Citations

Abstract Objective To evaluate the feasibility of collecting Patient-Reported Outcomes Measurement Information System (PROMIS) data within an electronic health record (EHR) for patients undergoing basivertebral nerve ablation (BVNA). Design: Retrospective feasibility study. Setting: Academic community-based health system. Subjects: Seventy-one unique patients (73 procedures) treated with BVNA between 2022–2025. Methods PROMIS Pain Interference, Pain Intensity, and Physical Function surveys were administered at baseline and at 3-, 6-, and 12-month follow-up using EHR-embedded automated workflows. In parallel, a structured quality improvement intervention was implemented to improve survey completion via emphasis on baseline survey completion. The intervention included a standardized nursing rooming checkpoint to verify PROMIS completion prior to the procedure, staff education with scripted patient engagement language, real-time EHR visual prompts using dot phrases to identify incomplete surveys, and monthly site-level performance dashboards reviewed with clinical staff and leadership. Completion rates were extracted from institutional dashboards and workflow bottlenecks were identified through process mapping and staff feedback. A two-proportion test compared pre- and post-intervention baseline completion rates. Clinic visit duration was tracked as a balancing measure to evaluate potential workflow burden. Results Seventy-one patients underwent 73 BVNA procedures. Completion rates were 31.82% at baseline, 77.78% at 3 months, 40.00% at 6 months, and 100% at 12 months among patients reaching those timepoints. Longitudinal engagement was 56%, while longitudinal completeness was 33%. Baseline survey completion improved from 31.82% (21/66) before intervention to 100% (6/6) following implementation (z ≈ 3.0, p ≈ 0.003) durable through three months. Clinic workflow efficiency was not adversely affected, with 83% of visits remaining within the standard 30-minute time slot and no statistically significant increase in visit duration (p ≈ 0.36). Conclusions PROMIS data collection during interventional spine care is feasible and can be reliably integrated into routine clinical workflows when supported by targeted quality improvement interventions. Improving baseline survey capture substantially expands the denominator of patients eligible for longitudinal outcome measurement without increasing clinical workload. Hybrid implementation strategies combining automated EHR deployment with structured clinical oversight may enable reliable PROMIS integration in procedural spine practice.

Abstract INTRODUCTION We describe the reliability of remote self‐administered digital cognitive measures completed via the Mayo Test Drive (MTD) web‐based platform. METHODS A total of 1846 participants (mean age = 70, SD = 12, range 31–101; 48% male; 96% White; 99% non‐Hispanic; 97% cognitively unimpaired) with two to four complete MTD sessions at ∼7.5‐month intervals were included. Test‐retest reliability was assessed using single‐rating, absolute‐agreement, and two‐way mixed intraclass correlation coefficients (ICCs) with 95% confidence intervals. ICCs for in‐person‐administered traditional neuropsychological measures were compared to MTD for a subset of 244 participants. Analyses also compared reliability across demographic, residential, and session context subgroups. RESULTS Reliability was good for the MTD Composite (total ICC = 0.79 [0.77, 0.80]), and moderate‐to‐good for the primary outcome variables for each MTD subtest (total ICCs 0.70–0.83 for Stricker Learning Span and Symbols). The reliability of the remote self‐administered MTD was similar to in‐person‐administered cognitive measures. DISCUSSION MTD showed moderate‐to‐good reliability, supporting its use in longitudinal monitoring.

Abstract Introduction Daily fluctuations in sleep disturbances have been shown to shape pain experiences among individuals with chronic pain. Additional biobehavioral factors, such as abuse history, depression, current and long-term anxiety, opioid use, physical functioning, and fatigue, may also affect daily pain outcomes. Yet the extent to which these factors collectively contribute to daily pain intensity and unpleasantness remains insufficiently understood. Methods Using baseline data from the SPINII randomized controlled trial (R01NR017168; McCrae, PI), women with insomnia and fibromyalgia (N = 294, x- age = 40) completed 14 days of sleep diaries assessing sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and pain intensity and unpleasantness (0–100). Additional predictors included abuse history, Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and PROMIS-57 physical functioning and social functioning. Linear mixed models examined the effects of sleep and related factors on daily pain. Results Significant predictors of pain intensity included higher between-person SOL (b = 0.08, p < .001) and WASO (b = 0.08, p < .001), lower between-person TST (b = -0.10, p < .001), lower within-person TST (b = −0.03, p < .001), opioid use (b = 2.84, p = .029), poorer physical functioning (b = −0.35, p = .008), and higher depression scores (b = 0.20, p = .046). Pain unpleasantness showed nearly identical patterns, with only physical functioning becoming non-significant. Random intercepts and residual variance values were significant in both models (p < .001), indicating within- and between-person variation in pain. ICCs of .80-.85 revealed that the majority of variance was between-person, while non-significant autocorrelations (p > .05) indicated minimal day-to-day carryover effects beyond stable individual differences. Conclusion Overall sleep quality and emotional health shape pain experience more strongly than daily fluctuations. Although TST offers some next-day relief, chronic contributors are more relevant to daily pain. Effects were largely consistent; between- and within-person TST showed strong effects, and depression had a slightly larger effect on pain unpleasantness than pain sensitivity, reinforcing a multidimensional biopsychosocial pain process. These findings highlight the need for integrated interventions that strengthen sleep, emotional well-being, and physical functioning. Support (if any) NIDA

