Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.

Background: Little research to date has examined the quality of data obtained from resident performance evaluations. This study sought to address this need and compared inter-rater reliability obtained from norm-referenced and criterion-referenced evalua-tion scaling approaches for faculty completing resident performance evaluations.Methods: Resident performance evaluation data were examined from 2 institutions (3 programs, 2 internal medicine and 1 surgery; 426 residents in total), with 4 evaluation forms: 2 criterion-referenced (1 with an additional norm-referenced item) and 2 norm-referenced. Faculty inter-rater reliability was calculated with intraclass correlation coefficients (ICCs) (1,10) for each compe-tency area within the form. ICCs were transformed to z-scores, and 95% CIs were computed. Reliabilities for each evaluation form and competency, averages within competency, and averages within scaling type were examined.Results: Inter-rater reliability averages were higher for all competencies that used criterion-referenced scaling relative to those that used norm-referenced scaling. Aggregate scores of all independent categories (competencies and the items assessing overall competence) for criterion-referenced scaling demonstrated higher reliability (z=1.37, CI 1.26-1.48) than norm-referenced scaling (z=0.88, CI 0.77-0.99). Moreover, examination of the distributions of composite scores (average of all competencies and raters for each individual being rated) suggested that the criterion-referenced evaluations better represented the performance continuum.Conclusion: Criterion-referenced evaluation approaches appear to provide superior inter-rater reliability relative to norm-referenced evaluation scaling approaches. Although more research is needed to identify resident evaluation best practices, using criterion-referenced scaling may provide more valid data than norm-referenced scaling.

User-chosen passwords reflecting common strategies and patterns ease memorisation but offer uncertain and often weak security, while system-assigned passwords provide higher security guarantee but suffer from poor memorability. We thus examine the technique to enhance password memorability that incorporates a scientific understanding of long-term memory. In particular, we examine the efficacy of providing users with verbal cues-real-life facts corresponding to system-assigned keywords. We also explore the usability gain of including images related to the keywords along with verbal cues. In our multi-session lab study with 52 participants, textual recognition-based scheme offering verbal cues had a significantly higher login success rate (94.23%) compared to the control condition, i.e. textual recognition without verbal cues (61.54%). When users were provided with verbal cues, adding images contributed to faster recognition of the assigned keywords, and thus had an overall improvement in usability. So, we conducted a field study with 54 participants to further examine the usability of graphical recognition-based scheme offering verbal cues, which showed an average login success rate of 98% in a real-life setting and an overall improvement in login performance with more login sessions. These findings show a promising research direction to gain high memorability for system-assigned passwords.

INTRODUCTION: The rate of burnout among residents has reached an alarming level and negatively impacts learning, attrition, and patient care. We implemented a comprehensive Surgery Resident Wellness Program in a large academic program and aimed to assess the degree this initiative improved resident burnout based on validated burnout and well-being models utilizing voluntary surveys. MATERIALS AND METHODS: A voluntary survey was sent to surgical residents and included the Maslach Burnout Inventory and The Psychological General Well-Being Index. These were graded according to the respective validated scale for each test. The survey was administered prior to establishing a wellness program, and at 6 month- and 24 month-intervals following its establishment. These data were analyzed using univariate analysis based on survey data from each of the time points. RESULTS: The survey had a 51% response rate. The baseline, 6-month, and 24-month mean scores for MBI personal accomplishment were 32.80, 32.91, and 35.57, emotional exhaustion was 23.48, 23.0, and 24.42, and depersonalization were 10.94, 9.54, and 11.11. Resident burnout was present in 16 of 31 (51.61%), 14 of 33 (42.42%), and 12 of 27 (44.44%) residents at each time point. The rate of change in resident burnout was -17.8% at 6 months and -13.9% at 24 months. The averaged PGWBI global scores were 66, 73, and 83 among the participants who took the survey at each time interval. CONCLUSIONS: Conclusion Implementation of a structured wellness program was associated with a decrease in resident burnout and an increase in overall resident wellness. (C) 2021 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.

