Jacobs Institute of Women's Health
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Return of Bob
No full textMedium: Digital print.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1017/thumbnail.jp
The emergence of academic pediatric acute and urgent care fellowships: entrustable professional activities
No full textOBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) defined 6 core competencies (medical knowledge, patient care, practice-based learning and improvement, systems-based practice, interpersonal and communication skills, and professionalism) to be used as a framework for outcomes-based assessment. Concurrent to the development of specialty-specific competencies and milestones, the concept of entrustable professional activities (EPAs) were introduced. EPAs describe what a learner can do at each of the 5 levels of entrustment. There are four pediatric acute and urgent and urgent care (PAC) fellowships to date, however, no curricular consensus exists. This article seeks to develop a set of nationally agreed-upon PAC-specific EPAs to be used by emerging fellowships. METHODS: Multi-step iterative qualitative study using a web-based survey was used for EPA development and validity. A modified-Delphi panel, comprised of pediatric educators from multiple institutions, participated in four rounds to reach consensus (≥80%). EPAs were ranked using a 5 point-Likert scale, then from most important to least important in series, and finally individually as yes/no for each EPAs inclusion. RESULTS: Survey response rate was 83% (19/23). Six of the 7 EPAs were deemed on average to be high priority or essential. There was clear consensus on four EPAs and less agreement amongst the other three. Ultimately, 3 of the 7 EPAs reached consensus for inclusion, with agreement ranging from 84% to 100%. CONCLUSION(S): PAC-specific EPAs focusing on clinical excellence, procedural competence, and high-quality care were all deemed essential components for PAC fellowships. Delineation of these EPAs will be critical to guide development of fellowship curricula
Education, training, and perceptions of physician competency among medical cannabis patients in Israel
No full textBACKGROUND: Medical cannabis use is expanding globally, yet knowledge gaps persist among both patients and healthcare professionals. This study aimed to examine age-related differences in medical cannabis use patterns, sources of education and training, and perceptions of physician competencies among medical cannabis patients in Israel. METHODS: A cross-sectional survey of 233 Israeli medical cannabis patients assessed use patterns, education and training sources, and perceptions of physician competencies. Data were analyzed by age groups (18-33, 34-48, 49-64, 65 +) using descriptive statistics, chi-square tests, and ANOVA. RESULTS: Use patterns differed significantly by age. Smoking was common among participants aged 18-33 (40 %) and 34-48 (37.8 %) but less common in the 49-64 group (16.7 %) and the 65 + group (10 %; p \u3c .001). Conversely, ingestion-based methods were reported by 65.5 % of participants aged 65 + and by 72.2 % in the 49-64 group, but only by 45.9 % and 50 % in younger groups (p \u3c .01). Among 57.6 % of participants who knew the THC/CBD concentration of their cannabis, mean THC concentration decreased with age (p \u3c 0.05), while mean CBD concentration increased with age (p \u3c 0.01). Most participants (89.8 %) received education on medical cannabis, primarily from physicians (74.7 %), but 35.4 % used internet sources, and 20.1 % reported peer networks. CONCLUSION: This study identifies age-related differences in medical cannabis use patterns, information sources, and perceptions of physician competencies. Future research should explore how tailored patient education and clinician training can address these differences and improve guidance for medical cannabis use
Predictive Value of Free Light Chain Burden in Patients with AL Amyloidosis Treated with Bortezomib-Based Regimens
No full textA difference between involved and uninvolved free light chain (dFLC) equal or higher than 180 mg/L is part of the 2012 Mayo staging system for AL amyloidosis given its negative impact on overall survival. However, none of the 758 patients evaluated to develop and validate this staging system received bortezomib or daratumumab-containing regimens. Over the past two decades, cyclophosphamide-bortezomib-dexamethasone (CyBorD) and, more recently, daratumumab-CyBorD (DaraCyBorD) have become cornerstone treatments for AL amyloidosis, demonstrating high efficacy in rapidly normalizing FLC levels. We hypothesized that in newly diagnosed AL amyloidosis patients treated with bortezomib and daratumumab-based regimens, a baseline high free light chain burden may no longer predict adverse prognosis. In this retrospective, multicenter study of 223 newly diagnosed AL amyloidosis patients treated with CyBorD or DaraCyBorD therapy, we investigated: 1) the association between baseline involved FLC (iFLC) and dFLC hematological response at 28 days and 3, 6, 9 and 12 months following commencement of therapy ; 2) the overall survival of patients with baseline low (\u3c180mg/L), medium (180-400 mg/L) and high (\u3e400 mg/L) dFLC ; and 3) the prognostic value of bone marrow plasma cell burden in determining response to CyBorD or DaraCyBorD therapy and overall survival; and finally, the prognostic value of the 2012 Mayo staging system in the CyBorD and DaraCyBorD cohorts. Our findings suggest that a dFLC over 180 mg/L no longer holds prognostic value in the era of CyBorD/DaraCyBorD-based AL amyloidosis therapy and question the utility of the Mayo 2012 staging system in the era of highly effective chemo-immunotherapies
