Publications by Year: 2025

BACKGROUND AND AIMS: Studies assessing gastrointestinal stromal tumors (GISTs) have found no survival differences based on margin status; however, small sample sizes, merged anatomic locations, and limited follow-up have been limitations. This study examined the impact of margin status on overall survival in a large national cohort of patients with resected gastric GISTs.

METHODS: Data on patients with gastric GISTs were abstracted from the National Cancer Database, with data collected over a 16-year period (2004-2020). Exclusion criteria included the presence of other primary tumors, unknown patient/tumor characteristics, macroscopic residual margins, metastasis at diagnosis, and prior chemotherapy. The cohort was stratified according to tumor size. R0 is defined as microscopically negative margin, and R1 is microscopically positive margin.

RESULTS: After exclusions, there were 8448 patients in the analysis cohort: 8221 (97.3%) had R0 resections, and 227 (2.7%) had R1 resections. On univariate analysis, tumor size ≤5 cm (P < .001), T1 stage (P < .001), low grade (P < .001), and low mitotic index (P < .001) were associated with a decreased risk of death. Margin status (R0 vs R1) did not have an impact on survival in the combined (P = .249), ≤5 cm (P = .961), ≤3 cm (P = .595), or ≤2 cm (P = .614) cohorts. There was also no difference in the risk of death based on the resection margin, in which the hazard ratio (R1 vs R0) with a 95% confidence interval was 1.206 (.862-1.633). In multivariate analysis, the resection margin status did not affect overall survival (P = .666).

CONCLUSIONS: Congruent with prior studies, there was no difference in survival when comparing R0 with R1 resections in gastric GIST patients without metastasis over an extended follow-up period. These data may be helpful in assessing suitability for endoscopic resection for patients with gastric GISTs.

Acute food bolus impaction is frequently encountered in pediatric patients with underlying esophageal conditions. Traditional endoscopic methods for removing friable boluses, such as meat, are often time-intensive and challenging. This report explores the novel application of cryoadhesion, or freezing and adhering an object to a cryoprobe, for esophageal meat bolus extraction. A 25-year-old man with trisomy 21 and eosinophilic esophagitis presented with acute food bolus impaction. After unsuccessful conventional endoscopic maneuvers, a cryoprobe was externally attached to an endoscope and used to achieve cryoadhesion and extraction of the meat bolus. Within 10 minutes, the meat bolus was successfully removed attached to the cryoprobe without mucosal injury. The patient tolerated the procedure well and was discharged the next day without adverse events. Cryoadhesion via a flexible cryoprobe may offer a feasible alternative for removing challenging food impactions. Further investigation is warranted to evaluate its safety and efficacy.

INTRODUCTION: Physical Medicine and Rehabilitation (PM&R) physicians (physiatrists) care for patients with a variety of neurologic, musculoskeletal, chronic pain, and sports-related conditions. These conditions can cause physical disabilities, cognitive, sensory, or other functional impairments, which make these patients susceptible to the impacts of climate change. The purpose of this scoping review is to describe the existing literature at the intersection of climate change and PM&R practice, and to identify publication trends.

METHODS: The search used electronic databases PubMed, CINAHL, Embase, Cochrane Library, and Web of Science to identify studies related to PM&R and climate change search terms published or in press between January 2008 to July 2023. Articles were reviewed for relevance to PM&R and climate change and were categorized into three groups: (1) Health effects of climate change, (2) PM&R interventions that address health impacts of climate change, and (3) Other relevant points of interest.

RESULTS: A total of 38 articles met the inclusion criteria. Twenty-one articles discussed the health effects of climate change on patients encountered in PM&R practice, with most describing the negative health impacts of air pollution and increased heat. There were 13 articles regarding PM&R interventions that address health impacts of climate change, largely related to disaster preparedness or management, but also including methods for addressing heat illness, telemedicine, and a waste audit. There were four articles about other points of interest, including PM&R providers' perceptions of climate change. Of all the included articles, there was one randomized controlled trial and the rest were observational in design. The number of studies published in the past 15 years has generally trended upwards, with the majority coming from North America.