Leonard, Grey MD; Cao, Jing PhD; Scielzo, Shannon PhD; Zheng, Yi BS; Tellez, Juan BS; Zeh, Herbert J. MD, FACS; Majewicz Fey, Ann PhD Author Information

OBJECTIVE: Resident well-being is an increasingly relevant issue in medical education; however, there is no consensus on how to best measure well-being. The "fuel gauge," is a simple, easy-to-use tool developed to measure resident well-being and previously applied in an Internal Medicine Residency Program at our institution. The current study sought to evaluate its acceptability and usefulness in a surgery program. DESIGN: Weekly fuel gauge data was retrospectively collected from August 2017 through December 2018 along with resident Postgraduate Year designations. SETTING: This study was conducted at a single, large general surgery residency program that rotates through a variety of hospitals, including a University hospital, a large county hospital, a Veterans Affairs hospital, and a freestanding Children's hospital. PARTICIPANTS: Categorical general surgery residents at every level of training as well as preliminary interns and off service intern rotators from urology, oral and maxillofacial surgery, and otolaryngology were eligible for the study. Fuel gauge submissions which did not denote a score were excluded from analysis. RESULTS: Out of 130 residents, 103 (79.2%) completed at least 1 fuel gauge assessment with a weekly mean response rate of 41.5%. Low scores were submitted by 39.8% of resident participants. Narrative feedback was provided in 6.2% of submissions with increased length associated with decreased fuel gauge score. CONCLUSIONS: The fuel gauge was well accepted by a large general surgery program with no decline in participation rates over the study period. The tool provided residents with a direct line of communication with their program's administration, and a feasible way for the program director's office to monitor and identify residents who were struggling with regard to their well-being. (C) Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.

710 Background: Oncologic treatment at National Cancer Institute (NCI) designated comprehensive cancer centers improves outcomes in a variety of malignancies. Racial disparity plays an important role in cancer outcomes and prognosis. Racial outcomes were compared in early stage colorectal cancer patients that presented to a comprehensive cancer center. Methods: This is a retrospective analysis on patients diagnosed with AJCC stage II or stage III colorectal cancer and underwent surgery or adjuvant chemotherapy within the University of Texas Southwestern and Simmons Comprehensive Cancer Center. Pertinent data points were abstracted from EMR including demographic data and dates of initial diagnosis, surgery, adjuvant chemotherapy, progression, and death. Results: Between 4/2011 and 11/2015, 203 patients were identified and 167 patients had complete follow up data available. Median age of cohort was 62 (range 21-90) and most of the patients were men (52.7%). Stage II comprised 44.3% of patients while 55.7% were diagnosed at stage III. One hundred and twenty patients (71.9%) were white, while 34 patients (20.4%) identified as black and the rest belonged to other races. Hispanic ethnicity was identified in 10.4% of patients. There was no significant difference between white and black cohorts between variables age (median 62 vs. 64.5 years; p = 0.44), gender (p = 0.43), and stage (p = 0.99) of colorectal cancer. Similarly there was no significant difference between white and black race in regards to days to surgery (median 17 vs 32 days; p = 0.53), first medical oncology appointment (30 vs. 34 days; p = 0.23) and days to adjuvant chemotherapy (42 vs 52 days; p = 0.24). The rate of recurrence (10.9% vs. 26%; p = 0.09), rate of death (14.1% vs 14.7%; p = 1.0), median relapse free survival (41.7 vs. 36.2 months; p = 0.173) and median overall survival (42 vs. 38.5 months; p = 0.491) from colorectal cancer were also not significantly different between white and black races. Conclusions: Oncologic treatment at NCI designated comprehensive cancer centers may lead to racial parity in colorectal cancer outcomes. Further research should be completed to compare these results to those seen at safety net hospitals.