Use of harm reduction practices by state-licensed specialty substance use treatment programs
No full textINTRODUCTION: Specialty substance use treatment programs may adopt harm reduction practices to protect the health of their patients with opioid use disorder (OUD). Two such harm reduction strategies are distributing naloxone to clients and refraining from discharging clients if they have positive urine drug screens for drugs. The purpose of this study was to understand the prevalence of programs that adopt each of these harm reduction practices and the characteristics of clients attending programs that adopt both practices in a sample of state-licensed substance use treatment programs in New Jersey. METHODS: We conducted a cross-sectional survey of specialty treatment programs in New Jersey about a) naloxone dispensing and b) use of urine toxicology screens in client discharge decisions. We linked this survey to the treatment programs\u27 administrative records of client admissions for OUD treatment between July 2021 to June 2022 (n = 14,838). We estimated the proportion of programs that reported that they adopted each practice. We then examined program and client characteristics associated with applying these harm reduction practices using regression methods. RESULTS: Of 108 programs included in this analysis, 55.6 % dispensed naloxone and 50.9 % did not consider toxicology screens in discharge decisions. Opioid treatment programs (OTP) were significantly more likely to adopt both harm reduction practices than non-OTPs. Clients referred by correctional programs, as opposed to self-referred to treatment, were significantly less likely to attend a program that used either harm reduction practice. CONCLUSIONS: Our findings suggest efforts are needed to increase adoption of harm reduction practices in SUD treatment settings, especially that are not OTPs, and programs serving clients referred by the criminal justice system
Effect of prenatal multiple micronutrient supplementation vs iron and folic acid supplementation on size at birth and subsequent growth through 24 months of age: a systematic review and meta-analysis
No full textBACKGROUND: Prenatal multiple micronutrient supplements (MMS), in comparison to iron and folic acid (IFA) supplements, improve pregnancy outcomes, but less is known about their effect on infant growth. OBJECTIVE: We conducted a systematic review of trials comparing maternal MMS to IFA and assessed the effect on infants\u27 anthropometric outcomes at birth, three, six, 12, 18, and 24 months of age. METHODS: We included trials from a Cochrane review and new studies identified through systematic literature searches in three databases. We calculated the pooled effect estimates with 95% confidence intervals (CI) using a generic inverse variance method, with fixed (primary analysis) and random effects, and assessed subgroup differences. RESULTS: The 19 included trials showed that MMS, compared to IFA, led to significantly greater: length and weight from birth to six months, head circumference (HC) from birth to 12 months, and mid-upper arm circumference (MUAC) through three months. Infants born to pregnant women taking MMS were longer at birth (mean difference: 0.05 cm (95% CI 0.02, 0.08)), and had higher length-for-age Z-score at birth (0.09 (0.06, 0.12)), three (0.09, (0.06, 0.12)) and six-months (0.04, (0.01, 0.07)) of age, but not thereafter. MMS resulted in significantly higher weight-for-age Z-score and HC-for-age Z-score until six months, and higher weight-for-length Z-score and MUAC-for-age- Z-score until three months. MMS reduced the risk of stunting (Risk Ratio (RR) 0.86, 95% CI 0.82-0.91), underweight (0.86 (0.81- 0.90)), small HC (0.84 (0.79, 0.90)), and low MUAC (0.90 (0.82, 0.99)) at three months, and wasting (0.90 (0.85, 0.96)) at birth. For some outcomes, effects were greater when MMS continued postpartum and in settings with higher prevalence of low birthweight. CONCLUSIONS: Prenatal MMS improved size at birth and subsequent infant growth through six months of age, but not thereafter. Results strengthen the evidence on MMS benefits beyond birth outcomes. PROSPERO REGISTRATION NUMBER: CRD42024551864
SGLT2 inhibitors Use in Kidney Disease: What Did We Learn?
