Jacobs Institute of Women's Health
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State of the art in menopause: current best practice approaches from the IMS World Congress 2024, Melbourne
No full textThe 19th World Congress on Menopause, hosted by the International Menopause Society in 2024, convened global experts to discuss the latest advances in menopause management. This review highlights key focus areas presented at the congress, offering insights into best practices for clinical application. Cardiovascular health remains a priority, with emphasis on recognizing sex-specific risk factors and exploring emerging therapies. Osteoporosis management underscores the role of menopausal hormone therapy (MHT) as foundational, complemented by anti-resorptive and bone-forming agents in high-risk populations and those not candidates for MHT. Addressing genitourinary symptoms and sexual health, vaginal estrogen therapy is confirmed as a safe and effective option with vaginal dehydroepiandrosterone (DHEA) and oral ospemifene as suitable alternatives, while testosterone therapy offers benefits for hypoactive sexual desire disorder in postmenopausal women. Sleep disturbances, depression and workplace challenges linked to menopause were explored, with tailored interventions such as MHT and cognitive behavioral therapy specifically for sleep recommended. Cancer risk management stressed the need for a multidisciplinary approach to risk reduction beginning with lifestyle modification, and with non-hormonal therapies prioritized for symptomatic treatment of menopausal symptoms in those with hormone-sensitive cancers. Lastly, perimenopause management highlighted comprehensive approaches integrating symptom relief and contraceptive needs
Nature\u27s Embrace
No full textPhotographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1034/thumbnail.jp
Wheeling Out the Old, and Rolling in the New: Current Challenges in Wheelchair Accessibility and Management in Hospital Settings
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Status Epilepticus Protocol Variation Across Accredited National Association of Epilepsy Centers Members
No full textOBJECTIVES: Status epilepticus (SE) is a neurologic emergency that requires urgent recognition and medical management. SE management remains heterogeneous across centers. METHODS: We analyzed SE treatment protocols from level 3 and level 4 epilepsy centers. Discrete data including stabilization measures, timing of treatment phases, medications, doses, and routes of administration were collected from each protocol and described using frequency for categorical variables and median for continuous variables. The distribution of treatment times and dosing were compared with the AES guideline. RESULTS: A total of 256 SE treatment protocols were included. Only 66% of SE protocols detailed treatment times. Doses below recommendations occurred in 4% of protocols for initial benzodiazepine (BZD) and 14% for first non-BZD medications. Infusion therapy was outlined in 61% of protocols. DISCUSSION: Despite the importance of timeliness in SE management, one third of institutional protocols did not specify treatment times. This analysis of US hospital inpatient SE protocols provides expert opinion regarding infusion therapy management and highlights gaps and targets for improvement in SE treatment
Contribution of maternal adherence to the effect of multiple micronutrient supplementation during pregnancy: a systematic review and individual participant data meta-analysis
No full textMultiple micronutrient supplements (MMS) in pregnancy reduces the risk of infant low birthweight (LBW) and improves other maternal and infant outcomes as compared to iron-folic acid supplements (IFA) alone. However, the impact of timing of initiation and adherence on the MMS effectiveness in real-world programs remains unclear. To address this, we conducted a two-stage individual participant data meta-analysis that included 15 randomized trials (61,204 pregnant women) and assessed whether the relative effect of MMS differed by: adherence alone; adherence in combination with gestational age at initiation; and the total number of tablets taken. We also evaluated the observational association of these factors with outcomes among participants who received MMS. Compared to IFA; the relative effect of MMS on the primary outcome of continuous birthweight was greater with higher adherence (p-value for interaction\u3c0.05). Among women who took ≥90% of supplements, MMS increased birthweight by 56g (95%CI: 45, 67g), while among women who took \u3c60% of supplements, there was no difference in birthweight between MMS and IFA (mean difference (MD): 9g; 95%CI: -17, 35). Higher adherence was also associated