708 Background: Colorectal cancer is the fourth most common cancer diagnosed in the United States and accounts for > 50,000 deaths nationwide annually. With data showing that oncologic treatment at National Cancer Institute (NCI) designated comprehensive cancer centers improves outcomes in a variety of malignancies, understanding the drivers behind this is vital to help bring the world-class care being administered at comprehensive cancer centers to underserved populations across the U.S. One component of colorectal cancer care that has a paucity of data afforded to it is the effect of increased time from diagnosis to surgery on survival. Methods: Patients diagnosed with AJCC stage II or stage III colorectal cancer between 4/2011 and 11/2015 and either underwent surgery or adjuvant chemotherapy within the University of Texas Southwestern system were selected. Several pertinent data points were abstracted via the EMR including date of diagnosis, surgery, adjuvant chemotherapy, progression, and death. A retrospective analysis was performed on the abstracted data to determine if the number of days between diagnosis and surgery was correlated with increased survival. Spearman coefficients were calculated to determine correlations between the data. All tests were two-sided. Results: Out of 203 patients identified, 113 patients had complete data available and were included in the study. The average age at diagnosis was 62.6 and average follow-up time was 41.4 months. Median time to surgery was 21 days (25th percentile-75th percentile: 4 – 53 days). There was a significant negative correlation between days from diagnosis to surgery and mortality (Spearman’s r = -.392, p < .001). Survivors had a mean of 42.7 days from diagnosis to surgery (SD = 56.4) and nonsurvivors had a mean of 61.7 days (SD = 46.9). Conclusions: There was a significant negative correlation seen in days between diagnosis and surgery and survival during the study period, which indicates that early surgical intervention may be an underappreciated indicator of quality colorectal cancer care. Further research should be conducted to better understand the relationship between early surgical intervention and prognosis in limited-stage colorectal cancer.

3605 Background: Ethnic disparities can impact clinical outcomes of young-onset colorectal cancer (CRC) patients. We aimed to determine if differences in outcomes based on ethnicity exist in young–onset CRC treated at an NCI-designated comprehensive cancer center program. Methods: A retrospective chart review for stage II – IV young-onset CRC patients ≤45 years old diagnosed between 04/2011 and 11/2015. Patients had to undergo treatment at safety-net Parkland Hospital (PH) or at the Simmons Comprehensive Cancer Center (SCCC) in Dallas, TX. Demographic data, dates of surgery, adjuvant chemotherapy, recurrence or death were obtained. Results: Of 123 patients that met inclusion criteria, 15 were excluded due to incomplete information. Of the remaining 108 patients, 36 (33%) and 72 patients (67%) were treated at SCCC and PH, respectively. Sixty (55%) were non-Hispanic vs 48 (44.4%) Hispanic. There were more Stage IV patients at SCCC vs Parkland (58.3% vs 30.6%, p < 0.01) but there was no difference regarding ethnicity. Also, no significant difference was seen between non-Hispanic White (NHW), Hispanic, and Black patients in median days to colectomy (1 vs 13 vs 0; p = .402) or adjuvant chemotherapy (55.5 vs 53.0 vs 64.0 days, p = .820). Hispanic patients had significantly better overall survival (OS) than Black or NHW patients (p = 0.025). The OS benefit was driven by improved 5-year OS in stage II/III Hispanic vs NHW vs Black patients (95% vs 62% vs 60%; p = 0.06). Multivariate Cox Regression analysis showed stage II/III (p < 0.001) and Hispanic ethnicity (p < 0.001) were independently associated with improved outcomes. Conclusions: In young-onset CRC treated at an NCI-designated comprehensive cancer center, Hispanic ethnicity had better OS than other ethnicities and this was largely due to better outcomes in stage II and III CRC. The causes for these ethnic differences in young-onset CRC patients needs further exploration. [Table: see text]

Background: Despite focus on increasing the quality of ambulatory education training, few studies have examined residents' perceptions of learning during case discussions with their preceptors (i.e., "check-out"). The objective of this study was to assess the difference between residents' and preceptors' perceptions of behaviors that should occur during check-out discussions. Methods: We conducted a cross-sectional survey of categorical internal medicine and family medicine residents and preceptors. The survey was distributed electronically and assessed 20 components of the check-out discussion. Results: Of 38 preceptors, 22 (61%) completed the survey. Of 172 residents, 82 (48%) completed the survey. For residents, we identified discrepancies in desired and perceived check-out behaviors. Specifically, utilizing a dependent sample t-test, residents felt that all 20 areas needed additional teaching during check-out (P < 0.05). Preceptors believed that demonstrating physical examination skills in the patient room during check-out was significantly more important than did residents (P = 0.01). Increasing years of preceptor experience did not statistically relate to their valuation of components important to residents. Discussion: Our research highlighted a major deficiency in training in the check-out process, with residents desiring more patient management education in all components. Moreover, faculty and residents do not necessarily agree with what is an important focus in the "teachable moment." Our results serve as a training needs assessment for future faculty development seminars and highlight the need to consider resident learning needs in general.

