The Art of Clinical Negotiation.

The art of clinical negotiation is an important, yet underappreciated aspect of medicine. Key components of negotiation include the need to consider principles over personalities, to explore all options before deciding on the best course, to realize if consensus cannot be achieved then compromise may still be possible, to work from evidence to incorporate contextual factors, and to stay evidence based. These principles can be helpful in many settings, including contract negotiation, drug pricing, and research.

Virus nanotechnology for intratumoural immunotherapy.

Viruses can be designed to be tools and carrier vehicles for intratumoural immunotherapy. Their nanometre-scale size and shape allow for functionalization with or encapsulation of medical cargoes and tissue-specific ligands. Importantly, immunotherapies may particularly benefit from the inherent immunomodulatory properties of viruses.

Cannabidiol prescribing in the United States: An analysis of real-world data.

Background: Off-label prescribing of Epidiolex® (pharmaceutical cannabidiol) comes with both potential benefits and risks for patients. The aims of this study were to: (1) identify the percentage of people prescribed Epidiolex® who do not have diagnostic indications for Epidiolex® (Lennox Gastaut Syndrome [LGS], Dravet Syndrome [DS], and Tuberous Sclerosis Complex [TSC]) and (2) examine potential co-prescribing of medications that may interact with Epidiolex®.

Method: Using TriNetX analytics, a web-based database of de-identified electronic health records spanning >110 million people in the United States, we analyzed 4214 people receiving Epidiolex® in 2022.

Cost-effectiveness of Oral Immunotherapy for Egg Allergy According to Age of Therapy Commencement.

Background: Egg oral immunotherapy (OIT) can induce desensitization or remission of egg allergy in children.

Objective: To determine the cost-effectiveness of OIT for raw egg allergy in school-age children compared with egg avoidance, and the most cost-effective age at which to commence treatment.

Methods: A decision-analytic Markov model estimated the health and cost outcomes of 1,000 children aged 4 years with egg allergy, comparing different ages of OIT commencement (ages 4-12, inclusive) versus ongoing egg avoidance.

Feasibility, Acceptability, and Validity of Home Continuous Glucose Monitoring-Based Oral Glucose Tolerance Test in Youth.

Context: Home-based approaches to type 2 diabetes (T2D) screening in youth may facilitate early diagnosis.

Objective: To evaluate feasibility, acceptability, and validity of a continuous glucose monitoring (CGM)-based oral glucose tolerance test (OGTT).

Design: Prospective observational study.

Strengths-Based Assessment and Inclusive Language for Patients With Intellectual and Developmental Disabilities.

Pediatric dermatology patients with intellectual and developmental disabilities (IDD) and comorbid cutaneous conditions often face barriers to effective healthcare due to differences in communication preferences and sensitivities to environmental factors. The clinical intake process serves as a potential intervention point to help better understand and meet patients' needs. Strengths-based assessment and considerations around identity-first versus person-first language are tools that can improve the clinical intake process in pediatric dermatology.

Reducing Deep Sedation and Benzodiazepine Use in Mechanically Ventilated Patients During Critical Care Transport: A Quality Improvement Initiative.

Objective: Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport.

The Management of Non-Muscle-Invasive Bladder Cancer in a Veteran Patient Population: Issues and Recommendations.

The ability of the Veterans Health Administration System to care for veterans with bladder cancer is influenced by the increased complexity of both veterans and the system's capacity to do so, which is determined by personnel and equipment allocation. Herein, we review the guidelines for bladder cancer management in the context of this population and highlight unique veteran characteristics that impact the delivery of bladder cancer care within the Veterans Health Administration System. There are opportunities for standardization and implementation, which can improve the quality of this care, and we summarize the questions for which coordinated research efforts may provide answers.

Implementation of Electronic Medical Record Interventions to Maximize Opioid Disposal after Surgery in Routine Clinical Practice.

Background: Despite guideline directed opioid prescribing after surgery, many patients retain excess opioids. Leftover pills increase the risk for misuse, diversion, and dependency. It is unclear whether interventions applied in routine clinical practice can increase excess opioid disposal rates.

Patient-provider interactions about cannabis for therapeutic purposes vary as a function of provider type: A pilot study.

Background And Objectives: Limited evidence guides the efficacy and safety of cannabis for therapeutic purposes (CTP). Healthcare providers lack requisite knowledge to advise and support patients. This study aimed to describe and compare several aspects of initial CTP interactions across different provider types.

Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters.

Importance: Understanding the diagnostic accuracy of postoperative trial of void (TOV) parameters is important for decision making related to postoperative catheterization.

Objective: The aim of the study was to compare the diagnostic accuracies of common postoperative TOV parameters.

Design: The study population comprised a prospective cohort undergoing outpatient urogynecologic procedures at a tertiary referral center from September 2018 to June 2021.

Gut microbiome shifts in adolescents after sleeve gastrectomy with increased oral-associated taxa and pro-inflammatory potential.

Background: Bariatric surgery is highly effective in achieving weight loss in children and adolescents with severe obesity, however the underlying mechanisms are incompletely understood, and gut microbiome changes are unknown.

Objectives: 1) To comprehensively examine gut microbiome and metabolome changes after laparoscopic vertical sleeve gastrectomy (VSG) in adolescents and 2) to assess whether the microbiome/metabolome changes observed with VSG influence phenotype using germ-free murine models.

Design: 1) A longitudinal observational study in adolescents undergoing VSG with serial stool samples undergoing shotgun metagenomic microbiome sequencing and metabolomics (polar metabolites, bile acids and short chain fatty acids) and 2) a human-to-mouse fecal transplant study.

Family-Centered Care and Collaboration: A Scoping Review of Medical Guidance for Parental Substance Use.

Background: A significant proportion of US families are affected by substance use disorders. Both child- and adult- serving systems are called upon to care for families, yet the disciplines involved inherently have different priorities, preventing a true family-centered care model.

Objectives: The purpose of the scoping review was to explore the alignment of current national guidance related to the medical care of families affected by substance use disorders (SUD).

The prognostic utility of heart rate and blood pressure response to regadenoson stress.

Background: Although heart rate response (HRR) to regadenoson stress has been shown to be a strong predictor of outcome, it has not been investigated in a large all-comers cohort. The prognostic utility of systolic blood pressure response (SBPR) has not been investigated in comparison with HRR.

Methods And Results: In a retrospective cohort of 10,227 patients undergoing regadenoson stress single-photon emission computed tomography myocardial perfusion imaging (MPI), HRR, and SBPR were calculated as 100×(peak hyperemia value-baseline value)/baseline value.

The Grenada Learning and Memory Scale: Psychometric features and normative data in Caribbean preschool children.

Objective: Neuropsychological assessment of preschool children is essential for early detection of delays and referral for intervention prior to school entry. This is especially pertinent in low- and middle-income countries (LMICs), which are disproportionately impacted by micronutrient deficiencies and teratogenic exposures. The Grenada Learning and Memory Scale (GLAMS) was created for use in limited resource settings and includes a shopping list and face-name association test.

Peri-Intubation Push-Dose Vasopressors in Critical Care Transport.

Objective: Push-dose vasopressors are commonly administered to attenuate peri-intubation hypotension. The aim of this study was to describe the current use of push-dose vasopressors in critical care transport.

Methods: This was a retrospective chart review of adult patients (≥ 18 years) intubated between January 2017 and May 2023 who received push-dose vasopressors.

Timing and content of serious illness conversations for patients with advanced heart failure in a specialty-aligned palliative care service.

Background: Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions.

Objectives: To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal).

Methods: In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021.

Food allergy prevention through the decades: An ounce of humility is worth a pound of cure.

Food allergy prevention has undergone a significant transformation over the past 3 decades. This review provides an overview of the evolution of food allergy prevention, highlighting changes in guidance, cost-effectiveness of prevention, the role of shared decision-making, and the emergence of oral immunotherapy for those in whom primary prevention fails. Changes to food allergy prevention over recent decades can be conceptualized into five epochs, which have followed a general trend of loosening restrictions on the allergen introduction timeline.

Modeling Historic Arsenic Exposures and Spatial Risk for Bladder Cancer.

Arsenic is a bladder carcinogen though less is known regarding the specific temporal relationship between exposure and bladder cancer diagnosis. In this study, we modeled time-varying mixtures of arsenic exposures at many historic temporal windows to evaluate their association with bladder cancer risk in the New England Bladder Cancer Study. We used arsenic exposure estimates up to 60 years prior to study entry and compared the goodness of fit of models using these mixtures to those using summary measures of arsenic exposures.