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Exploring the Link Between Inflammatory Bowel Disease and Chronic Kidney Disease: A Nationwide Database Study.
No full textIncreasing Genetic Testing Uptake Through Workflow Optimization: A Quality Improvement Study in Pediatric Hearing Loss.
No full textBACKGROUND/OBJECTIVES: Although genetic testing is recommended for pediatric hearing loss, referral rates within otology and audiology practices remain low. This study evaluated referral rates, referral pathways, and genetics appointment completion before and after implementation of a quality improvement (QI) referral protocol in an ethnically diverse pediatric cohort.
METHODS: Phase 1 (January-August 2023) included chart reviews of 88 pediatric patients with hearing loss to assess whether genetics referrals were made and completed. Data collected included demographics, referral modality (clinical note documentation, routed note to genetics, or direct referral order), and appointment status. In Phase 2 (September 2023-September 2024), a standardized referral protocol was implemented requiring all newly diagnosed patients to be referred using one of three predefined pathways. Providers received brief training and reminder cards. Chart reviews were then conducted for an additional 114 patients.
RESULTS: A total of 202 patients were included (Phase 1:
CONCLUSIONS: Genetic referrals for pediatric hearing loss remain underutilized but improved substantially following implementation of a standardized referral protocol. These findings highlight the importance of optimizing referral pathways and providing ongoing provider education. QI initiatives represent a practical strategy to enhance access to genetic evaluation and support precision care
Glucagon-like peptide 1 receptor agonists and the risk of developing malignancies of the liver.
No full textA Systematic Review and Meta-Analysis of Breast Arterial Calcification and Its Association with Cardiovascular Disease and All-Cause Mortality.
No full textBreast arterial calcification (BAC), detected on routine mammography, is the calcification of medial arteries. BAC has been suggested to be linked to cardiovascular disease (CVD) risk. A systematic search was done that identified studies examining BAC, CVD risk factors (diabetes, hypertension, dyslipidemia, smoking, obesity), cardiovascular outcomes [stroke, myocardial infarction (MI), heart failure (HF), cardiac mortality], and all-cause mortality. Additionally, an atherosclerotic CVD (ASCVD) composite outcomes including MI, stroke, and cardiac mortality was analyzed. A random-effects model was used to calculate risk ratios (RR) and odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with Q values and I2 statistics. 45 studies were included in the final meta-analysis, representing 68,584 women. BAC prevalence was 17.1%. Among cross-sectional studies, BAC was associated with diabetes (OR 1.97, 95%CI: 1.71-2.27, I2= 70.78%), hypertension (OR 1.82, 95% CI: 1.52-2.18, I2=88.3%), and hyperlipidemia (OR 1.24, 95% CI: 1.06-1.45, I2= 76.4%). BAC was negatively associated with smoking (OR 0.50, 95% CI: 0.41-0.61, I2=78.4%). BAC was associated with known CVD (OR 2.71 95% CI: 2.13-3.45, I2 = 76.7%). Among cohort studies, BAC was associated with incident stroke (RR 2.05, 95%CI: 1.58-2.65, I2=50.8%), HF (RR 2.14, 95%CI: 1.38-3.32, I2= 87.1%), cardiac death (RR: 2.94, 95%CI: 1.32-6.54, I2= 72.7%), ASCVD (RR 1.58 95% CI: 1.23-2.04 I2 =81.9%) and all-cause mortality (RR 2.04, 95%CI: 1.08-3.84, I2= 96.78%). Significant interstudy heterogeneity in this meta-analysis is a limitation on confidence in the pooled results. In conclusion, BAC observed on mammography may serve as a marker for increased CVD risk and mortality in women; however, future research is needed to standardize BAC assessment and confirm its clinical utility in CVD risk stratification
Learning From Our Failures: When Anterior Temporal Lobectomies Fail.
