Objective To determine the incidence trend of 25-hydroxyvitamin D [25(OH)D] values >50 ng/mL and associated toxicity. Patients and Methods We conducted a retrospective, population-based study in Olmsted County, MN, from January 1, 2002 through December 31, 2011 (10 years) using the Rochester Epidemiology Project. Individuals were eligible if they resided in Olmsted County, MN, during the study period and had a measured 25(OH)D value >50 ng/mL (>125 nmol/L). The date of the first 25(OH)D value >50 ng/mL was considered the index date for incidence determination. Hypercalcemia, the primary vitamin D toxicity, was considered potentially associated with the 25(OH)D concentration if measured within 3 months of the 25(OH)D measurement, and such cases had medical record review. Results Of 20,308 total 25(OH)D measurements, 1714 (8.4%), 123 (0.6%), and 37 (0.2%) unique persons had 25(OH)D values >50, ≥80, and ≥100 ng/mL, respectively. The age- and sex-adjusted incidence of 25(OH)D values >50 ng/mL increased from 9 to 233 per 100,000 person-years from 2002 to 2011 (P<.001), respectively, and was greatest in persons of age ≥65 years (P<.001) and in females (P<.001). Serum 25(OH)D values were not significantly related with serum calcium values or with the risk of hypercalcemia. Medical record review identified four cases (0.2%) where 25(OH)D values >50 ng/mL were associated temporally with hypercalcemia, but only one had clinical toxicity associated with the highest observed 25(OH)D value of 364 ng/mL. Conclusion The incidence of 25(OH)D values >50 ng/mL increased significantly between 2002 and 2011, without a corresponding increase in acute clinical toxicity.

Objective To evaluate physician perceptions and attitudes toward telemedicine use at a tertiary care academic institution in Northeast Florida during the COVID-19 pandemic. Methods An anonymous 38-question cross-sectional survey was developed using Qualtrics and emailed to all staff physicians from all specialty disciplines at the Mayo Clinic Florida. The survey was open from August 17, 2020 through September 1, 2020. Collected data included general demographics and employment information, attitude and experience with telemedicine use before and during COVID-19, perception of patients’ experience, and the effect of telemedicine on burnout. Results The survey was distributed to 529 eligible physicians at our institution, with 103 physicians responding (19.5%). The distribution of specialties was 22.3% primary care specialties, 40.8% other internal medicine subspecialties, and 17.5% surgical specialties. Collectively, 63% found comparable quality of care when provided virtually (vs. in-person), while 80% perceived telemedicine as cost-effective. A total of 76% of physicians felt that telemedicine increased flexibility and control over patient-care activities, with 36% reporting improved work-life balance and 30% reporting improved burnout symptoms. Overall, 42% preferred using telemedicine over in-person visits when possible. Conclusions Physicians generally held positive attitudes regarding the adoption of telemedicine, and perceived that the quality of healthcare delivery as generally comparable to in-person care. Future studies are needed to explore attitudes regarding telemedicine after the pandemic, and how this virtual technology may be further utilized to improve physicians’ professional and personal well-being.

White patients with 25(OH)D values of less than 20 ng/mL had greater all-cause mortality than those with values of 20 to 50 ng/mL, and white patients had greater mortality associated with low 25(OH)D values than patients of other race/ethnicity. Values of 25(OH)D greater than 50 ng/mL were not associated with all-cause mortality.

Background: About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia. Objective: To determine predictors of improved outcomes following a multicomponent treatment program. Design: We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program. Setting: Tertiary care center. Patients: This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program. Intervention: An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention. Measurements: Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program. Results: The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up. Limitations: Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression. Conclusions: The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes. Registration: Specific registry and specific study registration number—Institutional Review Board—(IRB# 19-000495). Funding Source: No funding.