Faculty Bibliography

In 2024, the International Anal Neoplasia Society (IANS) published the first consensus guidelines for anal cancer screening, outlining recommendations for patients who are most impacted by anal cancer. This study assesses provider knowledge and practice of these guidelines. A 37-item cross-sectional survey was distributed electronically to physicians, nurse practitioners, and physician assistants across ten specialties within a single health system. The survey assessed familiarity with anal cytology, guideline knowledge, screening practices, and barriers to screening. Descriptive statistics and bivariate analyses compared primary care providers (PCPs) to subspecialists. 87 providers completed the survey (62% physicians, 21% nurse practitioners, 17% physician assistants); 60% were Primary Care Physicians (PCPs) and 40% subspecialists. 55% had never heard of the IANS guidelines, and 76% had never performed an anal Pap test. Among the 70 providers completing the knowledge assessment, the median score was 10/20 (Inter Quartile Range (IQR) 8-12). Providers performed worst when identifying screening recommendations for solid organ transplant recipients (7% correct) and cisgender women with HIV (13% correct). No significant differences were found between PCPs and subspecialists across any measure. Qualitative responses identified scope of practice uncertainty (78%), lack of training (20%), and limited access to high-resolution anoscopy (9%) as primary barriers. Provider knowledge and utilization of anal cancer screening guidelines remain critically low across specialties. These findings highlight the urgent need for institution-wide education, standardized ordering pathways, and clear referral processes to improve screening rates.

BACKGROUND/UNASSIGNED:Ulcerative colitis is monitored through clinical, laboratory, endoscopic, and histologic measures. Persistence of histologic inflammation despite clinical and endoscopic remission is associated with disease flare. METHODS/UNASSIGNED:We compared the identification of clinically significant histologic inflammation by general and IBD-specialized gastroenterologists (GI) using a simplified binary scoring system and looked at associations with disease relapse. RESULTS/UNASSIGNED:Both general and IBD-specialized GIs identified significant inflammation associated with relapse, though IBD-specialized GIs scoring had stronger correlations with relapse. CONCLUSIONS/UNASSIGNED:Our findings suggest simple histologic assessment can inform risk stratification, and further work is needed to optimize monitoring patients with histologic inflammation despite endoscopic remission.

The heart and brain are interconnected, and risk factors that impact the heart can negatively affect the brain and cognition. Among the underlying features that foster both poor brain health and poor heart health are obesity, diabetes, physical inactivity and low sleep quality. Obesity and type 2 diabetes are associated with an increased likelihood of cognitive impairment and dementia. Further, obesity is a causal factor in obstructive sleep apnea, leading to intermittent hypoxemia, neuroinflammation and cognitive dysfunction. Cerebrovascular disease with reduced cerebral blood flow brings on stroke and elevates dementia risk. Like cardiovascular disease, cerebrovascular disease is also accelerated in the setting of obesity, likely through the same mechanisms involving endothelial dysfunction and damage to macrovasculature and microvasculature from hypertension, dyslipidemia and inflammation. Obesity is considered a risk factor for recurrent stroke. The protracted low-grade chronic elevation of inflammatory markers found with excess adiposity leads to oxidative stress and promotes both endothelial dysfunction and a pro-thrombotic state. Greater loss of brain volume has been documented in middle-aged and older adults with obesity compared with young adults with obesity. Obesity poses a threat to the cardiovascular and cerebrovascular health and well-being of individuals worldwide. Unfortunately, treatments directed at reducing caloric intake are of limited effectiveness. This review will focus on the latest research into the link between excess adipose tissue and cardiac and brain health, with attention to dietary and lifestyle interventions that may be protective of the integrity and function of the vasculature and brain.

