Publications by Year: 2026

IMPORTANCE: Despite increasingly widespread use of artificial intelligence (AI)-driven ambient scribes in medicine, the extent to which they are associated with clinician practice is not well studied.

OBJECTIVE: To characterize differences in documentation and treatment of psychiatric symptoms in primary care outpatient notes generated using ambient scribes compared with human or no scribes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a matched retrospective case-control design to evaluate primary care annual visit notes from the Massachusetts General and Brigham and Women's Hospital systems between February 2023 and February 2025. A random sample of notes from 4 types of visits, matched 1:1 using sociodemographic and clinical features, was used: those using an ambient scribe, those using a human scribe, those occurring during the same period without a scribe (contemporaneous), and those occurring prior to scribe deployment. Data analysis was performed from April 25 to May 1, 2025.

EXPOSURE: Use of an AI ambient scribe.

MAIN OUTCOMES AND MEASURES: Neuropsychiatric symptom documentation, in terms of estimated Research Domain Criteria (RDoC), using a Health Insurance Portability and Accountability Act-compliant large language model (GPT-4o version gpt-4o-11-20; OpenAI); antidepressant prescriptions and diagnostic codes; and referral for mental health follow-up.

RESULTS: Among 20 302 notes, the mean (SD) age of the patients was 48 (14) years and 11 960 (59%) were for visits by female patients; 1026 (5%) met criteria for moderate or greater depressive symptoms by Patient Health Questionnaire-9 score. Estimated levels of RDoC symptoms in all 6 domains were significantly greater in the AI-scribed notes compared with other groups. In a multiple logistic regression model, likelihood of a psychiatric intervention (referral, new diagnosis, or antidepressant prescription) was significantly lower among AI-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.83; 95% CI, 0.72-0.95), but not for human-scribed visits compared with contemporaneous unscribed visits (adjusted odds ratio, 0.97; 95% CI, 0.85-1.11).

CONCLUSIONS AND RELEVANCE: In this retrospective cohort study using a matched case-control design examining outpatient primary care notes, incorporation of AI ambient scribes in primary care was associated with greater levels of neuropsychiatric symptom documentation but lesser likelihood of documented management of psychiatric symptoms. Further study will be required to determine whether these changes are associated with differential outcomes.

IMPORTANCE: Home blood pressure monitoring (HBPM) is essential and universally recommended for hypertension management, but patterns of real-world patient engagement with HBPM have not been studied and remain largely unknown.

OBJECTIVE: To evaluate patient engagement with HBPM in a remote hypertension management program.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzing prospectively collected program data was conducted within a remote hypertension management program at a large academic health care system, Mass General Brigham, in Boston, Massachusetts. Data were collected from from September 2018 to June 2022. Adults with uncontrolled hypertension enrolled in the program were eligible for inclusion. Data analyses were conducted from February to April 2025.

INTERVENTIONS: Patients received free automated HBPM devices, education, and ongoing personalized support from health care navigators via telephone and messaging, with algorithm-guided medication titration.

MAIN OUTCOMES AND MEASURES: The primary outcome was engagement at baseline. Weekly HBPM frequency was categorized as no engagement (0 measurements), low engagement (1-11 measurements/week), intermediate engagement (12-23 measurements/week), and high engagement (24-28 measurements/week).

RESULTS: A total of 3390 patients were enrolled in the remote hypertension program; median (IQR) patient age was 61 (52-69) years, with 1958 (57.8%) female patients. Mean (SD) systolic BP at baseline was 143 (13) mm Hg, and most patients had comorbidities, including 1369 patients (40.4%) with atherosclerotic cardiovascular disease and 996 (29.4%) with diabetes. At baseline, 1107 patients (32.7%) had no engagement, 484 (14.3%) had low engagement, 618 (18.2%) had intermediate engagement, and 1181 (34.8%) had high engagement.

CONCLUSIONS AND RELEVANCE: In this cohort study of a remote hypertension management program, patient engagement with HBPM was suboptimal despite free devices, education, and personalized support with a navigator. To support optimal HBPM, innovative methods of BP monitoring that are more convenient and less burdensome for patients may enhance engagement and improve hypertension management outcomes.

