Symptom management in isocitrate dehydrogenase mutant glioma

According to the 2021 World Health Organization classification of CNS tumors, gliomas harboring a mutation in isocitrate dehydrogenase (mIDH) are considered a distinct disease entity, typically presenting in adult patients before the age of 50 years. Given their multiyear survival, patients with mIDH glioma are affected by tumor and treatment-related symptoms that can have a large impact on the daily life of both patients and their caregivers for an extended period of time. Selective oral inhibitors of mIDH enzymes have recently joined existing anticancer treatments, including resection, radiotherapy, and chemotherapy, as an additional targeted treatment modality. With new treatments that improve progression-free and possibly overall survival, preventing and addressing daily symptoms becomes even more clinically relevant. In this review we discuss the management of the most prevalent symptoms, including tumor-related epilepsy, cognitive dysfunction, mood disorders, and fatigue, in patients with mIDH glioma, and issues regarding patient\u27s health-related quality of life and caregiver needs in the era of mIDH inhibitors. We provide recommendations for practicing healthcare professionals caring for patients who are eligible for treatment with mIDH inhibitors

Clinical Characteristics and Outcomes of Patients With Rome IV Functional Dyspepsia Who Consume Opioids: A Real-World Study

INTRODUCTION: The prevalence of opioid use and its impact on healthcare outcomes among patients with Rome IV functional dyspepsia (FD) has not been reported in real-world clinical practice in the United Kingdom (UK). The primary aim of this study was to study the prevalence of opioid intake among outpatients diagnosed with Rome IV FD. Secondary aims were to determine (A) the differences in phenotype and healthcare resource utilization between patients who consumed opioids versus non-users, and (B) whether a combination of opioid cessation and a neuromodulator prescription could improve gastrointestinal (GI) symptoms. METHODOLOGY: Data were collected from consecutive patients diagnosed with FD according to the Rome IV clinical criteria in a single tertiary care neurogastroenterology outpatient clinic in the UK between January 2016 and December 2021. Patients who consumed opioids were provided with opioid cessation advice and prescribed a neuromodulator (the intervention). RESULTS: One hundred and fifty-six patients were diagnosed with FD and 48 (31%) were taking opioids. In a multivariate logistic regression model (OR, [95% CI]), older age (1.03 [1.004-1.059], p = 0.03), depression and/or anxiety (4.2 [1.4-12.5], p = 0.01), and chronic pain (4.0 [1.8-8.9], p \u3c  0.001) were independently associated with opioid consumption at baseline. At least 44% of patients adhered to opioid cessation advice and, among these persons, 29% reported symptom improvement in response to a neuromodulator. The intervention had a number needed to treat of 5.7 to achieve an improvement in clinical symptoms. CONCLUSION: Opioid intake in FD is independently associated with older age, depression and/or anxiety, and chronic pain. Encouraging opioid cessation may be an important strategy in the management of FD

Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination

IMPORTANCE: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts. OBJECTIVE: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines. DESIGN, SETTING, AND PARTICIPANTS: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines. EXPOSURES: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level. MAIN OUTCOMES AND MEASURES: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions. RESULTS: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P \u3c  .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P \u3c  .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P \u3c  .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P \u3c  .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P \u3c  .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P \u3c  .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P \u3c  .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred

Time-to-event prediction in ALS using a landmark modeling approach, using the ALS Natural History Consortium dataset.

BACKGROUND AND OBJECTIVES: Times to clinically relevant events are a valuable outcome in observational and interventional studies, complementing linear outcomes such as functional rating scales and biomarkers. In ALS, there are several clinically relevant events. We developed dynamic prediction models for several of these times to events that can be used for clinical trial modeling and personal planning. METHODS: Landmark time-to-event analysis was implemented to determine the effect of patient characteristics on disease progression. Longitudinal data from 1557 participants in the ALS Natural History Consortium dataset were used. Five outcomes in the ALS disease progression were considered: loss of ambulation, loss of speech, gastrostomy, noninvasive ventilation (NIV) use, and continuous NIV use. Covariates in our models include age at diagnosis, sex, onset location, riluzole use, diagnostic delay, ALSFRS-R scores at the landmark time, and ALSFRS-R rates of change from baseline. Internal and external validation techniques were used. RESULTS: For each of our models and landmark times, we present risk prediction intervals for random sets of patient characteristics. We demonstrate our models\u27 application for an individual\u27s personal predicted time-to-event. Our internal and external validation metrics indicate good concordance and overall performance. The time to loss of speech models perform the best for each metric in terms of both internal and external validation. DISCUSSION: Landmarking is an efficient, individualized risk prediction model that is intuitive for both clinicians and patients. Importantly, landmarking can be used for clinical trial modeling, personal planning, and development of real-world evidence of the impacts of treatment interventions

Hypertensive disorders of pregnancy trends in the United States post aspirin recommendation guidelines