OBJECTIVES/OBJECTIVE:To determine whether integrating an artificial intelligence (AI) decision-support system (VivoAID) into optical coherence tomography (OCT) interpretation improves diagnostic accuracy and efficiency for novice users evaluating basal cell carcinomas (BCCs). METHODS:Two dermatology research fellows completed a structured OCT training module for BCC identification using the VivoSight Dx system. Each independently reviewed 45 de-identified OCT scans (31 BCC-positive and 14 BCC-negative, negative ones included squamous cell carcinomas, keratoacanthomas, actinic keratoses and scar tissue), with ground truth established by expert clinical interpretation and histopathology, in two sessions: one unassisted and one AI-assisted. Session order was counterbalanced between learners, and scans were re-randomized for AI sessions. In unassisted sessions, learners manually classified scans; in AI-assisted sessions, they reviewed AI-annotated scans, recorded agreement/disagreement, and noted additional findings. Time-to-decision per scan was measured. A linear mixed-effects model in SAS assessed the effect of AI on decision time while accounting for scan difficulty. RESULTS:Without AI, correct BCC identification was 62% for Learner 1% and 64% for Learner 2 (combined 63%). With AI assistance, accuracy increased to 78% and 76%, respectively (combined 77%), reflecting relative improvements of 25% and 17% (combined +21%). Mean decision time decreased from 45 to 28 s for Learner 1 and from 35 to 22 s for Learner 2, yielding a combined reduction from 40 to 25 s (~38% faster). AI use significantly reduced decision time by an average of 15.1 s per image (p < 0.0001). AI standalone accuracy versus expert opinion was 64%, comparable to novice baseline performance. CONCLUSIONS:AI-enhanced OCT with VivoAID significantly improved novice users' diagnostic accuracy and efficiency, despite AI performance alone being similar to baseline novice interpretation. These data support VivoAID's role as a decision-support and potential educational tool in dermatology. Findings are limited by small sample size, single-institution design, and repeated review of the same scans. TRIAL REGISTRATION/BACKGROUND:None.

Low-grade serous ovarian carcinoma (LGSOC) is a rare epithelial malignancy characterized by frequent mitogen-activated protein kinase (MAPK) pathway alterations, hormone receptor expression, relative resistance to cytotoxic chemotherapy, and a prolonged, relapsing clinical course. Since publication of the 2023 international expert consensus, significant advances have reshaped the management of both newly diagnosed and recurrent disease. The 2026 LGSOC Consensus Conference convened an international multidisciplinary panel of experts in the field to review emerging evidence and update recommendations across pathology, molecular testing, translational biology, frontline and recurrent treatment, imaging, treatment-associated toxicity, regulatory strategy, patient advocacy, and future research priorities. Recommendations were informed by contemporary clinical evidence, multidisciplinary discussion, and patient perspectives. The updated consensus incorporates practice-changing data from NRG-GY019 supporting chemotherapy-containing postoperative therapy as the current reference approach for stage II-IV disease while recognizing selected circumstances in which endocrine monotherapy may represent individualized de-escalation. It also integrates recent advances in recurrent disease, including the US Food and Drug Administration's accelerated approval of avutometinib in combination with defactinib for KRAS-mutated LGSOC, emerging evidence supporting endocrine therapy combined with CDK4/6 inhibition, and refined guidance for biomarker-directed treatment selection, imaging assessment, toxicity management, and patient-centered survivorship. The panel emphasizes treatment-specific biomarker interpretation, multidisciplinary care, central pathology review for clinical trials, and the continued need for prospective studies addressing treatment sequencing, predictive biomarkers, and quality-of-life outcomes. This updated international consensus provides an evidence-based framework for the diagnosis and management of LGSOC while identifying priorities for future clinical research and drug development.

Palliative transarterial embolization is an established option for symptomatic renal tumors in patients who are poor surgical candidates, but conventional particle or coil techniques sacrifice uninvolved parenchyma and permit reflux-related non-target embolization. We report an 89-year-old man with atrial fibrillation, heart failure with preserved ejection fraction, and chronic obstructive pulmonary disease who presented with one month of gross hematuria, transfusion-requiring anemia, and acute kidney injury secondary to a 5.8 × 4.6 × 3.4 cm hypervascular right upper-pole renal mass extending into the collecting system. Deemed unfit for nephrectomy during the index admission, he underwent super-selective balloon-occluded embolization with ethylene vinyl alcohol copolymer delivered through a balloon-occlusion microcatheter. Hematuria resolved, hemoglobin stabilized without further transfusion, and creatinine returned to near baseline by post-procedure day 2. He remained free of hematuria for approximately 12 weeks despite resumption of apixaban. Recurrent intermittent bleeding from a persistent enhancing collecting-system component prompted readmission; surveillance imaging demonstrated a devascularized cortical tumor bed with an approximately 69% reduction in tumor volume and preserved parenchymal enhancement of the treated kidney. After interval stabilization, he underwent elective robotic nephrectomy with minimal blood loss. Pathology demonstrated clear cell renal cell carcinoma (grade 3, stage pT3a) with 50% tumor necrosis and post-embolization changes; urothelial carcinoma was excluded. Balloon-occluded ethylene vinyl alcohol copolymer embolization may provide effective temporizing hemostasis and histologically confirmed tumor devascularization in nonsurgical patients, serving in this case as a bridge to elective nephrectomy.

