Publications by Year: 2026

One of the key pillars of Ending the HIV Epidemic is ensuring adherence to oral HIV pre-exposure prophylaxis (PrEP). Men who have sex with men (MSM) who also have substance use disorders experience multiple challenges to maintaining PrEP adherence. We developed a digital pill system (DPS) linked to a personalized adherence intervention, PrEPSteps, to address barriers to PrEP adherence, and tested the feasibility and acceptability of this system, as well as its potential for an effect on PrEP adherence. We enrolled MSM with moderate to severe substance use disorder who were on oral PrEP in a two-arm pilot randomized controlled trial. Both arms received the DPS co-encapsulated with oral PrEP. Participants in the intervention arm also received "PrEPSteps" - a personalized cognitive-behavioral adherence intervention. Primary outcomes were feasibility and acceptability of DPS + PrEPSteps. To explore potential intervention effects, adherence changes from baseline to 3-month follow-up were compared across arms. At 6-month follow-up, adherence was assessed via self-report. Thirty-six participants were enrolled, 32, completed the run-in period, 28 were randomized, and 27 completed the 3-month intervention period. Of those, 26 completed six-month follow-up. Operation of the DPS and PrEPSteps was feasible, with consistent data recording throughout the 3-month intervention period. Qualitative interviews in the intervention arm at 3 months demonstrated PrEPSteps was acceptable. Intervention arm participants had 14% higher PrEP adherence (b = 13.67, 95%CI [.77-26.57], p = .039) at 3 month follow up. This effect persisted at six months, suggesting that PrEPSteps has the potential to improve PrEP adherence and help individuals sustain adherence benefits over time.Trial registration: www.ClinicalTrials.gov identifier: NCT03512418.

INTRODUCTION: Patients admitted for hip fracture surgery may receive care from a team led either by the operating surgeon or a hospitalist.

OBJECTIVE: To describe the prevalence of the hospitalist care model for hip fracture admissions and its association with patient outcomes.

DESIGN: We conducted a retrospective cohort study of patients admitted in 2018-2019 for fracture of the head and neck of the femur (ICD10 S72.0x-2x). We compared outcomes at hospitals with low versus high use of the hospitalist care model. Our exposure was the hospital-level adoption of hospitalist care, categorized into quartiles.

PARTICIPANTS: Fee-for-service Medicare patients 66 years old or greater.

MAIN MEASURES: Length of stay (LOS), professional services (Part B) inpatient spending, specialty consultation, discharge to home, all-cause 7- and 30-day readmissions, and 30-day mortality.

KEY RESULTS: A total of 294,150 patients with hip fracture were admitted to 2466 hospitals. Patients cared for in low-use (Q1) versus high-use (Q4) hospitals did not differ meaningfully in demographic characteristics or comorbidities. Hospitals ranged in use of the hospitalist care model from 12% in low-use (Q1) hospitals to 81% in high-use (Q4) hospitals. Low-use hospitals had significantly higher inpatient consult use (unadjusted: Q1 vs Q4, 1.06 vs 0.63 consults, p < 0.0001; adjusted: -0.36, p < 0.001) and length of stay (unadjusted: Q1 vs Q4, 6.04 vs 5.94 days, p < 0.0001; adjusted: -0.09 days, p < 0.05), but no significant difference in adjusted analyses for spending, likelihood of discharge home, 7- and 30-day readmission, or 30-day mortality.

CONCLUSIONS: Hospitalist care for older adults admitted for hip fracture surgery is both common and associated with slightly shorter length of stay.

INTRODUCTION: Gestational trophoblastic neoplasia (GTN) is a highly curable malignancy arising from placental trophoblasts, yet a small subset of patients develops multidrug resistance with limited therapeutic options. The discovery of high programmed death-ligand 1 (PD-L1) expression across trophoblastic tumors has provided a compelling biological rationale for immunotherapy, particularly immune checkpoint blockade targeting the PD-1/PD-L1 axis.

OBJECTIVE: To summarize current evidence on immunotherapy in GTN, integrating biological foundations, clinical experiences, and ongoing clinical trials, and to discuss future perspectives toward individualized, fertility-preserving management.

METHODS: A narrative review was conducted according to structured PRISMA-based principles. Literature was retrieved from PubMed, Scopus, and Web of Science from 2000 to 2025 using predefined descriptors related to GTN and immunotherapy. Eligible studies included clinical trials, case series, case reports, and translational research addressing immune checkpoint inhibitors in GTN.

RESULTS: GTN exhibits high PD-L1 expression, mirroring the immune-privileged nature of the placenta. Checkpoint inhibitors alone, such as pembrolizumab, avelumab, or the combination of camrelizumab plus apatinib (that potently suppresses the kinase activity of vascular endothelial growth factor 2), have demonstrated complete and durable responses in approximately 70-80% of patients with multidrug-resistant GTN, with acceptable safety and preserved fertility.

CONCLUSIONS: Immunotherapy has expanded therapeutic GTN, transforming refractory disease as a result of its immune responsiveness. Checkpoint inhibition not only achieves high remission rates but also offers fertility preservation and long-term survivorship. The future challenge lies in optimizing combination strategies, refining biomarkers, and ensuring equitable global access to these emerging treatments.

BACKGROUND: Antibiotics are commonly prescribed in older community-dwelling adults, contributing to adverse effects, antimicrobial resistance and increased healthcare costs. Prescribing patterns in dementia are unclear, although healthcare use and goals of care change around diagnosis.