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.

Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.

The significance of delineating goals of care (GoC) for geriatric patients has been well known to the palliative care community but is a relatively new concept to burn surgeons. We surveyed palliative care specialists (PCS) and burn surgeons (BS) to elicit their attitudes regarding: 1) the importance of goal setting for burned seniors; 2) each specialty’s confidence in their own ability to conduct GoC conversations; and 3) their confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multi-center consortium dedicated to palliative care in the burned geriatric patient. The instrument draft was sent to burn and palliative care providers unaffiliated with the consortium for beta-testing. The finalized instrument was electronically circulated to all active physician members of the American Burn Association (ABA) and the American Academy for Hospice and Palliative Medicine (AAHPM). Surveys underwent review and approval by the research committees of each organization. Responses were received from 45 subjects categorized as BS (7.3%) and 244 PCS (5.7%). PCS rated being more familiar with GoC, were more comfortable having a GoC discussion with laypeople, were more likely to have reported high quality training in performing GoC conversations, believed more palliative care physicians were needed in ICUs, and had more interest in conducting GoC conversations relative to BS. Interestingly, both sets of physicians believed themselves to perform GoC discussions better than their peers perceived them to do so. In regard to perceptions of the best model for conducting GoC discussions, BS favored leading team discussions, where PCS endorsed both PCS and BS led discussions. Both also generally agreed that GoC discussions should occur with 72 hours of admission. PCS were more likely to have reported training in determining GoC in fellowship and on-the-job training, have fewer years of experience in their specialty, and less frequently deliver care to burned seniors relative to BS. Regarding work setting, BS reported working predominantly in academic private centers and academic safety net hospitals, and PCS representing a wider array of contexts. Both BS and PCS believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions on the optimal leadership of these discussions. A dichotomy of views regarding the roles and responsibilities of BS and PCS in the conduct of GoC discussions for burned seniors highlights the need for future work to inform best practices.

BACKGROUND:To optimize resident learning, programs need to readily assess resident well-being. There is a lack of easy-to-use, acceptable instruments for this task.OBJECTIVE:We created a well-being "fuel gauge," and assessed the acceptability and feasibility of this weekly electronic communication pipeline for residents to report and discuss their well-being.METHODS:A well-being fuel gauge assessment was administered weekly over the course of 1 academic year (July 2016 to June 2017) in a large internal medicine residency program. The well-being gauge asked residents to report their fuel levels using a 1 to 5 Likert-type scale (1, empty; 3, half tank; and 5, full tank). Residents who provided low scores (1 or 2) were contacted by program leadership, and the program director sent weekly e-mail updates that addressed residents' comments on their well-being fuel gauge.RESULTS:Of 163 residents, 149 (91%) provided data on their well-being fuel gauge, with a 53% average weekly response rate. Fifty-four percent of residents (80 of 149) reported a low score over the course of the year, and 4 residents only used the assessment to report a low score. Comments on average consisted of 280 characters (SD = 357) and were lengthier and more prevalent with lower fuel gauge scores. We analyzed the relationship between scores and comments.CONCLUSIONS:The well-being fuel gauge was well accepted by most residents and was easy to administer and to oversee by program directors. It facilitated ongoing monitoring of well-being and follow-up to address factors contributing to low well-being.

Clark, Audra T. MD; Scielzo, Shannon A. PhD; Abdelnaby, Abier A. MD; Farr, Deborah E. MD; Lefevre, Rachael BS; Bailey, Lisa W. BA; Kazi, Salahuddin MD; Abdel Fattah, Kareem R. MD, MD Author Information