BACKGROUND: Early phase clinical trials (EP-CTs) investigate novel therapeutic approaches for patients with cancer, but little is known about patterns of supportive care service utilization and advance care planning (ACP) in this population. We sought to characterize these features in an EP-CT population and evaluate associations among receipt of supportive care services and ACP documentation.

METHODS: We retrospectively reviewed the electronic health record (EHR) of consecutive patients enrolled in EP-CTs at Massachusetts General Hospital from 01/01/17-12/30/19. We abstracted sociodemographics, performance status (Eastern Cooperative Oncology Group [ECOG] score), oncology history, trial details, as well as receipt and timing of six supportive care services (palliative care [PC], social work [SW], spiritual services [SS], parental support [PS], physical therapy [PT], and nutrition). We additionally abstracted receipt and timing of ACP documentation (defined as any EHR-documented conversation addressing illness understanding or values, preferences, or goals for future medical care, as identified using a structured keyword search). We then separately examined associations between receipt of any supportive care service and ACP documentation, number of supportive care services received and ACP documentation, and subtype of supportive care received and ACP documentation. These analyses used logistic regression models adjusted for age, sex, cancer type, and performance status.

RESULTS: During our study period, 376 patients participated in EP-CTs (median age 63.0 years, 55.9% female, 97.3% stage 4, median ECOG 1, median follow-up: 223 days, median time from diagnosis to EP-CT: 844 days). Nearly all received at least one type of supportive care across their illness trajectory (88.0%), with varied rates by service type (PC: 54.8%, SW: 64.1%, SS: 39.1%, PS: 8.0%, PT: 54.0%, nutrition: 61.2%). Most also had some form of ACP (73.9%) documented between diagnosis and death. Multivariable regression models demonstrated that receipt of any of the six forms of supportive care was associated with higher likelihood of ACP documentation (odds ratio [OR]: 9.18, 95% confidence interval (CI): 4.49-18.78, p < 0.001). Similarly, we observed associations between number of supportive care services received when considered as a continuous covariate and ACP documentation (OR1 service:1.89, 95%CI:0.90-4.03, p = 0.090; OR2 services: 15.36, 95%CI 5.78-40.78, p < 0.001, OR3+ services: 35.78, 95%CI: 14.35-89.24, p < 0.001). These associations also persisted when considering PC independently (ORPC = 11.17, 95%CIPC = 5.76-21.67, p < 0.001) from other supportive care services (ORother = 5.41, 95%CIother: 2.64-11.09, p < 0.001).

CONCLUSIONS: In this large cohort of EP-CT participants, most patients received supportive care services and had documented ACP, suggesting trial-related engagement does not impede care delivery. Notably, receipt of supportive care services correlated with ACP documentation. These findings underscore the importance of addressing individual supportive care needs among EP-CT participants.

BACKGROUND: Rectal cancer remains a significant clinical challenge with demand for conclusive biomarkers, essential in prognostication and therapy monitoring of neoadjuvant and adjuvant treatment strategies.

AIMS: The aim of the study was to evaluate AXL and cellular mesenchymal-epithelial transition factor (C-MET) biomarkers for cancer stem cells and to correlate them with clinicopathological characteristics and patient outcome data with respect to neoadjuvant chemoradiotherapy.

METHODS: Serum levels of soluble surface markers AXL and C-MET were retrospectively analyzed in 164 rectal cancer patients with additional immunofluorescent analyses of their primary tumor tissues.

RESULTS: Kaplan-Meier analysis confirmed the prognostic significance of Union for International Cancer Control stages, but with no significant correlation between investigated markers with patient age, gender, or tumor stage. In contrast, tumor tissues demonstrated stage-dependently increased marker expression. While AXL was detected at low levels, C-MET exhibited a bimodal distribution, with elevated levels seen in most patients, particularly post-neoadjuvant therapy and non-significantly in the subgroup with poorer response to neoadjuvant therapy (p=0.074).

CONCLUSIONS: AXL serum levels in the rectal cancer cohort were significantly different from healthy subjects but did not correlate with tumor stage or survival during and after neoadjuvant/adjuvant therapy. Soluble C-MET levels in the blood, influenced by neoadjuvant chemoradiotherapy, may serve as a predictive marker for treatment response.