DISCUSSION: Climate change threatens to negatively affect the health and wellbeing of patients requiring PM&R service, and most physiatrists are concerned about this. While the number of studies has increased over the past 15 years, substantial research gaps remain in the nexus between PM&R and climate change, and several regions around the world are poorly represented in the literature. Further studies are needed to help patients with disabilities adapt to and mitigate the climate crisis.

BACKGROUND: While some interactions between climate change and health have been well documented, the complex relationship between climate change, its proximate causes, and cancer is less clear. This scoping review was conducted to survey specific elements within existing peer-reviewed and grey literature addressing the impacts of climate change-related exposures on 1) cancer risks, 2) outcomes, and 3) care delivery.

METHODS: Following PRISMA guidelines, peer-reviewed and selected grey literature on these topics were identified using pre-specified eligibility criteria. Structured searches by independent reviewers and data extraction from multiple electronic databases were performed, from which syntheses were generated and research gaps identified.

RESULTS: Of 542 studies identified by title/abstract for full-text review, 182 studies were eligible for data extraction. Of these, 127 examined fossil fuel-related pollutant levels and excess cancer risks, 29 investigated the impact of climate change on cancer outcomes, and 31 examined the impact of climate change-related events on cancer care delivery. Overall, the effects of climate change-related exposures, or climate change's proximate causes, lead to increases in cancer risk. Climate change effects such as extreme weather events disrupt care and impact survival outcomes. Across these subject areas, climate change-related events' exacerbation of existing healthcare disparities was an emergent theme.

CONCLUSIONS: Climate change has impacts across the cancer care continuum. Research gaps include limited data on the direct effect of climate change on cancer outcomes and care delivery, population health research, and mitigation efficacy. More work is needed in education, adaptation, and climate preparedness for cancer patients and healthcare systems.

BACKGROUND: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard measure of OCD and the most common tool to assess OCD severity and treatment outcome. Relying on Y-BOCS total scores likely to capture overall severity well, but may obscure important qualitatively different OCD profiles. The current study aimed to identify profiles of OCD and their association to obsession/compulsion content domains (e.g., contamination), and treatment outcomes.

METHODS: Participants were adults 759 (49% women) seeking partial/residential treatment for severe OCD. The sample was on average 29.81(SD=11.95) years old and predominantly White (85%). Latent profile analysis was used to identify patterns of OCD symptoms using the self-reported Y-BOCS severity scale (Y-BOCS-SS). Profiles were validated using generalized linear models to capture the association between profiles and obsession/compulsion content and changes in OCD severity, depression, and quality-of-life.

RESULTS: Three profiles were identified: a "Severe with Lower Resistance" Profile (69% of sample) characterized by high severity with the greatest relative effort to resist symptoms, a "Moderate" profile (25%) characterized by uniform endorsement of items in the moderate range, a "Low Compulsion" (6%) profile characterized by high mean endorsement of obsession items and low endorsement of compulsion items. The profiles varied significantly in terms of endorsement of different obsession/compulsion domains but did not vary significantly in terms of treatment outcomes as measured by changes in OCD, depression, and quality-of-life.

CONCLUSIONS: Relying on Y-BOCS total score may fail to capture qualitatively different, albeit rare, presentations of OCD. However, these profiles were not predictive of treatment response.

In their article, Partono et al. report the results of a mixed-methods study aimed at evaluating the organizational features of medical-legal partnerships (MLPs) and their potential relation to overall quality of care and health outcomes for people living with HIV. The authors find that factors such as type of medical partner in the MLP (community-based healthcare organization vs. hospital system) and the colocation of legal and support services are associated with certain clinical outcomes such as greater appointment adherence and a greater reduction in viral load. This study is the latest in a series of efforts seeking to build the MLP evidence base and tie MLPs to meaningful, measurable health outcomes. The accumulation of empirical evidence evaluating the effectiveness of MLPs is an important trend in the literature.

