Faculty Bibliography
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school:LISOM
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13530
Cost comparison of phosphodiesterase type 5 inhibitors: rural vs urban New York State counties and online pharmacies
BACKGROUND/UNASSIGNED:Phosphodiesterase type 5 (PDE5) inhibitors are used to treat erectile dysfunction, but their cost can limit access. AIM/UNASSIGNED:This study examines PDE5 inhibitors pricing and demographic data across rural and urban New York State (NYS) counties, as well as small, large, and online pharmacies. METHODS/UNASSIGNED:-tests, Wilcoxon rank-sum, and Kruskal-Wallis tests were performed using R Version 4.4.1 (2024-06-14). OUTCOMES/UNASSIGNED:The cash price of the PDE5 inhibitors across various pharmacy chain types and county types. RESULTS/UNASSIGNED: = .177). CLINICAL TRANSLATION/UNASSIGNED:This study aims to highlight the pricing variability of PDE5 inhibitors to help patients identify cost-effective options to circumvent potential financial barriers. STRENGTHS AND LIMITATIONS/UNASSIGNED:This study was the first to examine PDE5 inhibitors pricing specifically within rural populations while also providing a comparative analysis of pricing differences between small and large pharmacy chains serving these communities. The study's limitations include a relatively small sample size of rural and small chain pharmacies resulting in power levels of 75% and 69%, respectively, which may impact the generalizability of the findings. CONCLUSION/UNASSIGNED:Enhancing drug price transparency for PDE5 inhibitors is vital for increasing access and pricing flexibility.
PMCID:12151535
PMID: 40496717
ISSN: 2050-1161
CID: 5869232
When Accelerated MD Program Is Not the Right Path: The Why and How to Support Accelerated Learners in the Transition to the 4-Year Program
Accelerated 3-year medical school programs (A3YP) allow students to complete medical school in 3 years rather than the traditional 4-year program (4YP). This paper describes the perspective of 14 A3YPs, exploring the rate of and reasons for transition out of an accelerated pathway into a traditional 4YP. As of 2023, 19% of students in A3YP transitioned to 4YP. The authors provide practical recommendations to guide transitions based on pooled experiences and expert consensus from members of the Consortium of Accelerated Medical Pathway Programs (CAMPP). Having clear policies that define academic, clinical, and professional expectations and processes to guide transition is important.
PMCID:12228619
PMID: 40625988
ISSN: 2156-8650
CID: 5890562
Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection
BACKGROUND/UNASSIGNED:Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals. METHODS/UNASSIGNED:This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression. RESULTS/UNASSIGNED:=0.01). CONCLUSIONS/UNASSIGNED:In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.
PMID: 40143807
ISSN: 1524-4628
CID: 5816392
Occupational and Environmental Cholangiocarcinoma-Related Toxic Exposures
Cholangiocarcinoma (CCA) is a malignancy that originates from the epithelial cells of the biliary system. Despite advancements in medical diagnostic techniques, CCAs remain a challenge to detect due to their silent clinical progression, making it difficult to diagnose these diseases. There are several well-established risk factors for CCA, including biliary tract infection and inflammation. However, there is also growing evidence that community and occupational exposures play a significant role in the development of bile duct cancers. This review examines the geographical distribution of these risk factors and the importance of surveillance in individuals exposed to these toxins who are more prone to developing CCA.
PMCID:12133134
PMID: 40469206
ISSN: 2341-4545
CID: 5862612
Recognizing and Responding to Child Neglect
Child neglect is a toxic stress with harmful outcomes. It is the most prevalent form of child maltreatment with continued trends for underreporting due to a lack of a widely accepted definition. Given this reality, pediatric clinicians may rely on subjective thresholds for its diagnosis. There are risk factors for neglect countered by protective factors that builds resilience in families. Pediatric clinicians are positioned to prevent neglect through their relationships with families across the life span. Currently, there are evidence-based screening tools available to ensure the skillful differentiation between the signs and symptoms attributable to neglect versus poverty.
