Citations

Background Clinicians often care for multilingual patients and generally prefer in-person rather than remote interpretation. However, little is known about the reasons for selecting specific interpretation modalities in intensive care units (ICUs) and acute inpatient care settings. Objective To examine the context and application of in-person interpretation in ICUs and acute care settings. Methods Semistructured interviews of interprofessional stakeholders were conducted to understand the advantages and limitations of in-person and remote interpretation modalities in ICUs and acute care settings. Thematic analysis of the interviews was performed. Results Forty-one interviews were completed. Certain contexts motivated preferences for selecting in-person rather than remote interpretation in ICUs and acute care settings. Three overarching themes were identified: (1) specific types of conversations (eg, goals-of-care, end-of-life, and difficult conversations), (2) additional patient-related communication barriers (eg, hearing problems, delirium), and (3) other considerations related to in-person interpreter expertise (cultural contexts and prebriefing) and barriers to use (eg, delays, difficulty contacting interpreters). Conclusions Acute care clinicians often prefer in-person interpretation owing to factors that are either specific to in-person interpretation or cannot be fully replicated via remote modalities. Acute care clinicians consider conversation complexity, patient factors, and unique benefits versus logistical barriers when considering in-person interpretation. Overall, in-person interpretation provides advantages over alternative modalities for several scenarios to improve the quality of care for patients with non-English language preference in ICUs and acute care settings.

Abstract INTRODUCTION Plasma phosphorylated tau 217 (p‑tau217) immunoassays are increasingly being used to assess Alzheimer's disease (AD) pathology despite limited data affirming test reliability over time. METHODS Clinical performance of the Fujirebio Lumipulse G p‑tau217 assay was assessed in 744 Mayo Clinic patients presenting for evaluation of cognitive impairment between July 2024 and December 2025. Cerebrospinal fluid p‑tau181/amyloid beta 42 or amyloid positron emission tomography, within 1 year of p‐tau217 testing, were used as reference. Analytical robustness was evaluated by tracking result frequencies over time, conducting quality control checks, performing 10 lot‑to‑lot comparisons, and comparing two versions of reagents. RESULTS Diagnostic accuracy for detection of AD pathology was 93% (95% confidence interval 91–95) with 23% intermediate results. Reduced estimated glomerular filtration rate was associated with increased intermediate results among amyloid‐negative individuals. Result frequencies remained stable, average imprecision was 8%, and analytical bias between lots and version changes were ≤ 11%. DISCUSSION The findings support plasma p‐tau217 reliability in clinical practice for evaluation of cognitively impaired individuals.

Abstract Varlilumab is a monoclonal antibody with agonistic activity on CD27. The efficacy of single-agent PD-1 inhibitors on aggressive B-cell non-Hodkin lymphoma is limited. Preclinical and phase 1 data suggest that Varlilumab is safe and may have synergistic activity with PD-1 inhibitors. In the DIAL study, we explored whether dual immunomodulatory therapy with Varlilumab and Nivolumab in patients with relapsed/refractory aggressive B-NHL was safe and effective. We conducted a randomized phase II clinical trial on adult patients with relapsed/refractory aggressive B-NHL. Patients were randomized to receive Nivolumab monotherapy in the control group and Varlilumab combined with Nivolumab in the experimental group. Crossover to the experimental group was allowed upon progression in the control group. The primary endpoint was the overall response rate based on the Lymphoma Response to Immunomodulatory Therapy Criteria (LYRIC). 54 patients underwent randomization, and 51 received assigned intervention and were included in the intention-to-treat analysis. Objective response was observed in 6 out of 51 patients (ORR 12%). There were 4 responders (ORR 16%) in the Nivolumab group and 2 responders (ORR 7.6%) in the Nivolumab and Varlilumab combination group (p = 0.3). None of the 7 patients that crossed over to the experimental group responded to the addition of Varlilumab. The ORR of patients who were previously exposed to CAR-T cell therapy was 13% (5 out of 39) compared to 8.3% (1 out of 12) in the unexposed patients (p > 0.99). The rate of treatment emergent adverse events was similar between groups, and there was no fatal TEAE in the study. The addition of Varlilumab to Nivolumb did not improve outcomes in patients with aggressive B-NHL. Even though this trial was not designed to evaluate immunotherapy as a rescue therapy after CAR-T failure, most patients (76%) had previously received CAR-T therapy, and their outcomes were equally poor.