PURPOSE: The utility of combination treatment with gemcitabine and camonsertib, an ataxia telangiectasia and Rad3-related kinase inhibitor (ATRi), in mediating tumor cell death was assessed in preclinical models, prompting clinical investigation. The phase 1b TRESR study (NCT04497116) aimed to evaluate the safety, tolerability and preliminary efficacy of the combination in patients with advanced solid tumors harboring DNA damage repair (DDR) gene alterations.

METHODS: Cell lines and tumor xenografts were tested across a range of dose levels and schedules. Patients (N = 76) harboring tumors with DDR gene alterations received camonsertib (80-120 mg) and de-escalating gemcitabine (1000-100 mg/m²) in 21- or 28-day cycles on an intermittent dosing regimen. Safety, tolerability, and preliminary efficacy were assessed to identify an optimal dosing regimen.

RESULTS: In pre-clinical models, low-dose camonsertib (1/3 maximum tolerated dose [MTD]) and gemcitabine led to tumor regression and was well tolerated with minimal body weight loss observed. In patients, synergistic toxicities were observed, primarily myelosuppression, resulting in gemcitabine de-escalation. The introduction of a one week on / one week off (1/1w) schedule in combination with low-dose gemcitabine allowed for spontaneous neutrophil recovery, fewer dose modifications, and improved tolerability. Tumor responses were primarily observed in patients with gynecological cancers, with tumor control maintained for greater than one year in some patients.

CONCLUSION: Camonsertib and low-dose gemcitabine demonstrated preliminary clinical activity, but due to challenging tolerability further evaluation is warranted to identify the optimal dosing regimen and subset of patients who may benefit most from this combination.

BACKGROUND: Clean intermittent catheterization (CIC) is an effective method of bladder emptying in children with neurogenic and non-neurogenic disorders that cause difficulty in urination. However, there is a lack of expert consensus on the standardized application of CIC in pediatric populations. This guideline intends to outline recommendations for standardizing CIC in children.

METHODS: A comprehensive literature review was performed by searching key academic databases, specifically PubMed, Embase, the Cochrane Library, and Web of Science. Eligible literature-including peer-reviewed clinical trials, cohort studies, case series, and expert consensus statements-was systematically identified, screened, and critically appraised. This guideline was developed according to the "WHO Handbook for Guideline Development (2nd edition)".

RESULTS: For children with symptoms of increased post-void residual (PVR) that may threaten the upper urinary tract, CIC is recommended regardless of the cause. Safe bladder capacity (SBC) and maximum bladder capacity measurement could guide optimal CIC frequency. When infants or young children require CIC, their caregivers should receive specialized training. The CIC procedure includes thorough hand and genital area cleansing, followed by careful catheter insertion to avoid contamination of surrounding tissues. Depending on the individual's ability to void, CIC will be either partial or complete. Partial CIC is recommended for individuals who are able to void partially. When implementing CIC, a collaborative model involving the patient, caregivers, and a multidisciplinary pediatric team specializing in lower urinary tract management should be adopted, and regular follow-up and efficacy assessments are required. Urodynamic study to determine the PVR and SBC in conjunction with a voiding/catheterization diary provides an objective basis for adjusting the frequency of catheterization and for determining whether to continue catheterization.

CONCLUSION: This guideline established a standardized protocol for children who require CIC to facilitate bladder emptying.

Supracondylar humerus fractures (SCHFs) are common injuries among children and typically occur after a fall on an outstretched hand. SCHFs may present with neurovascular injury specifically to the brachial artery and/or median nerve (or its deep motor branch), ulnar nerve, and/or radial nerve. Thorough examination of a patient's neurovascular status is imperative to appropriately guide treatment and determine whether a referral is needed. Minimally displaced SCHFs may be treated nonsurgically, whereas displaced injuries often require surgery. Displaced SCHFs may be treated nonsurgically with traction and splinting, but providers should expect a high rate of complications and notable disability. Of equal importance to consider is the status of the soft tissues. In resource-limited settings, such as rural or district hospitals, surgery for more severe SCHFs may not be feasible because of lack of fluoroscopy, implants, or staff adequately trained in musculoskeletal trauma. In these situations, referral to a hospital with increased resources and surgical capabilities is recommended when possible. We present an approach to the triage and treatment of SCHFs in various resource-constrained environments, broadly applicable to low- and middle-income countries.