Survey.

Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. We used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. We included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. Among US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity.

Dermatological guide for primary care physicians: full body skin checks, skin cancer detection, and patient education on self-skin checks and sun protection

Dermatological conditions and skin cancers are common health concerns that require early detection and intervention. Primary care physicians play a crucial role in recognizing these conditions and serving as the first line of defense against skin cancers. This guide provides a systematic approach to conducting thorough skin examinations and enhancing understanding of common presentations of precancerous and cancerous lesions. We emphasize the importance of performing annual full-body skin exams to facilitate early detection and management of skin conditions, including a step-by-step, systematic protocol for conducting these exams, comprising preparing the patient, documenting findings, educating the patient, and considering biopsy or referral for suspicious lesions. Furthermore, we explore the atypical features of skin lesions that raise clinical suspicion and warrant further investigation. We describe the characteristics of common skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. We stress the importance of patient education on self-skin checks and sun protection measures. By incorporating the knowledge and skills presented in this guide, primary care physicians can confidently perform thorough full-body skin checks, identify common dermatological findings and early signs of skin cancers, and provide comprehensive care to patients. This will help ensure optimal outcomes in dermatological health.

Testing the Effects of Individual Residents' Retrieval Practice on Standardized Examination Scores.

Residents have limited time and much to learn. Retrieval practice-studying using exam-style review questions-is a powerful educational tool for aggregate groups of learners, but it has not been tested for individual graduate medical education (GME) trainees. We conducted a retrospective observational study examining how individual residents' self-directed retrieval practice affected their learning. We used linear regression models to compare the number of exam-style multiple-choice practice questions each resident answered per year to their scores on annual In-Training Exams (ITE). We found that the higher a resident's ITE score was at the start of a year, the fewer practice questions they answered that year for both first- (p = 0.023) and second-year (p = 0.020) trainees. Then, the more questions a resident answered in a year, the more their ITE score increased over that year for both first- and second-year trainees (p = 0.026 and 0.025, respectively). Residents' prior ITE scores also independently predicted their subsequent ITE scores (p = 0.024 in the first and 0.007 in the second year), and the effect of their baseline scores was larger than the effect of the number of practice questions they answered. Individual residents' prior exam scores significantly predict their future exam scores, and their independent retrieval practice using exam-style review questions also significantly predicts the annual improvement in their scores. These findings add to the growing evidence supporting retrieval practice in GME, and they can inform individualized educational coaching for GME trainees.

Abstract 4792: Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data

Abstract Background: With advances in screening and therapy, the number of lung cancer (LC) survivors is rapidly increasing, with over half a million as of 2019. Prior studies demonstrated that the incidence of second primary lung cancer (SPLC) among LC survivors is 4-6 times that of initial primary lung cancer (IPLC) in the general population. However, the incidence of SPLC and surveillance strategies using computed tomography (CT) have not been examined in long-term LC survivors with over 5-year survival. We aim to estimate SPLC incidence among long-term survivors and the effectiveness of annual surveillance CT exams. Methods: We used data from SEER-Medicare with a cohort of 1,232,338 LC patients from the SEER cancer registry followed till death or last follow-up, who were also enrolled in Medicare in 1999-2020. The study cohort included 12,948 patients who were long-term survivors (≥ 5-year survival from IPLC) by age 65, received curative therapy for IPLC, and were continuously enrolled in Medicare 1 year prior to 5 years after IPLC diagnosis. The primary outcome was the 10-year cumulative SPLC incidence accounting for competing risk of death in the full study cohort and by receipt of surveillance CTs post-5-year survival, defined using detailed billing and LC-related ICD codes. To qualify as surveillance CTs, two annual CTs 9-18 months apart is required. Cox regression was used as exploratory analysis to examine the association between LC-specific survival (LC as cause of death) and the receipt of two CTs post-5-year survival as a binary variable, adjusting for SPLC diagnosis, age, sex, marital status, race, IPLC stage, income, education, and poverty. Results: Of 12,948 long-term LC survivors, 46% (n=6,015) were male, 90% (n=11,476) had early-stage disease, 77% (n=9,945) had undergone surgery for initial curative treatment, and 3.8% (n = 486) received two surveillance CTs initiated within 18 months post-5-year survival. The 10-year cumulative incidence of SPLC was 5.06% [95% CI: 5.00-5.12%] in the SEER cohort but was substantially higher among long-term LC survivors at 13.6% [13.0-14.2%]. Those who received two annual surveillance CTs after 5-year survival had a significantly higher 10-year SPLC incidence (23.3% [19.4 - 27.2%]) than those who received one or no CT (13.2% [12.6 - 13.8%]). The adjusted hazard ratio of the association between LC-specific survival and receipt of two CTs was 0.67 [0.59-0.80, p &amp;lt; 0.0001]. Conclusions: The high cumulative risk of SPLC among long-term LC survivors warrants tailored surveillance strategies. Our exploratory analysis showed a high SPLC detection rate among those who received two annual surveillance CTs vs. those who did not, with significantly higher LC-specific survival in the former. Future work will include extensive analysis accounting for time-varying exposure of multiple surveillance CTs using rigorous causal inference methods. Citation Format: Chloe C. Su, Eunji Choi, Julie T. Wu, Allison W. Kurian, Michelle C. Odden, Manisha Desai, Leah M. Backhus, Heather A. Wakelee, Ann N. Leung, Joel W. Neal, Summer S. Han. Nationwide patterns of incidence and surveillance of second primary lung cancer among long-term lung cancer survivors using SEER Medicare data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4792.