Surgeons are at high risk of developing long-term Work-Related Musculoskeletal Disorders (WMSDs) due to awkward sustained postures. Passive spine-supporting exoskeletons are a potential intervention to improve posture and reduce fatigue. The NekSpine ® was evaluated by 21 surgeons (15 male) across two hospital sites within a quaternary academic hospital system. Each surgeon performed at least two comparable procedures, one with the exoskeleton and one without. Surgeons completed pre- and postoperative surveys assessing NASA-TLX workload, usability, body-part discomfort, overall fatigue, and workflow disruptions. Eighty-two cases were evaluated (43 exoskeleton cases). Compared with baseline cases, surgeons reported reduced neck and upper back discomfort and lower overall fatigue when using the exoskeleton. The NekSpine ® exoskeleton may reduce spinal discomfort and fatigue during surgery, supporting its potential as an ergonomic intervention for surgeons.

Abstract Purpose Large language models (LLMs) have proven performance for certain diagnostic tasks; however, limited studies have evaluated their consistency in recommending appropriate medication regimens for a given diagnosis. Medication management is a complex task that requires synthesis of drug formulation and complete order instructions for safe use. Here, the performance of GPT-4o, an LLM available with OpenAI’s ChatGPT, was tested on 3 medication management tasks. Methods GPT-4o performance was tested on 3 medication tasks: identifying available formulations for a given generic drug name, identifying drug-drug interactions (DDIs) for a given medication regimen, and preparing a medication order for a given generic drug name. For each experiment, the model’s raw text response was captured exactly as returned and evaluated using clinician evaluation in addition to standard LLM metrics, including Term Frequency-Inverse Document Frequency (TF-IDF) vectors, normalized Levenshtein similarity, and Recall-Oriented Understudy for Gisting Evaluation (ROUGE-1/ROUGE-L) F1 score between each response and its reference string. Results For the first task of drug-formulation matching, GPT-4o had 49% accuracy for generic medications being matched to all available formulations, with an average of 1.23 omissions per medication and 1.14 hallucinations per medication. For the second task of drug-drug interaction identification, the accuracy was 54.7% for identifying the DDI pair. For the third task, GPT-4o generated order sentences containing no medication or abbreviation errors in 65.8% of the cases. Conclusion Model performance for basic medication tasks was consistently poor. This evaluation highlights the need for domain-specific training through clinician-annotated datasets and a comprehensive evaluation framework for benchmarking performance.

Robotic surgery offers advantages over traditional open, laparoscopic, and endoscopic approaches, including faster patient recovery and reduced surgeon fatigue. The da Vinci 5 (DV5), is the newest system in the most widely used family of surgical robots. This pilot study examined the usability of the DV5 compared with the da Vinci Xi (DV Xi) from the perspective of the surgical team. A consulting surgeon, trainees, Certified Surgical Assistants (CSAs), and Certified Surgical Technicians (CSTs) were recruited during colorectal surgery cases using the DV5 or DV Xi. Team members completed pre- and postoperative surveys assessing discomfort, workload, and usability. Objective postural data were collected from the consulting surgeon and trainee. Nine cases were evaluated (DV5 = 5). The DV5 improved neck posture for surgeons and trainees, with no workload differences for other team members. The DV5 significantly improved physical ergonomic usability for the surgeon at the console.

Ear, nose, and throat (ENT) surgeons often perform multiple daily procedures requiring sustained postures while wearing headlights or loupes, increasing the risk of work-related musculoskeletal disorders (WMSDs). This in situ case study aimed to (1) evaluate ENT surgeon workload and (2) introduce ergonomic interventions through workflow changes, education, and personal protective equipment. Three trained ergonomists observed the intraoperative workflow of three ENT surgeons at a tertiary academic hospital, identifying awkward postures. Surgeons received education on surgical microbreaks and OR-Stretch before trialing passive exoskeletons. Exoskeleton effectiveness was evaluated using interviews and surveys. Workflow interventions improved neck posture. One surgeon reported reduced body-part discomfort but increased subjective workload when using the exoskeleton, while interviews identified aesthetic concerns. This exploratory case study identified workflow issues and introduced ergonomic interventions. Although one surgeon reported reduced discomfort with an exoskeleton, larger studies are needed to establish quantitative trends.

