Faculty Bibliography

BACKGROUND/OBJECTIVES/OBJECTIVE:The Family-centered Adolescent Sperm banking values clarification Tool (FAST) was developed to facilitate sperm banking communication and decision-making pre-cancer treatment. The FAST was tested in a pilot parallel randomized controlled trial (Fertility Preservation Discussions And Decisions: "FP-DAD"-NCT04268004), aiming to (i) assess feasibility/acceptability of FP-DAD; and (ii) examine efficacy regarding banking attempts (yes/no) and decision quality. Differences in decision quality by banking attempt were explored. DESIGN/METHODS/METHODS:Males (12-25 years, new cancer diagnosis) and caregivers were randomized to standard of care (fertility consult) or FP-DAD (fertility consult + FAST + interventionist-led discussion). One month later, FP-DAD participants completed acceptability surveys. Both arms completed the Brief Subjective Decision Quality measure. Descriptive statistics, chi-square, and independent samples t-tests/mixed-models examined relationships between variables. RESULTS:Acceptability ratings of FP-DAD were high (88%-100%). Recruitment and participation challenges limited the final sample size (21 adolescents and 32 caregivers). Banking attempts (67% in standard of care vs. 82% in FP-DAD) did not differ by arm. While decision quality was not significantly different between groups, effect sizes were medium-large for four of six items for adolescents (d = 0.6 to -0.90) and two of six for caregivers (d = 0.36 to -0.78). Decision quality was significantly higher across several domains among those who banked. CONCLUSIONS:FP-DAD had high acceptability, though feasibility challenges (e.g., time contraints) limited full family participation. Findings showed limited efficacy, but effect sizes suggest this may be due to sample size. Relationships between banking attempts and decision quality emphasize banking benefits. Findings will inform adaptations to the FAST for clinical implementation.

OBJECTIVE:To describe, via latent variable mixture modelling, distinct post-radical prostatectomy (RP) patient-reported outcome (PRO) recovery profiles, which are positioned to complement currently disseminated statistical averages for shared decision-making. PATIENTS AND METHODS/METHODS:Patients undergoing RP and completing the 26-item Expanded Prostate Cancer Index Composite 12 months after surgery were identified from the Michigan Urological Surgery Improvement Collaborative data registry. Hierarchical cluster analysis and latent variable mixture modelling was applied to urinary incontinence (UI) and sexual function (SF) recovery scores, and final models chosen based on optimal performance. RESULTS:A total of 3956 patients comprised the study cohort. Three distinct UI profiles were identified with prevalence of 49%, 37% and 14% from best to worst recovery, respectively. Four distinct SF profiles were identified with prevalence of 14%, 24%, 42%, and 20%, from best to worst recovery, respectively. The last two SF profiles had similar function scores but differed based on perception of function being bothersome. Limitations include incomplete PRO capture, which may introduce bias. CONCLUSIONS:We identify distinct UI and SF recovery profiles and their prevalence from a large, prospectively maintained registry, potentially improving interpretability of PRO data for decision making.

BACKGROUND:As new psychoactive substances (NPS) continue to emerge both in the US and globally, it is important to investigate characteristics of persons who use these substances. METHODS:Data on self-reported NPS use come from the National Drug Early Warning Rapid Street Reporting study, which uses a venue-intercept design to assess drug use and associated adverse effects among adults (≥18 years) in a given US city over a weekend period. Between January 2022 and November 2023, 6039 individuals were surveyed in person in 20 unique cities regarding prevalence and correlates of past 12-month NPS and other drug use. RESULTS:In the overall sample, 259 (4.3 %) individuals reported any past 12-month NPS use. Synthetic cannabinoids (n = 150, 2.5 %), novel opioids (n = 34, 0.6 %), and synthetic cathinones (n = 33, 0.6 %) were the most frequently reported NPS classes used. Those also reporting past 12-month common stimulant use (aOR=2.39, 95 % CI:1.68-3.39) and a higher number of common drugs used in the past 12 months (aOR=1.28, 95% CI:1.18-1.40) had higher odds of reporting any NPS use; those with a college education were found to have lower odds of reporting NPS use (aOR=0.46, 95% CI:0.28-0.78). CONCLUSIONS:While the self-reported use of individual classes of NPS was low relative to other drugs in this large, multi-city sample, NPS use was most common among those reporting polysubstance use. Those who used synthetic cannabinoids appeared to represent a distinct subgroup. Given the continued public health concern posed by NPS, surveys which systematically ask about specific NPS are increasingly needed.

