Background: Artificial intelligence (AI) is increasingly being integrated into healthcare, with applications ranging from predictive analytics to clinical decision support. In clinical nutrition, AI tools offer opportunities to improve workflow efficiency, enhance dietary assessment, and personalize nutrition care. Despite growing interest, little is known about registered dietitian nutritionists' (RDNs) perceptions of AI in clinical practice. The aim of the present study was to assess RDNs' attitudes toward AI use within a large healthcare system, along with their perceived barriers in this regard. Methods: A cross-sectional survey was developed through expert review and distributed electronically via REDCap to RDNs across Mayo Clinic's academic campuses and affiliated health system sites. The 23-item survey included Likert-scale items addressing AI's potential utilization within clinical care, perceived benefits and risks, and readiness for adoption. Responses were summarized using descriptive statistics. Factor analysis identified underlying constructs related to AI attitudes. Differences stratified by age and years of experience were evaluated using ANOVA. Results: Of the 185 RDNs invited, 64 (35%) responded. Two factors emerged: optimism regarding AI usage (Cronbach's α = 0.94) and skepticism about implementation (α = 0.76). The overall mean ± SD score for optimism was 0.1 ± 0.6 (neutral), while skepticism averaged 1.0 ± 0.6 (moderate). Skepticism differed by years of experience (p = 0.012), with the lowest levels observed among RDNs with ≥21 years of practice. No significant differences were observed across age groups. Discussion: RDNs demonstrated neutral attitudes toward AI use but expressed concerns about accuracy, training, and implementation challenges. Addressing these concerns through education and structured implementation strategies may facilitate successful adoption of AI in dietetic practice.

Background Anesthesia-specific milestone evaluations are intended to objectively assess performance in ACGME core competencies for anesthesiology residents. Recent reports in several medical specialties have documented differences in resident evaluations based on gender.Objective We studied the impact of faculty and resident gender on milestone evaluations during Anesthesiology residency.Design This was a retrospective analysis of 20,570 anesthesiology resident milestone evaluations from a single institution over a 7-year period during the ACGME milestones 1.0 time frame. Standardized scores were analyzed using a linear mixed model.Results 170 anesthesiology residents were evaluated by 194 faculty. For CA1 evaluations, mean standardized milestone scores for the core competencies of professionalism (p = 0.002) and interpersonal/communication (p < 0.001) and for overall assessment (p = 0.009) were dependent on faculty gender. For CA2 evaluations, regardless of the evaluator gender, the mean standardized milestone scores for many individual core competencies were significantly higher for female residents compared to male residents. For CA3 evaluations, mean standardized milestone scores did not differ significantly between male residents and female residents for any core competency, however overall assessment scores were dependent on faculty gender with male faculty scoring male residents more highly and female faculty scoring female residents more highly (p < 0.001).Conclusions We observed an association between faculty gender and milestone evaluation scores of residents that was most evident for CA1 residents. We also observed the overall assessment scores for male and female residents were significantly influenced by the gender of the faculty evaluator. Further work is required to better understand and mitigate gender bias to promote equity in resident assessment.

We examined if midazolam premedication via oral (PO) vs. intravenous (IV) route in pediatric patients was associated with risk for deep sedation in the postanesthesia care unit. Medical records from May 2018 to December 2023 of patients aged 2–17 years premedicated with midazolam were reviewed and stratified according to administration route. Sedation level was classified using the Richmond Agitation–Sedation Scale: deeply sedated (≤ − 4) or not (≥ − 3). Inverse probability of treatment weighting (IPTW) analysis was performed to assess whether midazolam administration route was associated with postoperative deep sedation. Among 5245 pediatric patients, 608 (11.6