INTRODUCTION: Medical professionalism has traditionally been defined by core standards for practitioners, yet consensus on its defining elements remains limited. Shifts in society, medical practice, and trainee perspectives have influenced how professionalism is understood and applied. This study aimed to establish a contemporary, consensus-based framework for medical educators and learners.

METHODS: Using a modified Delphi approach, 39 medical education experts from eight U.S. medical schools participated in three survey rounds and one in-person session. Participants rated 51 behaviorally-based items categorized under four domains: commitments to patients, colleagues, institutions/society, and self. Items were rated "essential," "important but not essential," or "not important," with consensus defined as 70% agreement.

RESULTS: Consensus was reached on 24 "essential" elements emphasizing patient-centered care, ethical practice, equitable care, communication, and cultural humility. Participants highlighted the importance of a shared framework while recognizing the risks of bias and the need for contextual sensitivity. Items related to physician self-sacrifice, attire, and social justice failed to reach consensus, reflecting concerns about burnout, subjectivity, and scope. Emphasis was placed on fostering professionalism through dialog, reflection, and context-aware evaluation.

CONCLUSION: The resulting framework captures evolving perspectives on professionalism, offering educators practical, adaptable guidance for teaching, reflection, and assessment across diverse educational settings.

INTRODUCTION: End-stage kidney disease (ESKD) affects many Americans, with higher risks in certain subgroups of the US population. Differential kidney health outcomes may stem from non-medical social drivers of health, cognitive difficulties, and functional limitations. Recommendations for individuals with ESKD are often standardized and may not account for unique challenges and access barriers that individuals face. These challenges lead to preventable differences in access to treatments such as home dialysis and kidney transplantation. This study examines the prevalence of unmet social, cognitive, and functional needs amongst patients receiving dialysis and evaluates the intersection of these barriers to inform strategies to improve kidney health outcomes for all patients.

METHODS: In a cross-sectional study, a convenience sample of 962 patients from diverse backgrounds, currently undergoing dialysis from multiple dialysis centers across the United States (aged 21-95 years), were surveyed. Descriptive, Spearman's correlation, logistic regression, and Chi-Square Test analyses conducted.

RESULTS: From our large sample, 45.1% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 51.0% experienced two or more mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (12.2%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst public insurance participants compared to those with private insurance, with 33.0% of Dual-eligible participants reporting three or more unmet needs.

DISCUSSION: This study highlights the significant intersection of social, cognitive, and functional barriers faced by patients receiving dialysis with ESKD, particularly those from vulnerable populations. Addressing these multifaceted needs through person-centered interdisciplinary care models and policy interventions is critical to reducing disparities and improving outcomes in kidney health outcomes.

We previously identified REELIN-COLBOS (RELN H3447R) and APOE Christchurch (APOE R136S) as candidate gene variants associated with protection against dementia in cases at the highest risk of Alzheimer's Disease (AD) due to the PSEN1 E280A mutation in Colombia. Here, we examined the frequency of these variants in a cohort of 135 Colombian oldest-old individuals, part of the Resist AD Project. Five carriers of the REELIN-COLBOS variant were identified and described here, whereas none of the cases carried APOE Christchurch. The first case is a 102-year-old APOE4/E3 carrier with stable performance on cognitive tests despite having suffered an episode of delirium due to pneumonia. FDG-PET revealed relatively preserved cortical glucose metabolism despite showing degenerative changes on MRI. Another case with a family history of early-onset dementia maintained independence until age 85. Despite significant comorbidities, the other three cases exhibited preserved cognition at baseline. These observations are consistent with the hypothesis that the Reelin-COLBOS variant may play a protective role against cognitive decline and support healthy aging, although further studies are needed in larger and more diverse populations to confirm this association.