Top Ten Tips Palliative Care Clinicians Should Know About Rheumatology.

Systemic autoimmune rheumatic diseases (SARDs) consist of a broad range of immune-mediated multisystem diseases. They are chronic, incurable illnesses that often present in early to mid-life and can be associated with a high symptom burden, disability, and early mortality. Treatment guidelines for similar chronic, life-limiting conditions with uncertain disease courses now recommend palliative care (PC) assessment at the time of diagnosis.

Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans.

Importance: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid.

Objective: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid.

Transthyretin Cardiac Amyloidosis: Current and Emerging Therapies.

Purpose Of Review: In this article, we describe current and newer TTR stabilizers, TTR silencers which include small interfering RNA agents (siRNA), antisense oligonucleotides (ASO) and CRISPR-Cas9 gene editing, and TTR depleters, which investigates the use of monoclonal antibodies to remove amyloid fibril deposits for patients with advanced disease.

Recent Findings: Once thought to be a rare and fatal condition, increased recognition, improved non-invasive diagnostic tools, and the explosive development of novel therapies, has transformed the landscape of transthyretin amyloid cardiomyopathy (ATTR-CM). Advances in cardiac imaging with respect to echocardiography, cardiac magnetic resonance imaging (CMR), and radionuclide bone scintigraphy has increased the diagnosis of ATTR-CM over the last twenty years.

Performance of the FORD Versus Other Available Models for the Noninvasive Prediction of Pulmonary Hypertension in Patients with Interstitial Lung Disease.

Purpose: Pulmonary hypertension (PH) is associated with morbidity and mortality in patients with interstitial lung disease (ILD). Several prediction models have been proposed to predict PH in ILD patients. We sought to discern how previously described prediction models perform in predicting PH in patients with ILD.

Blockchain Technology: Overview and Applications in Radiology.

Blockchain technology (BCT) enables the building of a distributed decentralized network that securely stores and exchanges unchangeable data, controlled by individual users. In healthcare, BCT may help streamline interoperability and information transmission while guaranteeing medical record authenticity and safeguarding patient privacy. Possible applications in radiology include patient-controlled image sharing, facilitation of multiinstitutional research, and artificial intelligence integration.

Outcomes of Intravitreal Aflibercept 8 mg in Eyes With Neovascular Age-Related Macular Degeneration Previously Treated With Faricimab.

Background And Objective: To assess the efficacy of intravitreal aflibercept 8 mg in treating neovascular age-related macular degeneration (nAMD) in patients previously treated with faricimab.

Patients And Methods: A retrospective study was conducted on nAMD patients with suboptimal response to faricimab injections who were switched to intravitreal aflibercept 8 mg. Visual acuity (VA) and optical coherence tomography features were evaluated.

Digital phenotyping of social functioning and employment in people with schizophrenia: Pilot data from an international sample.

Aim: Individuals living with schizophrenia experience significant impairments in social functioning. As a major clinical outcome, social functioning requires appropriate measurement tools that can capture its dynamic nature. Digital phenotyping, using smartphone technology to collect high volume ecologically valid data, can potentially capture these facets.

Advances in understanding dietary fiber: Classification, structural characterization, modification, and gut microbiome interactions.

Gut microbiota and their metabolites profoundly impact host physiology. Targeted modulation of gut microbiota has been a long-term interest in the scientific community. Numerous studies have investigated the feasibility of utilizing dietary fibers (DFs) to modulate gut microbiota and promote the production of health-beneficial bacterial metabolites.

Aprocitentan for Blood Pressure Reduction in Black Patients.

Background: Black individuals frequently present with resistant hypertension and disproportionately increased cardiovascular risk. We investigated the blood pressure (BP)-lowering effect of the dual endothelin receptor antagonist aprocitentan in Black individuals enrolled in the PRECISION study (Parallel-Group, Phase 3 Study with Aprocitentan in Subjects with Resistant Hypertension).

Methods: Patients with confirmed resistant hypertension were randomized to aprocitentan 12.

Directional Spatial and Spectral Attention Network (DSSA Net) for EEG-based emotion recognition.

Significant strides have been made in emotion recognition from Electroencephalography (EEG) signals. However, effectively modeling the diverse spatial, spectral, and temporal features of multi-channel brain signals remains a challenge. This paper proposes a novel framework, the Directional Spatial and Spectral Attention Network (DSSA Net), which enhances emotion recognition accuracy by capturing critical spatial-spectral-temporal features from EEG signals.

Posterior Cerebral Circulation Insufficiency Due to Internal Carotid Artery Stenosis With an Atypical Vertebral Artery Originating From the Internal Carotid Artery Territory.

Aberrant anatomical variation of the vertebral artery (VA) from an internal carotid artery (ICA) is considered a rare finding. The incidence of this phenomenon can lead to patients suffering from posterior circulation neurological deficit if the ICA becomes significantly diseased. VA atypical anatomical origin is considered one of the rare pathologies, not only precipitating neurovascular incidents but equally leading to severe difficulty in VA dissection and surgical exposure, especially in carotid artery procedures.

Vascularized composite allograft deceased donation in the United States.

Vascularized composite allograft (VCA) transplantation represents a significant advancement in reconstructive surgery and offers hope to individuals who experienced congenital disorders or severe tissue injuries to restore physical appearance, function, and enhance quality of life. VCA recovery introduces complexities to conventional solid organ recovery, and there remain concerns regarding the potential impact of VCA recovery on non-VCA organs for transplant. The current retrospective study examines deceased donor characteristics and observed-to-expected (O/E) organ yield ratios for 51 VCA donors recovered in the US between July 4, 2014 and March 31, 2024, compared with a contemporary cohort of non-VCA donors recovered in 2023.