Purpose While the clinical utility for Point-of-Care Ultrasound (POCUS) is well-established through its use in clinical practice to enhance diagnostic accuracy, expedite care, and improve patient interactions/communication, its impact on patient experience in outpatient consultative settings remains largely underexplored. We sought to evaluate patients’ experience and satisfaction by incorporating POCUS use during outpatient consultations. Methods In this prospective, cross-sectional survey study conducted in a consultative outpatient internal medicine practice, a continuous sample of 100 patients undergoing POCUS during routine medical evaluations participated. We assessed patient perspectives using a survey that was adapted from validated instruments. The following items were evaluated using the anonymized survey: the extent of patient understanding, the integration of POCUS into the consultation, its impact on patient-doctor communication, perceived quality of care, and overall patient experience. Results Most respondents felt better informed about their health (88%), more thoroughly examined (94%), and reported improved confidence in their physician’s assessment (92%) after the POCUS exam. In addition, POCUS was perceived as a natural part of the consultation (95%) and minimally burdensome (93%). Overall, 96% of study respondents agreed that POCUS improved their quality of care, and 98% described their experience as positive or very positive. Open-ended comments emphasized the immediacy of results, enhanced communication, and cost-effectiveness of the POCUS experience. Conclusion Incorporating POCUS in this environment improved patients’ perceptions of their physician, clinic, and overall care. These findings support the broader adoption of POCUS in similar clinical settings and its potential impact on healthcare delivery and patient satisfaction.

BACKGROUND:Oral mucositis (OM) pain in patients undergoing cancer treatments remains inadequately managed with conventional treatments. This study aimed to examine pain outcomes associated with methylene blue (MB) mouthwash compared with a standard supportive care mouthrinse in hospitalized patients with OM. METHODS:In this open label, non-randomized clinical trial, patients selected MB (0.05%) or standard-of-care mixed medication mouthwash. Both groups performed an oral rinse every 8 h for three days. The primary outcome was change in pain numeric rating scores (0-10) from pre-administration to post-administration. Secondary outcomes included changes in daily oral intake volume and opioid use. RESULTS:Forty-three evaluable patients were included in the analysis. Using a linear mixed model with subject-specific intercepts, both treatment groups demonstrated statistically significant reductions in pain from pre- to post- administration (standard of care: estimate=-0.64, 95% CI [-1.23, -0.05], p = 0.034; MB estimate=-0.87, 95% CI [-1.31, -0.42], p < 0.001). The administration timing-by-treatment interaction effect was not statistically significant, indicating that pain reduction did not differ significantly between groups. CONCLUSIONS:In this non-randomized study, MB mouthwash was associated with short-term pain reductions in OM-related pain similar to standard-of-care mouthwash. These findings support feasibility and tolerability and underscore the need for larger randomized trials.

BackgroundPostoperative respiratory depression (PRD) is potentially preventable yet remains difficult to preemptively detect. We evaluated whether three post anesthesia care unit (PACU) events-oversedation, caffeine administration for impaired arousal, and naloxone administration-can serve as early markers of delayed PRD requiring naloxone administration on wards.MethodsWe retrospectively identified patients who underwent general anesthesia between 2018 and 2023 at a quaternary care academic medical center. From electronic medical records, we retrieved PACU naloxone and caffeine treatments, scores of sedation assessments using the Richmond Agitation-Sedation Scale (RASS), and ward naloxone administrations within 24 hours after PACU discharge.ResultsAmong 95 870 patients, 186 (0.19%, 95% CI 0.17-0.22) required naloxone for respiratory depression after PACU discharge. Ward naloxone administration was independently associated with naloxone (OR 9.11, 95% CI 4.69-17.71, P < 0.001) and caffeine (OR 2.00, 95% CI 1.21-3.32, P = 0.007) administrations, and with PACU RASS scores ≤ -3 (OR 2.16, 95% CI 1.56-2.99, P < 0.001).ConclusionsNaloxone administration in PACU was the strongest predictor of delayed PRD, followed by oversedation and PACU caffeine administration, indicating that information routinely collected during PACU recovery may offer insight into delayed respiratory risk before transition to hospital wards. In light of the overall low incidence of ward naloxone use, these findings support selective, risk-based vigilance for patients exhibiting these PACU events rather than broad adjustments to existing monitoring practices.