Hospital practitioners have a high prevalence of work-related musculoskeletal disorders due to manual patient transfers. Reducing patient transfers can improve safety for staff and patients, especially those with unstable spines. A study at our academic hospital with the Safe TrAnsfer Tray prototype (STAT Tray V1) found transfers could be reduced to the two unavoidable transfers at the beginning and end of care. Surveys from 37 practitioners identified clinical challenges. User feedback informed design requirements for STAT Tray V2. Candidate materials were tested for MRI and CT compatibility, and pressure mapping evaluated padding combinations to reduce pressure-related injuries. STAT Tray V2 was designed for MRI and CT compatibility, current lift systems, and patients ranging from the 5th percentile female to the 95th percentile male while reducing pressure injury risk. Following manufacturing, usability testing will evaluate performance in the Emergency Department, imaging, operating suite, and ICU.

Abstract Purpose Bevacizumab is an effective treatment for radiation necrosis; dose dependent radiographic and edema response data are lacking. Methods Multicenter, retrospective cohort study of adult patients with primary central nervous system tumors or brain metastases who received bevacizumab for radiation necrosis between June 2021 and July 2024. Patients were grouped by bevacizumab dose (7.5 mg/kg vs 10 mg/kg administered every three weeks). Primary outcome was edema response, assessed by a blinded neuro-oncologist. Secondary outcomes included contrast enhancing disease response, clinical response, adverse events, treatment discontinuation, and re-dosing for recurrent radiation necrosis. Analyses were performed with and without adjustment for tumor type. Results 104 patients were included (7.5 mg/kg, n = 53; 10 mg/kg, n = 51). Edema response differed between dosing groups in unadjusted analyses (p = 0.032), favoring the 7.5 mg/kg cohort; however, this association was attenuated after adjustment for tumor type. Contrast enhancing disease response did not differ between groups in either unadjusted or adjusted analyses (p = 0.43). Clinical response was higher in the 7.5 mg/kg group (65.2% vs 37.8%, p = 0.013). Tumor type differed significantly between cohorts (p < 0.001), with more primary CNS tumors in the 10 mg/kg group. Rates of adverse events, treatment discontinuation, and re-dosing were similar. Conclusions While lower-dose bevacizumab was associated with greater edema reduction in unadjusted analyses, this effect was attenuated after accounting for tumor type. Importantly, 7.5 mg/kg dosing appeared sufficient for achieving edema control and contrast enhancing disease response. These findings support an individualized approach to bevacizumab dosing in radiation necrosis and highlight the need for prospective, tumor-stratified studies.

Importance Classifying disease based on underlying pathobiology rather than clinical phenotype has implications for the development of biomarkers and therapy development. Observations Transactive response DNA-binding protein 43 kDa (TDP-43) pathology is observed across a range of clinically defined neurodegenerative disorders including limbic predominant age-related encephalopathy (LATE), most cases of amyotrophic lateral sclerosis (ALS), inclusion body myositis, multisystem proteinopathy, and approximately half the cases of frontotemporal dementia (FTD). Despite this shared biology, the current nosology for these neurodegenerative disorders is based on their distinct clinical phenotypes. An alternative approach recognizes the central role of TDP-43 pathology in disease pathogenesis, reserving the use of clinical terms like ALS, FTD, or LATE to describe phenotypic manifestations of underlying pathobiology. This approach also recognizes the converging biomarker and neuropathological data indicating that pathology begins presymptomatically, before the overt clinical manifestations of disease appear. Conclusions and Relevance In proposing a pathobiological definition of disease, the goal is to provide a road map for developing biomarkers that accurately reflect the underlying pathobiology of disease and for advancing therapeutic candidates that effectively target fundamental disease mechanisms.