Abstract 1263: Interim results from a large-scale, prospective cohort study (JINLING) for multi-cancer early detection test in average-risk asymptomatic patients

Abstract Background: Previously, we reported that a multi-cancer early detection (MCED) test CanScan, which utilizes plasma cfDNA genome-wide fragmentomics-related features that can detect cancer signals and tissue of origin (TOO) signals across thirteen cancer types at 99% specificity in individuals with cancer. Here, we report the interim results of a first large-scale prospective clinical study in an asymptomatic population with average risk of cancer, the JINLING Cohort (NCT06011694). Methods: This ongoing prospective clinical study is enrolling participants aged between 45 and 75 years old without cancer-related symptoms, initiated in June 2022. Each participant will undergo peripheral blood collection for CanScan test and annual routine physical exams once a year for three consecutive years, with an additional two years of follow-up. The primary objective of the study was to evaluate the diagnostic performance of the CanScan test in the early detection of multiple cancers. Secondary objectives include the evaluation of TOO accuracy, its efficiency and clinical utility, lead-time relative to clinical diagnosis, and participants' attitudes and adherence to this test compared to standard care screening methods. Results: By June 2023, a total of 3724 participants with analyzable samples were included in the analysis. At the data cut off time of Sept 2023, 29 participants were clinically diagnosed with cancer, including 8 that were not in the 13 targeted cancer types. The majority of the cancers were found in the early stages (Stage I or II; 89.6%, 26/29). The CanScan test detected a cancer signal at a sensitivity of 55.2% (16/29; stage I: 10/21, 47.6%; stage II: 4/5, 80.0%; stage III: 2/3, 66.7%). For detected cancers, the prediction accuracy of the top predicted origin was 61.5% (95% CI [38.5%,84.6%]; stage I: 62.5% [5/8]; stage II: 1/3, 33.3%; stage III: 2/2, 100%). The accuracy was 84.6% (95% CI [61.5%,100.0%]; I: 87.5% [7/8]; II: 66.7% [2/3]; III: 100.0% [2/2]) when taking into account the top two predicted origins. Specificity was 97.9% (3619/3695) in non-cancer participants. Conclusions: In this one-year interim analysis of the large-scale, prospective, clinical cohort study, we investigated the efficacy of the MCED test within an asymptomatic population with an average-risk of cancer. the CanScan test demonstrates capability in detecting a wide range of cancer types and predicting TOO at early stages, highlighting an exceptional level of sensitivity and accuracy while maintaining a high level of specificity. Therefore, the MCED test holds significant potential for early cancer screening in asymptomatic populations, potentially transforming preventative healthcare and improving patient outcomes. Citation Format: Shanshan Yang, Hua Bao, Xiaoxi Chen, Min Wu, Shiting Tang, Ruowei Yang, Dongqin Zhu, Xuxiaochen Wu, Wanxiangfu Tang, Shuang Chang, Peng He, Xiuxiu Xu, Ya Jiang, Shuyu Wu, Sisi Liu, Xian Zhang, Xue Wu, Yang Shao. Interim results from a large-scale, prospective cohort study (JINLING) for multi-cancer early detection test in average-risk asymptomatic patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1263.

EXPRESS: Effectiveness of HMG-CoA reductase inhibitors on inflammation and metabolic markers in the US-Mexico border Hispanic population.