Objectives Long-term symptoms following infection with acute respiratory syndrome coronavirus-2 (SARS-CoV-2), termed post-acute sequelae of SARS-CoV-2 infection (PASC) or Long COVID (LC), persist beyond 90 days and may impact at least 10% of patients with acute infection. The exact cause of LC remains unknown, but several theories include persistent viral particles, immune dysfunction, and autonomic nervous system (ANS) imbalance, particularly involving the vagus nerve. Given the role of the vagus nerve in inflammation regulation, vagal nerve stimulation (VNS) is being explored as a treatment option. The present study aimed to evaluate the feasibility, safety, and exploratory effects of a handheld external transcutaneous cervical non-invasive VNS (tcVNS) on the primary endpoint of Post-COVID Functional Status (PCFS) grade, alongside secondary outcomes such as LC-related fatigue and other symptoms. Methods Participants from our Post COVID Care Clinic were randomized into treatment (tcVNS treatments two minutes, three times a day) and control (no VNS) groups for a study period of 12 weeks. Participants completed validated questionnaires, PET-CT scans, and inflammatory cytokines at baseline and 12 weeks. Results All randomized patients (8 tcVNS, 10 control) completed the 12-week study. Participants randomized to tcVNS were observed to have improvements in PHQ-9, PROMIS-F, and COMPASS-31 when compared to controls, but these differences were not statistically significant. Cortisol and DHEA were also observed to increase less in the tcVNS group when compared to the control group, but these changes were also not statistically significant. Conclusions tcVNS was well tolerated and may be a promising therapeutic approach for LC, a chronic disease with no approved treatments and very low rates of complete recovery.

OBJECTIVE:To determine the incidence and predictors of severe postoperative hypotension (SPOH) among patients in general care wards. PATIENTS AND METHODS:We performed a retrospective study of adult patients who underwent general anesthesia at Mayo Clinic between May 5, 2018, and December 31, 2020, and were discharged from the postanesthesia care unit (PACU) to general care wards. Multivariable logistic regression models were used to identify potential predictors of SPOH (defined as mean arterial pressure [MAP] ≤55 mm Hg within 48 hours after a surgical procedure that resulted in rapid response team activation or advanced interventions). RESULTS:Among 23,656 eligible patients, 172 (0.7%; 95% CI, 0.6-0.9) had SPOH. Independent predictors included lower body mass index (OR, 0.83 per 5-unit increase; 95% CI, 0.73-0.95; P=.006), longer procedure duration (OR, 1.14 per 1 hour; 95% CI, 1.07-1.22; P<.001), and intraoperative blood transfusion (OR, 4.32; 95% CI, 2.92-6.38; P<.001). A significant interaction was observed between preoperative and lowest PACU MAPs (P=.04); SPOH risk was highest for patients with low preoperative and PACU MAPs. Patients with a preoperative MAP of 70 mm Hg or less and a PACU MAP of 60 mm Hg or less had 9.84-fold higher odds of SPOH (reference, 93.3 mm Hg). CONCLUSION:Lower preoperative and PACU MAPs are associated with higher odds of SPOH. These findings highlight the need for greater postoperative surveillance of surgical patients with low perioperative blood pressure.

BACKGROUND:Opioids exert important negative effects on respiration, evident across a range of behaviours. The present study evaluated whether fentanyl administration decreases diaphragm muscle forces across levels of inspiratory loading in adult patients undergoing elective knee arthroplasty surgery. METHODS:Adult patients undergoing elective knee arthroplasty with no pulmonary pathology were randomly assigned to a fentanyl dose (25, 50, or 100 μg) in a double-blind, single-institution clinical trial. Ultrasound-based shear wave elastography was used to measure diaphragm Young's modulus (E). The primary outcome was change in the difference in E achieved across levels of inspiratory loading (E range) before randomisation and 10 min post-fentanyl (ΔE range) as a measure of fentanyl-induced changes in diaphragm force-generating capacity. RESULTS:Sixty-nine patients (average age 69 yr) were randomised, with final data analysis in 22, 22, and 19 patients from the 25, 50, and 100 μg groups, respectively. The ΔE range was compared across dose groups using analysis of covariance, with the pretreatment E range included as the covariate. The estimated treatment effect (95% confidence interval) for 50 μg vs 25 μg, and for 100 μg vs 25 μg was -0.7 (-9.5, 8.1) and -5.3 (-14.1, 3.6), respectively. There was no statistically significant effect of fentanyl on ΔE range (P=0.432). CONCLUSIONS:Fentanyl did not reduce the E range generated by the diaphragm muscle during inspiratory pressure-threshold loading, possibly reflecting relatively low levels of inspiratory loading or the presence of a fentanyl effect even at the lowest dose used (25 μg) in this older patient population. CLINICAL TRIALS ID:NCT05856136.