with greater effect of MMS on LBW and birthweight-for-gestational age centile and women who took more supplements experienced a greater relative impact of MMS on birthweight-for-gestational age centile and small-for-gestational age births (SGA) as compared to IFA. Observational analyses among participants who received MMS showed that ≥90% adherence was associated with increased birthweight (MD: 44g; 95%CI: 31, 56) and lower risk of LBW (RR: 0.93; 95%CI: 0.88, 0.98) and SGA (RR: 0.95; 95%CI: 0.93, 0.98), while \u3c75% adherence was associated with a greater risk of stillbirth (RR: 1.43; 95%CI: 1.12, 1.83) and maternal anemia (RR: 1.26; 95%CI: 1.11, 1.43) as compared to 75-90% adherence. Programs should invest in strategies that promote early initiation and high adherence to MMS. PROSPERO ID: CRD42022319207 INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) ID: CRD42022319207
Nutritional priorities to support GLP-1 therapy for obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
No full textBACKGROUND: Glucagon-like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-effectiveness. OBJECTIVES: We aimed to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity for the practicing clinician. METHODS: An expert group comprising multiple clinical and research disciplines appraised the scientific literature, informed by expert knowledge and clinical experience, to identify and summarize relevant topics, priorities, and emerging directions. RESULTS: GLP-1s reduce body weight by 5% to 18% in trials, with modestly lower effects in real-world analyses, and multiple demonstrated clinical benefits. Challenges include side effects, especially gastrointestinal; nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence with subsequent weight regain; and high costs with resulting low cost-effectiveness. Numerous practice guidelines recommend multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity, but use of such therapies with GLP-1s is not widespread. Priorities to address this include: (a) patient-centered initiation of GLP-1s, including goals for weight reduction and health; (b) baseline screening, including usual dietary habits, emotional triggers, disordered eating, and relevant medical conditions; (c) comprehensive exam including muscle strength, function, and body composition assessment; (d) social determinants of health screening; (e) and lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections. During GLP-1 use, nutritional and medical management of gastrointestinal side effects is critical, as is navigating altered dietary preferences and intakes, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training and appropriate diet, and complementary lifestyle interventions. Supportive strategies include group-based visits, registered dietitian nutritionist counseling, telehealth and digital platforms, and Food is Medicine interventions. Drug access, food and nutrition insecurity, and nutrition and culinary knowledge influence equitable obesity management with GLP-1s. Emerging areas for more study include dietary modulation of endogenous GLP-1, strategies to improve compliance, nutritional priorities for weight maintenance post-cessation, combination or staged intensive lifestyle management, and diagnostic criteria for clinical obesity. CONCLUSIONS: Evidence-based nutritional and lifestyle strategies play a pivotal role to address key challenges around GLP-1 treatment of obesity, making clinicians more effective in advancing their patients\u27 health
Building healthcare-community partnerships: process evaluation of a coalition approach to addressing cancer survivors\u27 health-related social needs
No full textBACKGROUND: Coalitions involving both healthcare organizations and community organizations, are a way of providing community support to patients. However, the impact of these collaborations and partner satisfaction can be hard to measure without the use of a theoretical framework to guide progress. METHODS: In January 2023 we established the BEAT-C coalition, guided by the Community Coalition Action Theory (CCAT), to improve clinical-community linkages for addressing non-medical needs among individuals affected by cancer in the Washington, D.C. region. To create broad representation, we invited organizations focused on faith, older adults, cancer support, health promotion, healthy food access, and community health to join. The coalition dedicated significant effort at the outset to establish trust, cultivate relationships, and define shared values, mission, goals, and objectives. To assess coalition functioning, we administered a modified version of the Coalition Self-Assessment Survey (CSAS) in December 2023. RESULTS: Sixteen individuals representing 10 