Citations

ABSTRACT Background Chronic gastroduodenal symptoms arise from heterogeneous gastric motor dysfunctions. This study applied multimodal physiological testing using gastric emptying scintigraphy (GES) with intragastric meal distribution (IMD) and Gastric Alimetry body surface gastric mapping (BSGM) to define motility and symptom associations. Methods Patients with chronic gastroduodenal symptoms underwent simultaneous supine GES and BSGM with a 30 m baseline, 99mTC‐labeled egg meal, and 4 h postprandial recording. IMD (ratio of counts in the proximal half of the stomach to the total gastric counts) was calculated immediately after the meal (IMD0), with < 0.568 defining abnormal IMD. BSGM phenotyping followed a consensus approach, based on normative spectral reference intervals. Results Among 67 patients (84% female, median age 40 years, median BMI 24 kg/m 2 ), median IMD0 was 0.76 (IQR: 0.69–0.86) with 5 (7.5%) meeting abnormal IMD criteria. Delayed gastric emptying ( n = 18) was associated with higher IMD0 (median 0.9 vs. 0.7, p = 0.004). On BSGM, 15 patients had abnormal spectrograms (5 [7.5%] high frequency and 10 [14.9%] low rhythm stability and/or amplitude); and in these patients, higher IMD0 (proximal retention) strongly correlated to delayed BSGM meal responses ( R = −0.71, p = 0.003). Lower IMD, indicating antral distribution, correlated with higher gastric frequencies ( R = −0.27, p = 0.03). BSGM abnormalities paired with abnormal IMD were associated with worse dyspeptic symptoms. Conclusion Proximal retention of food as assessed by IMD correlated with delayed emptying, and in the presence of neuromuscular spectral abnormalities (abnormal frequencies or rhythms), delayed motility responses on BSGM. Patients with multiple motor abnormalities experience worse dyspeptic symptoms.

Abstract Background Opioid stewardship policies could adversely affect pain management for patients with cancer. Yet patients with cancer are also at risk for opioid‐related harms. This study sought to determine trends in opioid prescribing by clinical stratum and pain for patients with cancer from 2016 to 2020. Methods A retrospective study was conducted of opioid‐naive adults with newly diagnosed cancer from 2016 to 2020 ( N = 10,232) in a large Connecticut health system. Logistic regression was used to calculate changes in the predicted probability of opioid prescribing from 2016 to 2020. Two subpopulations were examined: patients treated surgically ( n = 4405) and patients with metastatic cancer ( n = 2158). Flowsheet pain scores for patients with metastatic cancer were used to stratify by no pain (all scores, 0) versus any pain. The main outcomes were new (≥1 prescription in the 0–6 months after diagnosis) and additional (0–6 and 7–9 months) opioid prescriptions. Results A decline was observed in the predicted probability of new (71.1% to 64.6%; p < .001) and additional prescribing (27.2% to 24.2%; p = .07 [not significant]) declined. Among surgical patients, the predicted probability of new opioid prescribing fell (96.0% to 88.6%; p < .001), whereas additional prescribing was stable (13%). For patients with metastatic cancer with pain, new opioid prescribing was stable (56%). For those reporting no pain, the predicted probability of new opioid prescribing declined from 61.6% to 36.1% ( p < .001). Conclusions In the context of widespread policy changes, this study showed a modest decline in new and additional opioid prescribing for patients with cancer. In metastatic cancer, prescribing remained stable for patients reporting pain and declined steeply for those reporting no pain.

Abstract A blood-based multi-cancer early detection (MCED) test has demonstrated feasibility as a screening tool in large-scale clinical trials. The PATHFINDER 2 (PF2) study (NCT05155605) evaluates safety and performance of the MCED test in a diverse intended-use population. To gauge generalizability of study results, we assessed participant (ppt) baseline characteristics vs general US population data from the National Health and Nutrition Examination Survey (NHANES). PF2, a prospective, multicenter, interventional study, enrolled ppts aged ≥50 y from diverse clinical settings in North America. Enrollment targets for sex and race/ethnicity were established from the 2019 American Community Survey (US Census Bureau). Recruitment strategies were implemented to maximize enrollment for groups historically underrepresented in clinical studies. Exclusion criteria included clinical suspicion of cancer or cancer diagnosis/treatment within 3 y. Data on baseline characteristics and key cancer risk factors were collected at enrollment. We compared the PF2 study population to a nationally representative sample of US adults aged ≥50 y from 2017-2020 NHANES data. NHANES data were weighted using complex, multistage probability sampling to generate a nationally representative sample. There were 35,878 ppts enrolled in PF2; 35,307 clinically eligible and evaluable ppts were included in this analysis. Mean age was 64 y for both PF2 and NHANES; 56.2% were females in PF2 vs 53.6% (95% CI 52.0-55.3%) in NHANES. Race/ethnicity distribution for PF2 vs NHANES was 7.4 vs 11.0% (8.9-13.1%) Hispanic, 74.6 vs 69.7% (65.0-74.5%) non-Hispanic (NH) White, 8.6 vs 10.3% (7.6-13.1%) NH Black, and 5.8 vs 5.1% (3.5-6.8%) NH Asian. In terms of lifestyle characteristics for PF2 vs NHANES, 58.9 vs 29.2% (25.8-32.7%) had at least a bachelor’s degree, 74.8 vs 63.8% (60.6-67.0%) were married/living with a partner, 69.3 vs 53.8% (50.9-56.7%) had never smoked, 66.5 vs 70.4% (68.0-72.8%) were overweight/obese, and 24.2 vs 28.4% (26.4-30.3%) reported never using alcohol. PF2 enrolled a diverse ppt population that is reasonably reflective of the demographics of the US population aged ≥50 y. As is typical for clinical trials, a higher percentage of PF2 vs NHANES ppts reported lifestyle characteristics associated with better health. As the study population largely reflects the MCED test intended-use population, safety and performance results from PF2 are expected to reflect real-world clinical experience. Citation Format: Shirish Gadgeel, Nima Nabavizadeh, Dax Kurbegov, Charles McDonnell, III, James W. Lillard, Jr., Marc Matrana, Alan Roth, Andrea Johnston, Sami Tahhan, Rami Owera, Matthew Margolis, Anuraag Kansal, Margarita Lopatin, Margaret McCusker, Karthik V. Giridhar. Baseline participant characteristics from PATHFINDER 2, a prospective interventional study of a multi-cancer early detection test in a population setting [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C145.