Background:Remimazolam is increasingly used for procedural sedation and anaesthesia, yet real-world data across diverse clinical environments remain limited. Methods:We conducted a retrospective cohort study of all patients receiving remimazolam in a multisite US academic health system between 1 June 2021 and 29 February 2024. The primary outcome was patterns of remimazolam use, including recovery characteristics (time to return to baseline Richmond Agitation-Sedation Scale [RASS] score and PACU discharge readiness times). Secondary outcomes included flumazenil use and the incidence of critical events such as allergic reactions, cardiorespiratory depression, or death. Associations were analysed using linear mixed models and reported as geometric mean ratios (GMR) with 95% confidence intervals (CIs). Results:The cohort included 8011 patients undergoing 9431 procedures (median age 67 yr, inter-quartile range [IQR] 56-76), 85.2% of whom were ASA Physical Status ≥3. Most procedures (70.5%) occurred outside the operating room. Median remimazolam dose was 12 mg (IQR 8-20). Median time to baseline RASS was 13 min (IQR 5-30), and median PACU discharge readiness time was 30 min (IQR 15-55). In cardioversion cases, flumazenil use was associated with shorter PACU discharge readiness time (adjusted GMR 0.83, 95% CI 0.75-0.93; P<0.001) and shorter time to baseline RASS (adjusted GMR 0.63, 95% CI 0.48-0.83; P<0.001). Higher remimazolam dose was associated with longer recovery times (P<0.001), with a plateau observed above approximately 18 mg. Critical events occurred in 0.7% of procedures, including four possible IgE-mediated reactions (0.04%). Conclusions:In this large multicentre cohort, remimazolam was associated with rapid recovery and low rates of serious adverse events across diverse procedural settings and patient acuity levels.

Objective Reference values of regional cerebral oxygen saturation (rScO2) in preterm neonates across gestational age (GA) groups remain undefined. This study aimed to establish rScO2 references for neonates born before 32 weeks of gestation.Design A prospective observational cohort study.Setting Large tertiary neonatal referral centre in Croatia.Patients Preterm neonates without major comorbidities born between 2018 and 2022 with normal cranial ultrasound findings.Interventions rScO2 was assessed with near-infrared spectroscopy (NIRS) using neonatal sensors.Main outcome measures The primary analysis provided rScO2 reference ranges for the entire preterm neonatal cohort, followed by stratified analyses based on GA: extremely preterm, <28.0 weeks; very preterm, 28.0–30.0 weeks; and very preterm, 30.1–32.0 weeks. Quantile regression was used to estimate the selected rScO2 percentiles (5th, 10th, 50th, 90th and 95th) from 6 to 72 hours after birth.Results 114 neonates with median (IQR) GA of 29.9 (29.1–31.5) weeks were included: 22% were EP<28w, 29% were VP28–30w and 49% were VP>30–32w. The median rScO2 was 75.6% at 6 hours, 79.5% over the first 24 hours and exceeding 80% in the subsequent 48 hours. When analysed separately, notable differences emerged across prematurity categories, with the highest median rScO2 observed in the VP>30–32w group. Supplementary analyses, comparing rScO2 values across the three GA groups, revealed significant differences at 48 and 72 hours. The majority of the estimated rScO2 fifth percentiles between 6 and 72 hours were in the range ≥60%, with a single lowest estimate of 56.3% at 6 hours in the EP<28w group. Thus, for all subgroups, the estimated fifth percentile of rScO2 was above the brain hypoxic threshold.Conclusions The use of age-appropriate neonatal NIRS sensors provided the rScO2 reference values for very and extremely preterm neonates without major comorbidities 6–72 hours after birth.