Abstract Introduction Chronic and episodic headaches have a strong bidirectional relationship with insomnia and poor sleep outcomes. AM (morning) headaches are common among chronic pain populations, but additional research is needed to understand their pain experiences and potentially inform targeted interventions. Herein, we investigated whether presence of AM headaches is associated with differences in diary-based sleep parameters and pain ratings in women with pain and sleep complaints. We hypothesize individuals with AM headaches will have more sleep disturbances and fatigue as well as greater pain intensity and unpleasantness. Methods Women (N=293, Mage=39.59, SD 12.65, 65% with morning headaches) reporting insomnia and pain complaints (65% also reporting morning headaches) were recruited in mid-Missouri for an RCT (R01NR017168, ClinicalTrials.gov Identifier: NCT03744156). During baseline assessment, participants completed 2 weeks of daily electronic diaries and reported AM headache presence (Y/N). Independent samples t-tests (SPSS) evaluated differences in sleep parameters and pain ratings in those with and without AM headaches. Participants reporting diagnosed sleep apnea were excluded. Results Morning fatigue was higher among individuals with AM headaches (M=54.72+/-18.25) than those without (M=50.02+/-19.12), t(291)=-2.07, p=.04. Pain intensity was greater in the AM headache group in the morning (M=47.65+/-19.73 vs. M=42.52+/-21.91), t(291)=-2.04, p=.042, and evening, (M=49.62+/-19.10 vs. M=44.23+/-20.66), t(283)=-2.21, p=.028. Evening pain unpleasantness was also rated as higher among those with AM headaches (M=45.90+/-19.55) compared to those without (M=40.82+/-22.52), t(283)=-1.99, p=.048, but morning pain unpleasantness ratings only trended towards significance. Conclusion AM headaches can present as a chronic condition or as a symptom of other sleep disorders. Individuals with AM headaches had minimal sleep differences overall, but morning fatigue, pain intensity (AM and PM), and evening pain unpleasantness ratings were all significantly greater in those with AM headaches. Undiagnosed sleep disorders other than insomnia (i.e., obstructive sleep apnea) or other health concerns, like increased intracranial pressure, may have contributed to pain-related findings. Considering the high prevalence of COMISA in chronic pain populations, further investigation should examine its impact on sleep and headache severity. Support (if any) National Institute of Nursing Research (NR017168; Clinical trial: NCT03744156; PI: McCrae).

Introduction: Diabetes, a modifiable risk factor for dementia, is thought to impart increased risk of dementia through cerebral small vessel disease. While the importance of diabetes in midlife is well-documented, the influence of different glycemic levels, duration of diabetes, and Alzheimer’s disease genetic risk (apolipoprotein [ APOE ] ε4 genotype) in late-life on dementia risk remains uncertain. This could have implications for individualized prevention strategies. In this study, we investigated whether a higher glycemic level and longer duration of diabetes in late-life is associated with a higher risk of dementia, and whether associations vary by APOE ε4 genotype. Methods: We performed a prospective cohort analysis with the Atherosclerosis Risk in Communities Study using up to 11 years of follow-up (baseline, 2011-2013). We defined diabetes as glycated hemoglobin A1c (HbA 1c ) ≥6.5%, self-reported physician diagnosis, or use of any diabetes medication. Among those with diabetes, we categorized participants as having a lower glycemic level (HbA 1c <7%) or higher level (HbA 1c ≥7%), and duration as short (<5 years) or long (≥5 years). We estimated hazard ratios (HR) for incident dementia by HbA 1c levels and by diabetes duration in separate multivariable-adjusted Cox regression models. We tested for statistical multiplicative interaction on the relative risk of dementia by fitting interaction terms between diabetes measures and APOE ε4 genotype in separate regression models. Results: In 5030 participants without dementia (mean age, 75.4 years; 58.6% female; 21% Black; 28% with diabetes), there were 1167 (23.2%) incident dementia cases over a median follow-up of 9.0 years. Compared to no diabetes, a lower glycemic level and higher level were both associated with elevated dementia risk ( P -trend <.0001; Table). A higher glycemic level was associated with an elevated risk of dementia relative to a lower level (HR=1.47 [95% CI: 1.22-1.77]; Table). Compared to no diabetes, both shorter duration and longer duration were associated with an increase in dementia risk ( P -trend <.0001; Table). Longer duration was associated with an increased risk of dementia relative to shorter duration (HR=1.57 [95% CI: 1.24-1.98]; Table). Associations for glycemic level and diabetes duration did not significantly differ by APOE ε4 genotype (all P >.05). Conclusions: Diabetes management in older adults that includes lower glycemic goals may help reduce dementia risk.