OBJECTIVE: To describe trends in antibiotic dispensing and prevalence amongst Australians aged ≥70 years, compare dispensing between those with and without dementia and identify factors associated with dispensing.

METHODS: We analysed data from 13 659 ASPREE and ASPREE-XT participants (2010-20). Antibiotic dispensing was assessed using Pharmaceutical Benefits Scheme records, with rates stratified by age group. Interrupted time-series analysis compared dispensing rates and the proportion of broad- versus narrow-spectrum antibiotics dementia case and matched controls (matched on time since randomisation, age and sex). Negative binomial regression identified factors associated with dispensing.

RESULTS: Dispensing rates increased to 1651 per 1000 person-years (95% CI: 1604-99) by year 9. Annual prevalence averaged 47%. Broad-spectrum antibiotics were dispensed twice as often as narrow-spectrum. Individuals with dementia had higher dispensing both before and after diagnosis, but dementia was not independently associated with dispensing (IRR 1.06, 95% CI: 0.95-1.18). Female sex, polypharmacy, pre-frailty and higher depressive symptom scores were linked to higher dispensing, whilst hypertension, dyslipidaemia and alcohol use were linked to lower dispensing.

CONCLUSIONS: Antibiotic dispensing in older adults remains high, dominated by broad-spectrum agents. Dementia was not independently associated with increased dispensing. Female sex, polypharmacy, pre-frailty and depressive symptoms identified groups who may benefit most from targeted antimicrobial stewardship interventions.

We describe the development and delivery of a seminar to train emerging geriatric leaders from diverse disciplines in quality improvement science utilizing the Institute for Healthcare Improvement Model for Improvement. We implemented a six-session synchronous virtual quality improvement seminar employing a "flipped classroom" approach consistent with experiential learning, involving pre-work, in-session application through exercises and work-time, and homework, over three cohorts of learners (2022-2024). Content was adapted through formative evaluation in year one, with additional refinements in years two and three. Of those who completed a summative evaluation survey in year three (N = 23, 46% response), 60.8% pursued a quality improvement project described as completed (21.7%) or in progress (39.1%); 21.7% had presentations or publications about their projects. Most participants rated seminar topics and tools as somewhat or very useful (on a 1-3 scale), particularly the aims statement (M = 2.95, SD = 0.22), and project planning tools (M = 2.81, SD = 0.40). Participants agreed or strongly agreed they were using seminar information now (82.6%) and/or in the future (91.3%), and that their project improved patient care (60.8%). A quality improvement seminar for interprofessional emerging geriatric leaders was well received and may contribute to dissemination of scholarly products and improvements in patient care.

Correction for 'Ciprofloxacin-loaded bioadhesive hydrogels for ocular applications' by Islam A. Khalil et al., Biomater. Sci., 2020, 8, 5196-5209.

RATIONALE & OBJECTIVE: Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue.

STUDY DESIGN: A cross-sectional study.

SETTING & PARTICIPANTS: The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study.

EXPOSURES: Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.

OUTCOME: Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.

ANALYTICAL APPROACH: Logistic regression models.

RESULTS: Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99).

LIMITATIONS: Fatigue assessed at one point in time.

CONCLUSIONS: In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.

RATIONALE & OBJECTIVE: The Kidney Precision Medicine Project is obtaining kidney biopsies from people with chronic kidney disease (CKD) and acute kidney injury for comprehensive clinical, histopathological, and molecular characterization. Here, we describe histopathological findings from a subset of kidney biopsies from adults with CKD.

STUDY DESIGN: Descriptive case series of histopathology findings from adjudicated CKD biopsies.

SETTING & PARTICIPANTS: Kidney Precision Medicine Project enrolled adults with CKD and diabetes (DKD) and/or hypertension (HCKD) with persistent eGFR 30-59 mL/min/1.73 m2, urine albumin-creatinine ratio ≥30 mg/g, or urine protein-creatinine ratio ≥150 mg/g. Clinicopathological adjudication by study nephrologists and kidney pathologists was completed as part of a pilot program for 39 participants enrolled 2019-2022. Clinicians completed surveys to assess impacts of biopsies on diagnosis, prognosis, and management.

EXPOSURES: This is a descriptive study without defined exposures.

OUTCOMES: Characterization of glomerular, tubulointerstitial, and vascular histopathological features across CKD biopsies.

ANALYTICAL APPROACH: Continuous variables were summarized as mean (standard deviation) or median (interquartile range); categorial variables were summarized as count (percentage).

RESULTS: Participants' mean age was 59 years, 59% were female. Mean eGFR was 55 mL/min/1.73 m2; median urine albumin-creatinine ratio and urine protein-creatinine ratio were 81 mg/g and 211 mg/g, respectively. Among DKD-enrolled participants (N = 28), 15 (54%) had a primary diagnosis of diabetic nephropathy, 3 (11%) had hypertension-associated nephropathy, 2 (7%) had other glomerular diseases, and 8 (29%) had nonspecific findings. Among HCKD-enrolled participants (N = 11), 5 (46%) had hypertension-associated nephropathy and 6 (55%) had nonspecific findings. A range of glomerular, tubulointerstitial, and vascular findings was observed. 26% of clinicians stated results were different than expected; 77% stated results affected prognostic discussions.

LIMITATIONS: Small sample size and lack of longitudinal data limit generalizability.

CONCLUSIONS: Kidney biopsies in people with common causes of CKD demonstrate a broad range of histopathology and may have clinical utility. Unsuspected disease processes and unexpected and nonspecific findings precluding a definitive diagnosis are often present.