Introduction: Butyrophenones are effective prophylactic drugs against postoperative nausea and vomiting (PONV). Our practice used droperidol for PONV prophylaxis until supply chain issues in 2020 required a substitution to haloperidol. Objective: To compare the use of these two butyrophenones and their association with the magnitude of reduction PONV and sedation during admission to postanesthesia care unit (PACU). Methods: Retrospective review of the records of adult surgical patients administered a butyrophenone and admitted to the PACU, from May 2018 through December 2022. PONV was defined as administration of rescue antiemetics during PACU admission. Inverse probability of treatment weighing (IPTW) analysis was performed using generalized estimating equations with robust variance estimates to assess the effects of droperidol and haloperidol on PONV rate. Results: We identified 905 (2018 – 2020) and 651 patients (2020 – 2022) receiving droperidol or haloperidol, respectively. The IPTW PONV rate was 75 (8.3%) for droperidol and 84 (12.9%) haloperidol (odds ratio 0.60; 95% confidence interval 0.41 to 0.87, for the use of droperidol vs haloperidol). Moderate or higher levels of sedation (Richmond Agitation Sedation Scale score ≤ -3) was noted in 163 (18.0) of droperidol and 102 (15.7%) of haloperidol patients, which was nonsignificant, P=0.222, following IPTW adjustment, P=0.269. Median [interquartile range] PACU length of stay was comparable for two butyrophenones, 70 [51, 99] vs. 68 [48, 105] minutes for droperidol vs haloperidol, respectively, P=0.647. Conclusion: Droperidol was associated with lower rates of PONV during PACU admission than haloperidol, but the rate of sedation was higher.

OBJECTIVE:Postoperative nausea and vomiting (PONV) is a frequent adverse event after bariatric surgery and is associated with patient dissatisfaction and increased health care burden. Aggressive multimodal antiemetic prophylaxis and the use of propofol infusion during anesthesia are associated with the reduction of PONV. In this study, we examined the use of rescue antiemetics following bariatric surgery performed with 3 different anesthetic strategies designed to reduce PONV: (1) primary volatile (VOL) anesthetic and propofol (PROP) infusion (VOL+PROP), (2) volatile anesthetic with propofol and dexmedetomidine (DEX) infusions (VOL+PROP+DEX), or (3) opioid-sparing total intravenous anesthesia (PROP+DEX). METHODS:In this retrospective observational study, we included patients undergoing bariatric surgery from 2018-2022 who received 1 of 3 anesthetics: (1) VOL+PROP, (2) VOL+PROP+DEX, or (3) opioid-sparing PROP+DEX without a VOL. Inverse probability of treatment weighting analysis determined the association between the need for rescue-antiemetics in the postanesthesia care unit (PACU) and following PACU discharge. RESULTS:Three hundred thirty-two patients received VOL+PROP, 354 VOL+PROP+DEX, and 166 PROP+DEX, and all received prophylactic antiemetics during surgery. After surgery, the PROP+DEX patients received fewer rescue antiemetics in the PACU compared with VOL+PROP (11% vs. 24%, P =0.002), and VOL+PROP+DEX fewer compared with VOL+PROP (16% vs. 24%, P =0.023). This differential antinausea effect was limited to PACU stay only. Rescue antiemetic use increased across all anesthetic management groups following PACU discharge until midnight on the day of surgery (ranging from 38% to 46% across groups, P =0.71) and through the first postoperative day (ranging from 47% to 57% across groups, P =0.20). CONCLUSIONS:The benefit associated with anesthetic strategies designed to reduce PONV was present but did not persist past PACU discharge. This finding suggests that aggressive perioperative multimodal antiemetic prophylaxis combined with anesthetic strategies designed to prevent PONV after bariatric surgery have only a short-lived effect, thus health care staff in hospital wards may expect to encounter high rates of PONV in these patients. There is a need for the development of novel antinausea treatments to reduce the rate of this frequent postoperative complication.