PMID: 40335174
ISSN: 1557-8240
CID: 5872682
Complete/Near-Complete Itch Response Observed in Patients with Moderate-to-Severe Atopic Dermatitis Initiating Dupilumab: 3-Year, Real-World, Interim Data from the PROSE Registry
INTRODUCTION/BACKGROUND:Atopic dermatitis (AD) is a chronic, relapsing disease that can start at any age and has a significant negative impact on quality of life, including a significant itch burden. Here we report the proportion of patients in a real-world study achieving a complete/almost complete resolution of itch, as measured by the Peak Pruritus Numeric Rating Scale (PP-NRS) and improvement in overall disease severity score (ODS), in patients aged ≥ 12 years with moderate-to-severe AD up to 3 years after commencing dupilumab treatment. METHODS:PROSE is an ongoing, prospective, observational, multicenter registry in the USA and Canada, collecting real-world data from patients aged ≥ 12 years with moderate-to-severe AD who initiated dupilumab in accordance with country-specific prescribing information. Assessments include patient-reported PP-NRS (range 0-10) and clinician-measured ODS score (range 0-4). RESULTS:A total of 857 patients were enrolled, of whom 42% were male and 6.4% were adolescents aged ≥ 12 to < 18 years. The mean [standard deviation (SD)] age was 40.1 (17.9) years, and the duration of AD was 17.4 (16.2) years. The subsequent mean (SD) duration of dupilumab treatment was 23.1 (13.7) months. The proportion of patients achieving complete/almost complete itch resolution (PP-NRS score of 0 or 1) improved consistently over time, from 2.7% (17/622) of patients at baseline to 56.3% (58/103) at 3 years. Additionally, by year 3, 65.1% (54/83) of patients had an ODS score of no/minimal disease (score of 0 or 1), versus 2.2% (19/852) at baseline. CONCLUSIONS:In this real-world setting of the PROSE registry, adult and adolescent patients with moderate-to-severe AD followed up for up to 3 years after the initiation of dupilumab treatment experienced sustained and substantial improvement in pruritus and ODS, using the stringent endpoints of PP-NRS 0 or 1 and ODS 0 or 1. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier: NCT03428646.
PMID: 40234297
ISSN: 2193-8210
CID: 5827852
Long-term Effects of Mavacamten on Patients Based on Hypertrophic Cardiomyopathy Pathogenic Genetic Variant Status: Insights from VALOR-HCM Trial
PMID: 40163785
ISSN: 2574-8300
CID: 5818792
International journal of psychology = Journal international de psychologie. 2025:60(3).DOI: 10.1002/ijop.70047
Physiological and Psychological Resilience Among Healthcare Workers in COVID-19 Units-The Protective Role of Religious Beliefs
The COVID-19 pandemic profoundly impacted global health, with disproportionate consequences for healthcare workers (HCWs). Religious beliefs and practices may improve psychological resilience by fostering community, providing purpose and giving meaning to hardships. Yet, how religiosity impacts HCWs during a time of crisis is unclear. We therefore performed a cross-sectional study to investigate how religiosity contributes to resilience among HCWs who were routinely exposed to high levels of stress during the pandemic, through a physiological measure (the Auditory Sustained Attention Test; ASAT) and psychological self-reports. Forty-two HCWs were recruited from COVID-19 units and 44 HCWs from general internal medicine units during June and July 2022. COVID-19 HCWs showed significantly elevated emotional and attentional dysregulation with the ASAT, as measured by acoustic startle and prepulse inhibition, that was undetectable with self-reports. Furthermore, after dividing the HCWs into a 'high' and 'low' religiosity group, those in the 'low' group showed higher emotional and attentional dysregulation with the ASAT. Findings suggest that the ASAT has greater sensitivity at detecting emotional and attentional dysregulations than self-reports. Moderate or high religiosity may lead to better performance on the ASAT which could suggest greater resilience to mental health problems in the face of a crisis.