ABSTRACT Bispecific T cell engagers (BTEs) induce MHC‐independent cytotoxicity by bridging T cells to tumor cells via binding a T cell–activating receptor and a tumor‐associated antigen. BTEs have proven effective in hematologic malignancies and some solid tumors, yet their potential in glioblastoma (GBM) is largely unexplored. We developed a fully humanized BTE (hBTE) targeting interleukin‐13 receptor alpha 2 (IL13RA2), a tumor‐associated antigen widely expressed in GBM and associated with poor prognosis. In vitro, hBTE activated T cells and induced antigen‐dependent cytokine release and cytotoxicity against IL13RA2‐positive GBM cells. In vivo, hBTE showed robust target‐specific activity and markedly prolonged survival in primary and recurrent GBM xenograft models, without detectable off‐target local or systemic toxicity. Beyond GBM, hBTE also exhibited antitumor activity in IL13RA2‐expressing solid tumors, demonstrating selective tumor accumulation and therapeutic efficacy in models of breast cancer brain metastases and extracranial lung cancer. This work highlights the therapeutic potential of BTEs in IL13RA2‐expressing tumors and establishes a strong preclinical rationale for advancing hBTE therapy toward clinical translation in GBM and other tumors.

Hip arthroscopy is an increasingly common procedure to treat intra‐articular conditions such as labral tears and femoroacetabular impingement. With the increase in frequency of such procedures, so too are revision arthroscopic hip procedures. Capsular repair in the setting of revision hip arthroscopy can be challenging due to the presence of adhesions and scar tissue formation that obscure tissue planes, suboptimal quality of residual capsular tissue, and the presence of capsular tissue defects. This technical note aims to describe the key surgical principles and considerations of revision hip capsular closure.

Background/Objectives: Characterizing spinal cord multiple sclerosis (MS) lesions in MRI is critical for diagnosis, monitoring, and treatment evaluation. However, current automated approaches for lesion detection and segmentation are typically designed for specific MRI contrasts or acquisition sites, limiting their generalizability in real-world clinical settings where imaging protocols vary widely. This work proposes a robust multi-site, multi-contrast segmentation framework for spinal cord lesions. Methods: The segmentation model was trained and evaluated on a large-scale dataset comprising 4428 annotated images from 1849 persons with MS across 23 imaging centers, encompassing six MRI contrasts (T1w, T2w, T2*w, PSIR, STIR, and UNIT1) acquired at 1.5 tesla (T), 3 T, and 7 T. Results: Likert-type assessment performed by neuroradiologist ratings demonstrated superior generalization of the model compared to existing contrast-specific pipelines ( p < 0.01). Additional experiments evaluated robustness across spinal levels, acquisition resolutions, binarization thresholds, and quantitative evaluation on external labeled datasets. Conclusions: The proposed model can achieve accurate and reliable spinal cord MS lesion segmentation across heterogeneous MRI data, addressing a key barrier to clinical translation. The model is available in the Spinal Cord Toolbox v7.2 and higher. Code repository: https://github.com/ivadomed/seg-sc-ms-lesion-multicontrast

ABSTRACT BACKGROUND Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) testing has the potential to expedite decision-making and reduce emergency department (ED) length of stay for patients presenting with possible myocardial infarction (MI) by ensuring that results are consistently available when looked for by clinicians. We assessed the real-life effectiveness and safety of implementing POC hs-cTn testing in the ED. METHODS We conducted a pragmatic, stepped-wedge cluster randomized trial. The control arm was usual care with an accelerated diagnostic pathway utilizing a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a POC hs-cTnI. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model, and the safety outcome was 30-day MI or cardiac death. RESULTS Six sites participated with 59,980 ED presentations (44,747 individuals, 61±19 years, 49.5% female) from February 2023 to January 2025, in which 31,392 presentations were during the intervention arm. After adjustment for co-variates associated with length of stay, the intervention reduced length of stay by 13% (95% confidence intervals [CI], 9 to 16%. P<0.001), corresponding to a reduction of 47 minutes (95%CI, 33 to 61 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day MI or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39% respectively, P=0.54). CONCLUSIONS Implementation of whole-blood hs-cTnI testing at the POC into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing. (Australia New Zealand Clinical Trials Registry ACTRN12619001189112) Clinical Perspective What is new? Point-of-care troponin assays with good precision have become available and received regulatory approval as high-sensitivity assays. A pragmatic stepped-wedge cluster randomized trial implementing the validated Siemens VTLi high-sensitivity point-of-care assay into 6 emergency departments investigating ∼60,000 patients, was conducted to ascertain if the rapid turnaround time reduced lengths of stay. Introduction of the VTLi high-sensitivity point-of-care assay into clinical pathways reduced emergency department lengths of stay by an average 13% (47 minutes) without compromising safety. What are the clinical implications? Early decision-making using a point-of-care high-sensitivity troponin assay within a structured clinical pathway was safe. Faster turnaround means troponin results are consistently available when clinicians first seek them. This can facilitate earlier decisions and reduce patient length of stay.