Purpose: In this study, we compare the use of rescue antiemetics in transgender and gender-diverse (TGD) patients undergoing gender-affirming surgical procedures with cisgender patients undergoing matching procedures. Methods: TGD patients undergoing facial feminization, genitourinary, or chest procedures between 2018 and 2023 were matched to cisgender men and women controls (only women for chest/breast procedures) using age, smoking status, surgical duration, and year of surgery to compare the use of rescue antiemetics in the postanesthesia recovery room. Analyses were performed using generalized estimating equations with robust variance estimates to assess whether TGD patients' risk for receiving rescue antiemetics differed from matched cisgender controls. Results: We identified 397 TGD patients assigned male at birth (AMAB) and 194 TGD patients assigned female at birth (AFAB) undergoing gender-affirming surgery. Regardless of gender identity, AFAB patients received more prophylactic antiemetics than AMAB patients. Both unadjusted and adjusted (for patient and procedural variables) analyses failed to find evidence that the need for rescue antiemetics differed between matched cisgender and TGD patients (p > 0.41 for all unadjusted and p > 0.34 for all adjusted comparisons). Conclusion: When compared to matched cisgender controls, TGD patients undergoing gender-affirming procedures did not have a higher risk of needing postoperative rescue antiemetic therapy.

Objective: This study evaluated the feasibility and satisfaction of using a wearable brain activity sensing device for stress reduction among patients experiencing Long COVID (LC). Patients and Methods: Patients with LC (N = 45) were invited to participate in an open-label pilot study. Participants were asked to use a brain-sensing electroencephalogram (S-EEG) wearable device (Muse-S™) daily for 90 days and followed for an additional 90 days (180 days total participation). Study enrollment began June 28, 2022, and ended July 28, 2023. Results: Patients were predominantly female (82%), white (96%), and with an average age of 47.6 (±12.5) years. At the end of treatment (90 days), cognition, sleep, self-efficacy, and quality-of-life quality of life improved ( P < .001 to P = .04). In addition, stress and anxiety were significantly reduced ( P < .001). These significant changes persisted by end-of-study (180 days). For stress ( P = .023) and anxiety ( P = .033), a change from the baseline during follow-up was significantly associated with the amount of S-EEG usage. The end-of-study satisfaction survey indicated that patients were very satisfied with the S-EEG device, and 97% planned to continue using it. Conclusion: Results suggest that the S-EEG device improved cognition in LC, which is one of the main severe symptoms we see in our LC clinic. In addition, it helped reduce stress and anxiety. These findings have important clinical implications for LC patients using S-EEG as an adjunct to concurrent LC clinical care which includes pharmacotherapies.

Background: COVID-19 convalescent plasma (CCP) is obtained from people recently recovered from COVID-19 and contains viral-neutralizing antibodies. Because such treatment is safe and effective against SARS-CoV-2, the US Food and Drug Administration (FDA) has recently authorized the use of CCP for COVID-19 patients with immunodeficiencies. Currently available CCP is a ″hybrid″ product with antibodies from individuals who had both infection and vaccination (vaccine-boosted CCP). In this context, there is growing interest in CCP treatment outcomes in specific groups of immunocompromised patients. Specifically, B-cell depleted patients are at risk of not producing antibodies after either infection or vaccination. Hence, B-cell depleted patients are conceivably among those who would benefit the most from CCP. We thus conducted a systematic review and individual patient data meta-analysis to assess characteristics associated with 60-day survival in B-cell depleted patients transfused with CCP. Methods: The last search was April 2nd, 2024, and included all studies using CCP in B-cell depleted patients. Whenever not available in the publication, we requested individual participant data from corresponding authors of eligible studies. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Tools. Data were analyzed using conditional logistic regression. Results: We describe individual patient data extracted from 85 studies and synthesized into a cohort of 570 patients. The overall 60-day survival rate was 86.5%. Of patients with information available, 70.1% achieved SARS-CoV-2 clearance, and 64.3% had clinical improvement within 5 days of CCP transfusion. After controlling for age, sex, calendar year of infection and World Health Organization (WHO) disease severity, we found a significant association between 60-day survival and days since last anti-CD20 dose (OR=1.16 per 10-day increase; 95% CI 1.04 to 1.29; p=0.007) and transfusion of vaccine-boosted CCP (OR=9.49; 95% CI 2.01 to 44.82; p=0.005), but not with concomitant remdesivir treatment (OR=1.31; 95% CI 0.66 to 2.61; p=0.440). Discussion: Our study is limited to individual participant data analysis, with a majority of the studies included being case series and case reports. Overall survival in our cohort of B-cell depleted patients was consistent with prior meta-analysis of randomized controlled trials on survival of immunocompromised patient transfused with CCP (~84%). A novel finding from this analysis is that vaccine-boosted CCP with a presumably higher content of neutralizing antibodies is associated with a high survival benefit. Registration: The protocol for this systematic review and individual participant data meta-analysis was registered with PROSPERO (CRD42024516513) on March 1st, 2024. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The authors report no funding beyond support from their home institutions. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used openly available participant data from included studies. The study was determined by the Mayo Clinic Institutional Review Board as exempt. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data presented in the study are available upon reasonable request to the authors.