IMPORTANCE/UNASSIGNED:Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults. OBJECTIVE/UNASSIGNED:To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months. INTERVENTIONS/UNASSIGNED:Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention). MAIN OUTCOMES AND MEASURES/UNASSIGNED:Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle. RESULTS/UNASSIGNED:Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor's degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, -0.94; 95% CI, -1.78 to -0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03243422.

PURPOSE/OBJECTIVE:This study evaluated how frequently patients with early onset colorectal cancer received fertility counseling and whether patient characteristics affected the likelihood of receiving such counseling. METHODS:We conducted a single-center retrospective review of all new patients seen by medical oncology for colorectal cancer who were age 55 years or younger for men and 50 years or younger for women. Associations between patient demographics and clinical characteristics with receipt of fertility counseling were explored using univariate analyses and multivariable logistical regression analyses. RESULTS:A total of 194 patients were included, of whom 15.5% received fertility counseling. Using multivariate analysis, we found that age < 40 (OR 15.587, p < 0.0001, 95% CI 4.841-50.191) and female sex (OR 3.979, p = 0.0292, 95% CI 1.150-13.770) were correlated with increased likelihood of fertility counseling. Patients living in areas of higher household income were more likely to receive fertility counseling, with a statistically significant difference between the 3rd and 1st quartiles of income (p = 0.0369, 95% CI 1.161-115.940). CONCLUSION/CONCLUSIONS:A majority of patients with EOCRC did not receive fertility counseling despite the known toxicities of CRC treatment modalities on fertility. Older age, male sex, and residence in areas of lower income were associated with decreased likelihood of receiving fertility counseling.

BACKGROUND:The number of pediatric ophthalmology and strabismus (PO&S) fellowship positions filled each year remains consistently lower compared with other subspecialities. It is unclear where along the recruitment pathway trainees interested in pediatrics decide to select other subspecialities. This study assesses for differences in the competitiveness of ophthalmology residency applicants based on interest in PO&S, which may impact their ability to matriculate into residency. METHODS:and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. RESULTS:Of the 631 applications reviewed, 125 (19.8%) of applicants stated a subspeciality interest. Among those who stated an interest, 34 (27.2%) were interested in PO&S. When compared to all other applicants (with or without a stated subspecialty interest), applicants interested in PO&S were more likely to be female (P < 0.001). No significant difference was found in academic, research, or extracurricular variables based on subspeciality interest in PO&S. The same was true when applicants interested in PO&S were compared to those interested in competitive subspecialities (cornea, glaucoma, retina, or oculoplastics). CONCLUSIONS:Applicants interested in PO&S were observed to be as competitive as other applicants. Among students who expressed a fellowship interest, there was a high proportion interested in pediatrics. Recruitment efforts can be targeted toward encouraging medical students interested in pediatrics to apply into ophthalmology.

IMPORTANCE/OBJECTIVE:Patients with poor glycaemic control have a high risk for major cardiovascular events. Improving glycaemic monitoring in patients with diabetes can improve morbidity and mortality. OBJECTIVE:To assess the effectiveness of a patient portal message in prompting patients with poorly controlled diabetes without a recent glycated haemoglobin (HbA1c) result to have their HbA1c repeated. DESIGN/METHODS:A pragmatic, randomised clinical trial. SETTING/METHODS:A large academic health system consisting of over 350 ambulatory practices. PARTICIPANTS/METHODS:Patients who had an HbA1c greater than 10% who had not had a repeat HbA1c in the prior 6 months. EXPOSURES/METHODS:A single electronic health record (EHR)-based patient portal message to prompt patients to have a repeat HbA1c test versus usual care. MAIN OUTCOMES/RESULTS:The primary outcome was a follow-up HbA1c test result within 90 days of randomisation. RESULTS:The study included 2573 patients with a mean (SD) HbA1c of 11.2%. Among 1317 patients in the intervention group, 24.2% had follow-up HbA1c tests completed within 90 days, versus 21.1% of 1256 patients in the control group (p=0.07). Patients in the intervention group were more likely to log into the patient portal within 60 days as compared with the control group (61.2% vs 52.3%, p<0.001). CONCLUSIONS:Among patients with poorly controlled diabetes and no recent HbA1c result, a brief patient portal message did not significantly increase follow-up testing but did increase patient engagement with the patient portal. Automated patient messages could be considered as a part of multipronged efforts to involve patients in their diabetes care.