No full textChronic kidney disease (CKD) increases the risk for cardiovascular morbidity and mortality and it\u27s prevalence continues to rise throughout the world. Newer, more efficacious therapies, slow progression of CKD, decrease long term sequala like end stage kidney disease (ESKD) and cardiovascular events, improving survival. Post marketing cardiovascular outcome trials (CVOT) have demonstrated improved cardiovascular outcomes with use of sodium-glucose cotransporter-2 inhibitors SGLT2i) like canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin in patients with type 2 diabetes mellitus (T2DM), Similarly, secondary analysis of CVOT and renal outcome trials with the use of SGLT2i in patients without T2DM showed improved renal function and albuminuria. In these studies, non-diabetic CKD was defined as an estimated glomerular filtration rate (eGFR) of 20-75 ml/min/1.73 m2 with albuminuria ranging from 200-5000 mg/g in the absence of diabetes. As a class effect, in addition to modulation of hemodynamic and metabolic activities, SGLT2i exert renal protection by suppressing inflammation and fibrosis. We conducted an extensive search in the PubMed database for original papers published from 2009 through 2024 using keywords such as non-diabetic kidney disease, diabetic kidney disease, SGLT2i, and kidney outcomes. Based on our research of published literature, we present a review and propose, consideration of SGLT2i in non-diabetic kidney disease for long term cardiovascular and renal benefit (1). We will highlight relevant translational studies to propose a possible cell-based mechanism for cardiovascular benefits noted secondary to use of SGLT2i
Massive Bleeding in Children With Cancer or Hematopoietic Cell Transplant: International, Multicenter Retrospective Study, 2017-2021
No full textOBJECTIVES: To characterize the epidemiology and management of massive bleeding events in children with cancer and/or hematopoietic cell transplant (HCT). DESIGN: Multicenter, retrospective cohort study. SETTING: Nineteen pediatric hospitals in Europe and United States. SUBJECTS: Children ages 0-21 years old with malignancy and/or HCT and massive bleeding admitted from January 1, 2017, to December 31, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics, oncologic history, laboratory values, interventions, and PICU outcomes were collected. One hundred fifty-two bleeding episodes from 135 patients were analyzed. The median (interquartile range [IQR]) age was 7 years (2-14 yr). Forty-three percent (58/135) were female sex. Nineteen percent of children (26/135) had death attributable to hemorrhage. Forty percent had solid tumors and one-third had undergone at least one HCT. The majority of bleeding events occurred in the PICU (81/152, 53%). The median (IQR) platelet count at time of bleeding was 52 × 109/L (24-115 × 109/L), prothrombin time 18.5 seconds (15.2-24.8 s), activated partial thromboplastin time 42.2 seconds (33.2-56.0 s), and international normalized ratio 1.51 (1.21-2.11). To treat these bleeding events, 99% (148/152) of the time children received RBC transfusions, 84% (126/152) of the time plasma transfusions, 88% (132/152) of the time platelet transfusions, and less than one-fifth hemostatic medications. Half (77/152, 52%) of the time the children received high plasma ratios and half (73/152, 49%) received high platelet ratios. Pulmonary bleeding, oral/nasal bleeding, and receipt of prothrombin complex concentrate were each associated with greater odds of death attributed to hemorrhage: odds ratio (95% CI), respectively: 5.44 (2.250-13.171; p \u3c 0.001); 3.30 (1.20-9.09; p = 0.021); and 3.24 (1.18-8.93; p = 0.023). CONCLUSIONS: Children with malignancy and/or HCT have a high mortality rate from hemorrhage despite being hospitalized at the time of their bleeding event. The majority of children received balanced resuscitation. Definitive trials are needed to determine optimal hemostatic resuscitation practice in this population
Lichen Planus: A Cross-Sectional Evaluation of US Dermatologists\u27 Comorbidity Screening and Management Patterns
No full textINTRODUCTION: Lichen planus (LP) is a chronic inflammatory dermatosis affecting up to 0.91% of the US\u27s population. LP is associated with various comorbid conditions, among them autoimmune conditions. LP has various treatment strategies, although none are US Food and Drug Administration (FDA)-approved; this is further complicated by the lack of any clinical or expert guidelines. This study aimed to explore dermatology practitioners\u27 comorbidity screening patterns and treatment practices for management of LP. METHODS: An institutional review board (IRB)-approved, anonymous survey was distributed to members of the ODAC Conference listserv, targeting dermatology practitioners. The survey collected data on demographics, comorbidity screening, and treatment strategies. RESULTS: A total of 406 respondents (17.4% response rate) participated. Hepatitis C virus was the most screened for condition (91.0%), despite its overall low prevalence in patients with LP. Screening rates for highly prevalent comorbidities such as hypertension (10.1%), dyslipidemia (9.7%), depression (18.7%), and anxiety (17.3%) were low. Importantly, almost one-third (32.5%) of respondents reported performing no screening for any comorbid conditions. Topical corticosteroids were the most prescribed therapy (97.8%), followed by topical calcineurin inhibitors (67.7%) and intralesional corticosteroids (64.8%), consistent with high-level evidence for their use in LP treatment. Phototherapy and systemic treatments, including oral immunosuppressants and retinoids, were less frequently utilized despite strong evidence supporting their use. CONCLUSION: These data highlight gaps in the comorbidity screening practices among dermatology practitioners managing LP, with significant underscreening for prevalent conditions. While respondents commonly relied on some evidence-based topical treatments, there is notable underutilization of systemic treatments for moderate to severe disease. These results emphasize the need for clinical guidelines for LP management, aiming to enhance patient care and outcomes