INTRODUCTION/UNASSIGNED:To develop and validate a single-nucleotide polymorphism (SNP)-based noninvasive prenatal cell-free DNA (cfDNA) screening algorithm capable of identifying the cfDNA signal of the living fetus in vanishing twin (VT) pregnancies and assessing that twin's aneuploidy risk. METHODS/UNASSIGNED:Prospective study enrolling participants ≥18 years old at ≥9 weeks' gestation with an ultrasound-confirmed VT at 21 US sites (August 2021 to August 2023). The study protocol specified SNP-based cfDNA screening at enrollment and at two additional 3-week intervals. Neonatal buccal swabs evaluated the SNP profile of the living fetus. Cases lost to follow-up and with missing samples were excluded. Using SNP-based technology, an algorithm to identify the living fetus was developed based on the number of fetoplacental cfDNA signals and individual fetal fraction measurements. Concordance between cfDNA in maternal plasma and newborn buccal-swab SNP profiles was used to validate the algorithm in correctly identifying the living fetus. Common aneuploidies and fetal sex were determined for the living fetus. RESULTS/UNASSIGNED:Of 136 participants enrolled, 106 met criteria for the final analysis; 45 for development and 61 for validation. In the validation cohort, median gestational age was 10.7 weeks (range: 8.0-16.1 weeks) at ultrasound diagnosis of a VT. In 93.4% of validation cases, the algorithm identified the living fetus and gave an aneuploidy result; 90.2% within the first two blood draws. At the time the living fetus was identified, 39 samples had two fetoplacental signals and 18 had one. Aneuploidy results included 56 low-risk and one high-risk result for trisomy 21. Neonatal buccal swabs confirmed that the VT algorithm correctly identified the living twin and gave a correct aneuploidy result in 57/57 cases (100%; 95% confidence interval [CI]: 93.5%, 100.0%). Among 29 participants with all three blood draws and two fetoplacental signals at enrollment, two signals persisted in 93.1% at the second blood draw and 72.4% at the third. CONCLUSIONS/UNASSIGNED:The SNP-based algorithm accurately identified the living fetus in VT pregnancies in this small study. Aneuploidy risk assessment was validated in all cases where the cfDNA signal for the living twin was identified, though these findings should be interpreted with caution given the limited sample size. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT05004337.

BACKGROUND:Medication reconciliation (MedRec) is a cornerstone patient safety practice during care transitions. However, evidence regarding the specific implementation strategies that contribute to its effectiveness remains limited. This study sought to elucidate the essential ingredients of a Medication Reconciliation Standard Operating Protocol (MedRec SOP) and their impact on enhancing patient safety outcomes compared to usual care. METHODS:We conducted a mixed-methods systematic review following PRISMA guidelines. PubMed, Web of Science, and Embase were searched for studies (January 2000-May 2024) assessing MedRec interventions compared to usual care. Data on study design, MedRec SOP components, and patient safety outcomes were extracted. Random-effects meta-analyses were performed for quantitative synthesis. RESULTS:From 7209 screened records, 70 studies were included, describing 20 distinct MedRec SOP ingredients. Meta-analysis demonstrated that MedRec significantly reduced medication discrepancies (RR = 0.39, 95% CI 0.28-0.53), adverse drug events/reactions (RR = 0.61, 95% CI 0.47-0.79), 30-day all-cause readmissions (RR = 0.73, 95% CI 0.68-0.78), emergency department visits (RR = 0.60, 95% CI 0.52-0.68), and drug-related readmissions (RR = 0.51, 95% CI 0.31-0.84). Subgroup analyses identified pharmacist-led interventions and MedRec performed at hospital admission as particularly effective strategies. The SOP component "MedRec on admission" showed the highest effective ratio (ER = 9.40). CONCLUSIONS:Our systematic review supports the implementation of MedRec programs that include some components aimed at optimizing the MedRec intervention design. MedRec is a promising implementation strategy to improve patient safety and can be incorporated into the healthcare system. PROSPERO REGISTRATION NUMBER/UNASSIGNED:CRD42024491225.