No full textAnterior temporal lobectomy (ATL) remains the standard surgical treatment for drug-resistant temporal lobe epilepsy, yet 20% to 30% of patients experience persistent seizures and/or unfavorable neuropsychological outcomes. These results highlight that postoperative success is influenced not only by the technical execution of surgery but also by the accuracy with which epileptogenic networks are characterized. As such, we consider ATL failure through 2 broad mechanisms: incomplete treatment of the presumed epileptogenic network and limitations in the initial diagnostic understanding of the epileptogenic network. It is also becoming more evident that seizure outcomes alone do not fully capture surgical success, as cognitive, psychiatric, and functional consequences play a critical role in long-term quality of life. Drawing on contemporary evidence and discussions from the Temporal Lobe Club Special Interest Group at the 2025 American Epilepsy Society Annual Meeting, we present a framework for conceptualizing, reevaluating, and managing patients following ATL failure
Postdischarge Follow-Up of Infants With Congenital Diaphragmatic Hernia: Clinical Report.
No full textThis clinical report provides an updated evidence-based set of recommendations for the long-term follow-up of patients with congenital diaphragmatic hernia (CDH) after discharge from initial hospitalization. Since the last American Academy of Pediatrics report was published over 15 years ago, there have been significant advances in our understanding of the manifestations, diagnostic and surveillance approaches, and therapies for the cardiopulmonary, neurodevelopmental, gastrointestinal/nutritional, and surgical adverse outcomes that are commonly encountered in patients with CDH. Consideration is also given to patient and caregiver quality of life, which has been a relatively overlooked component of this disease in previous CDH guidance. Because CDH severity and the prevalence of adverse outcomes are not only variable but also change with patient age, differential guidance is provided based on low-risk and high-risk status and are presented in a timeline format. Providers may use the guidance in this clinical report to develop an individualized long-term plan that balances care with available resources to support quality of life through the lifespan
Publication productivity among international medical graduates and U.S. medical graduates in neurosurgery: A comparative assessment using the arms race control score.
No full textBACKGROUND AND OBJECTIVES: The Arms Race Control Score (ARCS) was developed to provide a quantitative assessment of publications among residency applicants. International medical graduates (IMGs) often have higher numbers of publications compared to U.S medical graduates (US MDs). However, there is limited knowledge of publication quality and effort among IMGs and US MDs. Our study analyzes publication productivity among IMGs and US MDs using the ARCS.
METHODS: Applicants were selected from ACGME-accredited training programs that enrolled both IMG and US MD residents over the 2018-2024 match cycle. Programs without IMG residents in a given year were excluded from the analysis. The total number of residency applicant publications (TNRAP), cumulative publication value unit (cPVU), cumulative ARCS (cARCS), number of publications with PVU\u3c 1, PVU ≤ 1 and high effort activity index (HEAI) were extracted using PubMed and the ARCS calculator.
RESULTS: Of 272 total applicants, 47.1% (n = 128) were IMGs and 52.9% (n = 144) were US MDs. IMGs had higher TNRAP, cPVU, cARCS, and number of PVU \u3e 1 and PVU ≤ 1 publications than US MDs (P \u3c 0.001). HEAI demonstrated no significant difference between IMGs and US MDs (p = .91). After accounting for match year, IMGs had 2.32-times higher TNRAP (IRR: 2.32, 95% CI: 1.76-3.97, p \u3c .001) and produced articles with PVU\u3e 1 at higher rates than US MDs (IRR: 2.26, 95% CI: 1.68-3.03, p \u3c .001). Among those with cPVU and cARCS scores above zero, IMGs had scores 2.19-times higher than US MDs (95% CI: 1.61-2.98, p \u3c .001) and 2.12-times higher than US MDs (95% CI: 1.59-2.83, p \u3c .001), respectively.
CONCLUSION: Among applicants who match into neurosurgery residency programs in the U.S, IMGs demonstrate higher publication count and higher research effort compared to US MDs. The proportion of high-effort publications relative to total publication output did not differ among groups