—System-assigned random passwords offer security guarantees against guessing attacks but suffer from poor memo-rability. In this work, we review the cognitive psychology literature and identify two training methods appropriate to aid users in memorizing system-assigned passwords. The method of loci exploits users’ spatial and visual memory, while the link method helps users by creating a chain of memory cues. We developed techniques to automatically take a given random password and generate training aids (videos) based on each of these methods. The results of a memorability study showed that both methods were significantly better than a control condition (no training) and that the method of loci had a login success rate of 86%, a high value for any recall-based study with system-assigned passwords. With a registration time of 160 seconds and a median login time of 9 seconds, this method holds promise as a direction to addressing the usability-security trade-off in user authentication. We further extend this idea to help users memorize long system-assigned random passwords that offer almost crypto-level security and conduct a second memorability study. The results of this study demonstrated that with the help of a password hint, 81% of participants were able to recall the password after a week. This indicates that the method of loci can be leveraged to help users memorize cryptographically-strong secret in just one session, and thus offers a more viable alternative to the spaced repetition technique, which involves dozens of sessions of user training.

Introduction. Given the choice, users produce passwords reflecting common strategies and patterns that ease recall but offer uncertain and often weak security. Addressing this usability-security tension in user authentication remains the key research issue in password studies for decades. In our research, we aim to understand how humans’ cognitive abilities could be leveraged to design more secure and memorable authentication schemes. To achieve this goal, we draw upon multiple theories from cognitive psychology and implement them in the context of improving memorability for systemassigned random passwords. In this workshop, we would provide a clear picture on our findings about the impact of memory cues and user interaction on the memorability of system-assigned passwords. We have conducted several studies in last three years including both lab and field studies on different populations that accommodate young and senior users. The findings from our studies are promising and the experiences are worth sharing . Below, we provide an overview of our major contributions in improving the memorability of system-assigned random passwords:

Updates3 May 2016Update in Rheumatology: Evidence Published in 2015Shannon A. Scielzo, PhD, Langdon Stone, MD, and Salahuddin Kazi, MDShannon A. Scielzo, PhDFrom University of Texas Southwestern Medical Center, Dallas, Texas.Search for more papers by this author, Langdon Stone, MDFrom University of Texas Southwestern Medical Center, Dallas, Texas.Search for more papers by this author, and Salahuddin Kazi, MDFrom University of Texas Southwestern Medical Center, Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0223 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This update summarizes key articles in rheumatology published in 2015 that improve our understanding of systems-level barriers, identify new developments in high-value care, and describe treatment advances. PubMed searches were performed by using rheumatic disease keywords. We reviewed the abstracts retrieved by these searches and identified a core set of articles for detailed review. Articles were independently reviewed and selected on the basis of quality of the study methods and relevance to general internists.Eight articles that were selected by all reviewers are discussed. At the systems level, one study found that the scarcity of rheumatologists is generating a need ...Reference1. O'Dell JR, Mikuls TR, Taylor TH, Ahluwalia V, Brophy M, Warren SR, et al; CSP 551 RACAT Investigators. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013;369:307-18. [PMID: 23755969] doi:10.1056/NEJMoa1303006 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Southwestern Medical Center, Dallas, Texas.Disclosures: Dr. Kazi reports that he is the Chair of the Registries and Health Information Technology Committee for the American College of Rheumatology and a member of the ABIM Rheumatology Board. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=M16-0223.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.Corresponding Author: Shannon A. Scielzo, PhD, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9030; e-mail, shannon.[email protected]edu.Current Author Addresses: Drs. Scielzo, Stone, and Kazi: University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9030.Author Contributions: Conception and design: S.A. Scielzo, S. Kazi.Analysis and interpretation of the data: S.A. Scielzo, S. Kazi.Drafting of the article: S.A. Scielzo, L. Stone, S. Kazi.Critical revision of the article for important intellectual content: S.A. Scielzo, L. Stone, S. Kazi.Final approval of the article: S.A. Scielzo, L. Stone, S. Kazi.Statistical expertise: S.A. Scielzo.Administrative, technical, or logistic support: S.A. Scielzo.Collection and assembly of data: S.A. Scielzo, L. Stone, S. Kazi. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 3 May 2016Volume 164, Issue 9Page: W61-W64KeywordsAutoimmune diseasesBiologicsCohort studiesDisease modifying antirheumatic drugsElectronic medical recordsHyperlipidemiaPregnancyRheumatoid arthritisRheumatologyTumor necrosis factor ePublished: 3 May 2016 Issue Published: 3 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...