organizations completed the adapted CSAS. Respondents generally responded positively regarding the coalition and made decisions primarily through discussion and agreement (75.0%). Respondents noted respect for leadership (81.3%) and respect for and from fellow coalition members (100.0%). While 56.3% reported meaningful action through the coalition, 31.3% thought there could be more meaningful action. Qualitative feedback mirrored these findings: participants positively regarded the coalition’s responsiveness and noted activities occurring through partnerships developed from the coalition, but some respondents emphasized a desire to act more swiftly. CONCLUSION: Our research described facilitators and barriers to early implementation of a theory-driven collaborative coalition to enhance cancer survivor support. Through the continued efforts of the coalition and increased community capacity building, the multi-disciplinary efforts of the coalition have potential to address the needs of cancer survivors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-12883-7
Association of Hospitalizations With Randomized Glycemia-Lowering Treatment in GRADE
No full textOBJECTIVE: To compare rates of and risk factors for hospitalizations among Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) participants taking metformin and randomly assigned to insulin glargine U-100, glimepiride, liraglutide, or sitagliptin. RESEARCH DESIGN AND METHODS: Intention-to-treat (ITT) (N = 5,047) and on-assigned-treatment (AT) (N = 4,830) data sets were used. Baseline differences between those hospitalized versus those not hospitalized were assessed. Kaplan-Meier analysis was used to determine incidence for time to first hospitalization, and log-rank tests were used to determine treatment group differences. Time-to-event analyses were used to examine factors affecting subsequent hospitalization risk. RESULTS: During GRADE, 1,636 participants (32.4%) were hospitalized at least once and 751 (14.9%) were hospitalized more than once. Hospitalized participants were older, less likely to be Hispanic, more likely to be White, and more likely to have a history of hypertension and had higher baseline BMI. There were no treatment group differences in incidence for time to first hospitalization in the ITT data set (P = 0.148), but a reduced hazard rate was observed for those taking liraglutide versus those taking glimepiride in the AT data set (hazard ratio 0.78 [95% CI 0.66, 0.92]; P = 0.022). Factors increasing the risk for subsequent hospitalizations included meeting the secondary outcome (HbA1c \u3e7.5%, confirmed), each prior hospitalization, and change from assigned treatment (29%, 41%, and 56% increase in risk, respectively). Assignment to liraglutide versus glimepiride reduced this risk by 13%. CONCLUSIONS: Hospitalizations were common in GRADE, and rates were nearly identical across treatment groups. The small, but significant, reduction in risk for subsequent hospitalizations among participants assigned to liraglutide versus glimepiride may influence treatment decisions in populations similar to GRADE participants
Prevalence and Clinical Manifestation of Astrovirus Gastroenteritis in Adults: A Seven-Year Study in Washington D.C., USA
No full textGastroenteritis is commonly caused by viral etiologies. The inclusion of astrovirus on multiplex, syndromic gastrointestinal PCR panels allows for the detection and characterization of infected patients. This retrospective, observational, clinical study examines the epidemiology and clinical characteristics of astrovirus infections in adults from our institution in Washington D.C. (USA) over a seven-year period. Chart abstraction was performed to collect patient demographics, laboratory results, clinical presentation, and management. The overall positivity rate of astrovirus was 0.6%. Peak seasons were late winter to spring (February-April). The mean age was 32 years old (range: 18-52 years). All patients presented with gastroenteritis symptoms and were immunocompetent except one. Symptoms varied among diarrhea, abdominal pain, vomiting, and fever, but patients in age group 30-39 years experienced less vomiting (p = 0.01). Infected patients had an increase in monocytes and neutrophils and a decrease in lymphocytes (p \u3c 0.001). Gastrointestinal co-infections were seen in 24% of our patients. In all patients, clinicians acknowledged the detection of astrovirus and discharged patients without further treatment. The median length of stay was 6 h, and no patients were admitted into the intensive care unit. We show that astrovirus infections in immunocompetent adults were associated with mild disease associated with specific cell counts and different symptoms correlated with age