Khalid, Muhammad

ABSTRACT Introduction Multiple myeloma is a malignant plasma cell disorder predominantly affecting older adults and poses a significant health burden due to its incurable nature, high relapse rate, and associated immune dysfunction. Daratumumab, when added to standard therapy, has shown promising results in large trials. This meta‐analysis compared clinical trials of daratumumab‐containing regimens with standard therapies in the treatment of multiple myeloma. The primary outcomes analyzed were overall response rate (ORR) and progression‐free survival (PFS). Methods A systematic search of PubMed, Scopus, Cochrane CENTRAL, and Google Scholar was performed from January 2015 through December 2024. After screening via Rayyan, data were extracted on an Excel spreadsheet. Quality was assessed using the Cochrane RoB 2.0 tool. Eligible randomized controlled trials (RCTs) were included and analyzed using RevMan 5.4. Outcomes assessed were ORR and PFS. Adverse effects were compared among therapies. Results Nine Phase III RCTs ( n = 4556) were included, with a mean follow‐up of 44.3 months. Daratumumab‐based regimens significantly improved PFS (HR 0.55, 95% CI 0.46–0.66) but did not confer a statistically significant overall survival advantage (RR 0.90, p = 0.25). ORR was inconsistent, with five trials favoring daratumumab and one favoring control. Safety analyses showed higher risks of pneumonia (RR 1.74, p < 0.0001), secondary malignancies (RR 1.46, p = 0.003), neutropenia (RR 1.25, p = 0.006), and thrombocytopenia (RR 1.17, p = 0.01). Lymphopenia showed a numerical increase but was not statistically significant. Conclusion Daratumumab plus standard therapy regimens significantly improve PFS in multiple myeloma, though the overall survival benefit remains unproven. While efficacy is notable, treatment is associated with increased risks of infections, hematological toxicities, and secondary malignancies, highlighting the need for careful patient selection and vigilant monitoring. Trial Registration The authors have confirmed clinical trial registration is not needed for this submission.

Abstract How medical inter-professional (IP) education should be introduced to students is still a matter of research. We evaluated IP student attitudes before and after a busy “hands-on” clinical experience. During 3 separate trips, first/second year medical and physician assistant students and third/fourth year nursing students traveled to Central America to work together for 1 week in an underserved clinical setting. Student opinions on inter-professional education were obtained before and after Brigade-1 using the Readiness for Inter-professional Learning Scale validated questionnaire. From these results, a modified version of the survey was developed that included quantitative and qualitative responses. For brigades-2 and -3, students received this modified version of the survey pre and post brigade. Quantitative data was analyzed via paired student t test, and qualitative data was analyzed to identify emerging themes using constant comparative methodology by three separate investigators. No significant quantitative differences between IP student groups were observed in their evaluation of the importance of inter-professional education either before or after the brigades. Qualitative data noted pre-brigade expectations of positive IP, experiential and patient-centered cultural learning. Pre- and post-brigade student perspectives maintained a strong belief that high functioning IP care benefited the patient. Post-brigade perspectives revealed a shift in attitude from purely positive expectations to more practical aspects of teamwork, respect, and interpersonal relationships. Students believe that patient care benefits from IP collaboration. After a busy clinical experience requiring collaboration, students realized that functional teams require appropriate skills, roles, and respectful interpersonal relationships.

Abstract Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates. In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians’ discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year. Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates. Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians’ 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.