People living with dementia have high rates of emergency department (ED) use and hospitalizations. Identifying factors that influence acute care utilization is important. We examined the influence of physical activity levels on risk of hospitalization and emergency department (ED) use in a population of older people living with mild cognitive impairment (MCI) or dementia. We included people with a diagnosis of MCI or dementia followed in Community Internal Medicine at Mayo Clinic, age 55 years and older, who had a clinic visit between June 1, 2019 and June 30, 2021 and had completed a social determinants of health questionnaire about physical activity levels. Physical activity was classified based on responses to questions about time spent exercising per week and rated as sufficiently active (≥150 minutes per week), insufficiently active (10-140 minutes) or physically inactive (0 minutes). The risk of hospitalization and ED visits across physical activity levels was examined using quasi-Poisson regression and presented as rate ratios (95% confidence interval (CI)), with adjustment for demographics, Charlson Comorbidity Index, marital status, living arrangement and body mass index. A total of 3090 persons living with MCI (n = 1308) or dementia (n = 1782) were included. People who were physically inactive were more likely to be older, female, not married, obese, have higher comorbid burden and a dementia diagnosis (p<0.001). Hospitalization and ED visit rates in those who were physically inactive were approximately double the rates for the sufficiently active group (p<0.001). Compared with those who were sufficiently active, people who were physically inactive had a significantly higher risk of hospitalization (rate ratio 1.73, 95% CI 1.30-2.31) and ED visits (rate ratio 1.59, 95% CI 1.26-2.01). Physical inactivity in older people living with MCI or dementia is associated with an increased risk of ED visits and hospitalization. Targeted physical activity interventions could potentially impact on acute care utilization in this population. Our findings emphasize an area for public health promotion in people living with MCI or dementia.

OBJECTIVES:To investigate the association between hormone therapy use and severe outcomes due to COVID-19 in perimenopausal and postmenopausal women. METHODS:Using the Rochester Epidemiology Project, we retrospectively searched for the records of women aged 40-65 years who had a documented case of COVID-19 between March 12 and September 29, 2020. We further identified those who were perimenopausal or postmenopausal. The rates of emergency department visits, hospitalizations, and deaths were compared by hormone therapy use. Logistic regression models were used to assess the odds of the combined outcome based on hormone therapy use. RESULTS:Among the 689 patients included in this study, the median age was 56 years, and 77.5% were White. Compared with patients currently using hormone therapy, those with past/never use of hormone therapy were significantly older, had more risk factors for severe COVID-19, and had a higher incidence of diabetes. A total of 102 emergency department visits/hospitalizations/deaths occurred among both groups. Participants with current hormone therapy use had similar rates and risk of emergency department/hospitalization/death outcomes as those without hormone therapy, even after adjusting for age and severe COVID-19 risk factors. CONCLUSIONS:Severe COVID-19 outcomes were not significantly different between women with current versus past/never use of hormone therapy. Our study adds to the data suggesting no harm with hormone therapy use in women with severe symptoms of COVID-19.