OBJECTIVE: To evaluate changes in the rates of hypertensive disorders of pregnancy (HDP) in the US after the publication of aspirin (ASA) recommendation guidelines by the USPSTF and ACOG. METHODS: A population-based retrospective cohort study was performed using the US Natality database. The pre-ASA group included births between 2010-2014. The post-ASA group were births between 2016-2021. Births in 2015 were excluded. Outcomes were rates of HDP. Univariate and multivariate analyses were performed. Using the 2010-2014 HDP trend, a projected trend was calculated and compared to the actual trend across the entire cohort. RESULTS: There were 12,127,659 births in the pre-ASA group and 17,665,217 births in the post-ASA group. The post-ASA group had a significantly higher rate of overall HDP than the pre-ASA group (7.7 % vs 4.9 %; aOR 1.58, 95 % CI [1.57-1.59]). When stratified by gestational age at delivery, the post-ASA group had a significantly lower rate of preterm HDP prior to 37 weeks (21.6 % vs 23.7 %; aOR 0.90, 95 % CI [0.89-0.91]) and preterm HDP prior to 34 weeks (6.0 % vs 7.5 %; aOR 0.79, 95 % CI [0.78-0.81]). The actual HDP trend post-ASA recommendation was higher than projected for overall HDP and preterm HDP \u3c 37 weeks but was not different for preterm HPD \u3c 34 weeks. CONCLUSION: While overall HDP is increasing, the rate of preterm births complicated by HDP has been decreasing. The actual trend for the overall HDP category and the two preterm HDP categories, however, remains either higher or no different compared to the projected trend post aspirin recommendation guidelines

Human papillomavirus-related cancers and human papillomavirus vaccination among Arab Americans: A call to unveil disparities and bridge the research gaps

Arab Americans, a diverse and rapidly growing demographic in the United States, face unique barriers to human papillomavirus (HPV) vaccination and cancer prevention, but there is a notable lack of research on HPV‐associated cancer incidence and vaccination rates in this community. Collaborative efforts among health care providers, public health agencies, researchers, and religious community organizations are essential to improve HPV vaccination uptake and reduce cancer disparities within this underserved population by including Middle Eastern and North African as a distinct category in national health surveys, conducting comprehensive epidemiological research, and developing culturally tailored interventions

Differences between allergy and dermatology in referral, evaluation, and management patterns for pediatric patients with atopic dermatitis

INTRODUCTION: Allergists and dermatologists often take different approaches to caring for pediatric patients with atopic dermatitis (AD). METHODS: A retrospective chart review was performed on patients \u3c 18 years old treated for AD within the University of Virginia health system from 2015 to 2020. Data were collected on patient and referring provider demographics as well as initial visit evaluation and management. RESULTS: A total of 269 patients presented to allergy, 685 patients presented to dermatology, and 14 patients presented to a combined allergy-dermatology clinic as an initial visit with a primary diagnosis of AD. Both specialties were most often referred to by a generalist though dermatology received more specialty provider referrals. In addition, allergy ordered more diagnostic testing (IgE, allergens, complete blood count), while dermatology prescribed more medications (topical corticosteroids, topical calcineurin inhibitors, immunosuppressants). Patients seen in the combined dermatology-allergy clinic were more likely to receive diagnostic testing than patients seen in dermatology clinic and were more likely to be prescribed medications than patients seen in allergy clinic. CONCLUSIONS: Our findings suggest allergists may focus more on identifying triggers of AD, while dermatologists largely focus on the prescription of therapies. Clinical care may be more comprehensive when allergists and dermatologists work synergistically

Institutional experience with implanted cardiac device risk level assessment: Comparing calculation and measurement

BACKGROUND: The use of in-vivo dosimetry is a long-standing but also labor-intensive component of risk-level assessment for patients with implanted devices. A calculation-only approach, using treatment planning system (TPS)-calculated doses along with imaging doses estimates when relevant, has the potential to streamline the physics workflow without negatively impacting patient safety. PURPOSE: To evaluate the feasibility of using a calculation-only approach for risk level assessment for patients with implanted electronic medical devices. METHODS: A total of 86 patients were included in this retrospective study. For each patient, in-vivo dosimetry measurements using optically stimulated luminescent dosimeter (OSLD) were compared to calculated doses (based on TPS calculated doses and an estimate of imaging doses when relevant). The comparison of OSLD doses and estimated predicted doses was structured in the following manner: (1) direct comparison of both absolute dose difference and percent difference for measured and calculated doses, (2) risk level assessment comparison using measured and estimated doses, and (3) sensitivity and positive predictive value assessment of each method for TG-203 risk level assessment. RESULTS: For all cases, the calculation-based approach yielded a risk level that was equivalent to or more conservative than the risk level from OSLD measurement. For 79 of 86 patients (91.9%), the calculated and measured doses provided the same risk level. For 7 of 86 patients (8.1%), the calculated dose yielded the more conservative risk level. The calculation-based dose estimate provided a sensitivity of 1.00 with a positive predictive value of 0.92. CONCLUSIONS: The use of a calculation-only approach has the potential to reduce workload while maintaining the efficacy of risk-level assessment for patients with implanted devices

The sociocultural ecology of resilience: A comparative study among women in the United Kingdom

Resilience is often framed as an internal, individual process. However, this perspective overlooks the complex relationship between individuals and their social and ecological contexts. Drawing on insights from evolutionary anthropology, psychology, and public health, this paper explores how women who use drugs from two regions in the United Kingdom perceive resilience and navigate intricate sociocultural environments of recovery. It also considers factors that promote resilience and those that can cause harm. This study was conducted in two regions of England: Northeast England (n = 14), including Newcastle upon Tyne and Durham, and Greater London (n = 10). Participants, who were actively engaged in recovery services, participated in one-on-one in-depth interviews that included questions about their perceptions of and direct experiences with substance use and recovery. They were also asked to share their journeys into addiction and subsequent recovery while reflecting on the barriers and facilitators to recovery for women in their community. Our findings support a growing body of research that emphasizes recovery as a relational process. Women in Northeast England and London relied on social networks, particularly through peer meetings, to navigate their recovery. Additionally, key themes included the impact of community and institutional harm, particularly in promoting isolation and emotional distress. This study highlights the significance of social learning and relational resilience in addiction recovery, framed within a sociocultural-ecological model. These findings underscore that recovery is not solely an individual process but one deeply embedded in broader sociocultural and relational dynamics