HMG-CoA reductase inhibitors (statins) are commonly used for dyslipidemia management to reduce the risk of cardiovascular disease (CVD). High-sensitivity C-reactive protein (hs-CRP) is an emerging systematic low-grade inflammatory marker associated with atherosclerotic CVD development. Despite racial/ethnic disparities in the use and response of statins and the anti-inflammatory effects of statins, the effectiveness of statins on inflammation and metabolic markers is unknown among Hispanics. We performed a retrospective cohort study using 150 adult patients scheduled for an annual physical exam at a family medicine clinic between January 1, 2021, and December 31, 2021. Effect size with a 95% confidence interval (CI) was estimated using adjusted regression analyses. Among 150 patients, 52 (34.67%) received statins. Patients who received statins had significantly reduced median hs-CRP (1.9 vs. 3.2, p=0.007), mean low-density lipoprotein (LDL-C) (101.18 vs. 124.6, p<0.001), and total cholesterol (172.6 vs. 194.5, p<0.001) concentrations compared to those who did not receive statins. In the propensity-scores matched analysis, lower concentrations of log-transformed hs-CRP (regression coefficient [RC], -0.48; 95%CI: -0.89, -0.07), LDL-C (RC, -19.57; 95%CI: -33.04, -6.1), and total cholesterol (RC, -23.47; 95%CI: -38.96, -7.98) were associated with statin use. In addition, hepatic steatosis (adjusted relative risk [aRR]=0.25; 95%CI: 0.08, 0.78, p= 0.017) was significantly lower among patients with the use of statins. Our study suggests that HMG-CoA reductase inhibitors may help reduce inflammation among Hispanic patients with dyslipidemia and hypertension. These findings have useful implications for preventing risk and disparities associated with cardiovascular and other inflammatory-induced diseases among the fastest-growing US Hispanic minorities.

Abstract A002: Collaboration between the physician/researcher and patient/survivor is key

Abstract In May 2009, I went to see my primary care physician for a routine annual physical exam. I told her that I thought I was starting menopause. She did a typical physical including a pelvic exam and did not notice anything abnormal; but she decided to send me for a vaginal ultrasound. The ultrasound revealed that both my ovaries were massive. My physician sent me to my gynecologist for further follow up. My gynecologist advised me to have a complete hysterectomy and she had a CA-125 blood test done. It came back elevated. She told me I had ovarian cysts. A family friend, an OB-GYN, reviewed my test results and urged me to get a second opinion with a gynecological oncologist. Fortunately, I was able to see a Gyn-Onc who scheduled surgery. This doctor confirmed that I had complex ovarian cysts but could not determine if there was any malignancy until my surgery. Urging patients to see gynecological oncologists is one of the most important things that can be done to save women’s lives. During my debulking surgery it was discovered that I had High Grade Epithelial Ovarian Cancer. I started a six-month chemotherapy regime of Taxol and Carboplatin. It was hard on my body—I became anemic, required blood transfusions, had digestive problems, and experienced a level of fatigue that I never knew existed. Halfway through chemo I had genetic counseling and decided to take the BRCA1 gene mutation test. I tested positive—most likely because of my Eastern European Ashkenazi Jewish heritage. There is a history of breast cancer, pancreatic cancer, colon cancer and brain cancer in my family. Due to my BRCA1+ status I had a prophylactic mastectomy and breast reconstruction which took place in December 2010. Here is a video that I created to help bring awareness to the importance of genetic testing: https://youtu.be/Fm72svK2zKw I am a Research Advocate for OVCA patients and survivors. I participate in clinical trials. I teach yoga and mindfulness practices at retreats for cancer survivors. I participate in OCRA’s Survivors Teaching Students program at the University of Washington Medical School. I am a peer mentor for Imerman’s Angels, OCRA and Sharsheret. I serve as a Survivor Ambassador for: Clearity Foundation, Amy K. Rosenthal Foundation, Rivkin Foundation and Powell Drescher OVCA Research Foundation. I am a peer reviewer for the DOD’s Ovarian OCRP. In April 2023 I attended the Annual Meeting of American Association for Cancer Research as part of the AACR Scientist↔Survivor Program. During the poster sessions I met almost 100 researchers whose focus is Ovarian Cancer and only six of them had ever met an actual Ovarian Cancer patient/survivor. I want my survivorship to impact the discovery of effective tests for early diagnosis and treatment of OVCA. I believe that the collaboration between the physician/researcher and the patient/survivor will bring new solutions to dealing with an OVCA diagnosis and treatments. Citation Format: Deborah J. Binder. Collaboration between the physician/researcher and patient/survivor is key [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A002.