Impact of Expanded Eligibility for Veterans With Other Than Honorable Discharges on Treatment Courts and VA Mental Health Care.

Background: US Department of Veterans Affairs (VA) eligibility policies now allow comprehensive mental and behavioral health care services to be provided to veterans who received an Other Than Honorable (OTH) discharge upon separation from service. Research has shown a disproportionate mental health burden and elevated rates of criminal-legal involvement among these veterans. Eligibility policy shifts may impact programs and services designed to support veterans with criminal-legal involvement, such as veterans treatment courts.

Initial clinical experience with [Lu]Lu-PNT2002 radioligand therapy in metastatic castration-resistant prostate cancer: dosimetry, safety, and efficacy from the lead-in cohort of the SPLASH trial.

Introduction: SPLASH (NCT04647526) is a multicenter phase III trial evaluating the efficacy and safety of [Lu]Lu-PNT2002 radioligand therapy in metastatic castration-resistant prostate cancer (mCRPC). This study leveraged a lead-in phase to assess tissue dosimetry and evaluate preliminary safety and efficacy, prior to expansion into a randomized phase. Here we report those results.

Histopathology of incidental non-neoplastic findings in transgenic CByB6F1-Tg(HRAS)2Jic mice used in toxicity studies.

This technical report presents a collection of illustrative images and concise descriptions of non-neoplastic microscopic findings noted in transgenic CByB6F1-Tg(HRAS)2Jic (Tg.rasH2) mice from 26-week-carcinogenicity studies. A unique finding in the Tg.

A Group Approach to Clinical Research Mentorship at a Veterans Affairs Medical Center.

Background: The US Department of Veterans Affairs (VA) is committed to conducting research that improves the health and quality of life of veterans. Mentorship is vital for developing and advancing a novice VA investigator's research agenda; however, there are several barriers to effective research mentorship.

Observations: The VA Clinical Research Mentorship Program was developed to assist clinician investigators with writing and submitting competitive grant applications.

Impact and Recovery of VHA Epilepsy Care Services During the COVID-19 Pandemic.

Background: The Epilepsy Centers of Excellence (ECoE) is a network of facilities within the Veterans Health Administration that evaluates and treats veterans with epilepsy and seizure disorders. This article outlines how the COVID-19 pandemic impacted ECoE services and recovery.

Methods: Directors of 17 ECoEs were surveyed 4 times between May 2020 and July 2022 on 5 domains: functioning of outpatient epilepsy clinics, outpatient electroencephalogram, epilepsy monitoring unit, anticipated permanent operational changes, and utility of national and local recommendations.

Associations of Concordant and Shared Lung Cancer Screening Decision Making with Decisional Conflict: A Multi-Institution Cross-Sectional Analysis.

Unlabelled: Many organizations recommend structured communication processes, including formal shared decision making (SDM), for patients undergoing lung cancer screening (LCS) using low-dose computed tomography (LDCT). We sought to understand if concordant and shared LCS decision making was associated with decisional conflict. In this prospective, observational study, we enrolled patients from 3 medical centers (2 Veterans Health Administration, 1 academic facility) after a decision-making interaction about undergoing LCS but before receiving the LDCT.

The Impact of a Metformin Recall on Patient Hemoglobin A1c Levels at a VA Network.

Background: In May 2020, the US Food and Drug Administration (FDA) asked 5 pharmaceutical companies to voluntarily recall some formulations of metformin due to contamination. This observational study sought to provide insight changes in hemoglobin A (HbA) levels when veterans switched to alternative antihyperglycemic agents following the recall.

Methods: This study included veterans aged ≥ 18 years with type 2 diabetes who were receiving health care from Veterans Integrated Service Network 6 and had an active metformin sustained-action (SA) prescription as of June 1, 2020.

Multidisciplinary Amputation Prevention at the DeBakey VA Hospital: Our First Decade.

Background: In 2011, the Veterans Health Administration (VHA) undertook multidisciplinary efforts to improve care for patients with nonhealing foot ulcers and reduce leg amputation rates. This article examines the impact of interdisciplinary care for amputation prevention in the VHA.

Methods: The VHA patient population was characterized using internal registries.

Unraveling the interconnectedness between physician burnout and symptoms of depression, anxiety, and stress: a network analysis among Chinese psychiatrists.

Background: The COVID-19 pandemic significantly increased the levels of burnout and symptoms of depression, anxiety, and stress among healthcare professionals. However, research on the interrelations between burnout and psychological symptoms is scarce, particularly among psychiatrists. This study addresses this gap in a national sample.

Management of a COVID-19 outbreak using a multidisciplinary approach and infection prevention control practices at a community living center in Veterans Administration Hospital, North Texas.

Background: The increase in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cases due to the omicron strain led to reduced acute care hospital beds at the Veterans Administration (VA) Hospital, North Texas; veterans with non-severe coronavirus disease 2019 (COVID-19) disease were managed at a community living center (CLC), a VA nursing home. The management of non-severe COVID-19 in VA nursing homes has not been extensively described.

Methods: We describe resident characteristics and outcomes, and infection control practices implemented during 2 COVID-19 outbreak periods (January 12-February 15, 2022, June 28-July 14, 2023).