PMCID:11973412
PMID: 40189791
ISSN: 1464-066x
CID: 5823552
5-Year Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients
BACKGROUND:The PARTNER 3 (Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients with Aortic Stenosis) trial compared SAPIEN 3 transcatheter aortic valve replacement (TAVR) to surgery in low-risk patients with symptomatic, severe aortic stenosis. Echocardiographic outcomes at 5 years are unknown. OBJECTIVES/OBJECTIVE:This study sought to compare 5-year echocardiographic results of TAVR and surgery in the PARTNER 3 trial. METHODS:Echocardiograms for 1,000 randomized patients were obtained at baseline, 30 days, 1 year, and annually through 5 years and were analyzed by a core lab consortium. The composite primary endpoint of death, stroke, or rehospitalization was adjudicated by a clinical events committee. RESULTS:At 5 years, ≥ mild aortic regurgitation was higher following TAVR vs surgery (24.5% vs 6.3%; P < 0.001), with low ≥ moderate aortic regurgitation in both groups. TAVR patients had higher mean transaortic gradient (12.8 ± 6.5 vs 11.7 ± 5.6 mm Hg; P < 0.001), stroke volume index (44.6 ± 9.7 vs 41.1 ± 9.2; P < 0.0001), and aortic valve area (1.87 ± 0.46 vs 1.82 ± 0.46; P = 0.895). Fewer TAVR patients had low-flow stroke volume index (P < 0.001) and left ventricular hemodynamic burden (valvulo-arterial impedance; P < 0.01). Tricuspid annular plane systolic excursion was also higher with TAVR (P < 0.001), as was right ventricular-to-pulmonary artery coupling (P < 0.0001). In the combined cohorts, 30-day moderate to severe prosthesis-patient mismatch, mild to severe aortic regurgitation, or low stroke volume index were not predictive of clinical outcomes; only low right ventricular-to-pulmonary artery coupling and high valvulo-arterial impedance at 30 days were associated with increased risk of the 5-year composite primary endpoint. CONCLUSIONS:In low-risk patients with severe aortic stenosis, TAVR, compared to surgery, was associated with similar, stable valve hemodynamics at 5 years with less frequent low-flow state, lower valvulo-arterial impedance, and better right ventricular function. (PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients with Aortic Stenosis [P3]; NCT02675114).
PMID: 40243974
ISSN: 1876-7591
CID: 5828622
A Phase 1/2 multicenter trial of DKN-01 as monotherapy or in combination with docetaxel for the treatment of metastatic castration-resistant prostate cancer (mCRPC)
BACKGROUND:Dickkopf-related protein 1 (DKK1) is a Wingless-related integrate site (Wnt) signaling modulator that is upregulated in prostate cancers (PCa) with low androgen receptor expression. DKN-01, an IgG4 that neutralizes DKK1, delays PCa growth in pre-clinical DKK1-expressing models. These data provided the rationale for a clinical trial testing DKN-01 in patients with metastatic castration-resistant PCa (mCRPC). METHODS:(combination) for men with mCRPC who progressed on ≥1 AR signaling inhibitors. DKK1 status was determined by RNA in-situ expression. The primary endpoint of the phase 1 dose escalation cohorts was the determination of the recommended phase 2 dose (RP2D). The primary endpoint of the phase 2 expansion cohorts was objective response rate by iRECIST criteria in patients treated with the combination. RESULTS:18 pts were enrolled into the study-10 patients in the monotherapy cohorts and 8 patients in the combination cohorts. No DLTs were observed and DKN-01 600 mg was determined as the RP2D. A best overall response of stable disease occurred in two out of seven (29%) evaluable patients in the monotherapy cohort. In the combination cohort, five out of seven (71%) evaluable patients had a partial response (PR). A median rPFS of 5.7 months was observed in the combination cohort. In the combination cohort, the median tumoral DKK1 expression H-score was 0.75 and the rPFS observed was similar between patients with DKK1 H-score ≥1 versus H-score = 0. CONCLUSION/CONCLUSIONS:DKN-01 600 mg was well tolerated. DKK1 blockade has modest anti-tumor activity as a monotherapy for mCRPC. Anti-tumor activity was observed in the combination cohorts, but the response duration was limited. DKK1 expression in the majority of mCRPC is low and did not clearly correlate with anti-tumor activity of DKN-01 plus docetaxel.
PMID: 38341461
ISSN: 1476-5608
CID: 5635542