Objectives To develop an internationally validated, structured robot‐assisted radical nephroureterectomy (RARNU) training programme through expert consensus. Materials and Methods A RARNU‐specific questionnaire was developed/adapted from previously published, validated questionnaires for robot‐assisted urological procedures. This included five key domains and 11 surgical steps. In all, 30 upper tract urothelial carcinoma experts were invited to participate. A two‐stage modified Delphi approach was employed. Consensus was defined as ≥80% agreement. Modifications and additional statements were proposed during the second round following qualitative/quantitative feedback from the initial round. Results Response rates for the first and second Delphi rounds were 80% (24/30) and 92% (22/24), respectively. All agreed that adoption of a standardised training curriculum can improve clinical outcomes during the RARNU learning curve. There was ≥92% agreement on all proposed RARNU steps. Five RARNU clinical modules of increasing complexity were defined using individual step difficulty and number of prior RARNU cases required, with ≥96% agreement among respondents. Respondents unanimously agreed that the final assessment should be based on a procedure‐specific scale focusing on the hilar dissection, ureteric dissection, and bladder cuff excision steps. No consensus was reached for the annual minimum RARNU volume required for eligibility as a RARNU curriculum host centre. Conclusion This is the first structured training curriculum for RARNU using international expert consensus. This will help guide surgical educators and trainees toward independent completion of a full RARNU.

Healthcare organisations face mounting challenges to maintain financial sustainability given increasing expenses, decreasing reimbursements and changing patient needs. Because of the increasing costs of operating a healthcare institution, it is no longer viable to pursue achieving financial sustainability just by adding more clinical visits and capacity, increasing hospital admission and throughput, performing more surgeries or simply working harder. To address these challenges, healthcare leaders should adopt a culture of continuous process improvement that engages and empowers clinical and operational teams to identify and eliminate waste, optimise revenue and enhance quality and safety. This paper presents a case study of Project ROSE (Revenue Optimization and Supply Enhancement), a project initiated by a community-based integrated health system in the upper Midwest. The goal was to achieve substantial financial savings within one year through revenue optimisation, supply chain improvements and service and maintenance contract enhancements. We describe the vision, goals, methods, results and lessons learned. We also discuss the implications and recommendations for other healthcare institutions that seek to implement similar initiatives that may reduce the burden on their clinical teams and allow them to work smarter, not harder. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.

OBJECTIVE The Centers for Medicare & Medicaid Services (CMS) requires a low C-peptide level for insulin pump coverage unless the individual is β-cell autoantibody positive, which precludes coverage of automated insulin delivery (AID) systems for many people with type 2 diabetes. RESEARCH DESIGN AND METHODS In the Randomized Trial Evaluating the Efficacy and Safety of Control-IQ+ Technology in Adults With Type 2 Diabetes Using Basal-Bolus Insulin Therapy study evaluating the t:slim X2 insulin pump with Control-IQ+ technology, adults with insulin-treated type 2 diabetes were categorized into high C-peptide (n = 195) and low C-peptide (n = 59) groups based on CMS criteria. RESULTS In the AID group, mean HbA1c decreased from baseline by 0.8%, which was significantly greater than in the control group with both high (P &lt; 0.001) and low (P = 0.02) C-peptide levels. Results were similar in participants ≥65 years old. CONCLUSIONS The benefit of AID is present with high and low C-peptide levels. Thus, requiring a low C-peptide level as a prerequisite for AID therapy is not warranted.

Intravoxel incoherent motion MRI parameters derived from two software packages demonstrated diagnostic value for breast cancer, with multivariable combinations of histogram metrics achieving high diagnostic accuracy.

Abstract Aims Type 2 myocardial infarction due to myocardial oxygen supply–demand imbalance is associated with poor outcomes. There are no guidelines to inform care for these patients. The consensus on the assessment and management of type 2 myocardial infarction is gained. Methods and results An international e-Delphi study including experts in type 2 myocardial infarction identified through systematic review was conducted. Participants were asked to describe their approach to (i) definition and diagnosis, (ii) risk stratification, (iii) assessment of coronary artery disease and cardiac function, (iv) specialty management, (v) treatment and secondary prevention, and (vi) communication and rehabilitation. Statements generated in round one were circulated, with consensus defined a priori as ≥70% agreement on a 5-point Likert scale. Where no consensus was reached, statements were amended and recirculated for a final round. The response rate was 56% (38/68), 54% (37/68), and 72% (49/68) in the first, second, and third rounds, respectively. Following the first round, 67 unique statements were generated across six domains. Overall, consensus was achieved on 64% (43/67) of statements. Consensus was achieved for 42% (5/12) of statements on the diagnosis of type 2 myocardial infarction, 75% (3/4) on risk stratification, 50% (9/18) on the assessment of coronary artery disease and cardiac function, 60% (6/10), on specialty management, 100% (9/9) on treatment and secondary prevention, and 79% (11/15) on communication and rehabilitation. Conclusion Consensus was obtained across a number of domains for the assessment and management of patients with type 2 myocardial infarction. However, there was limited agreement amongst experts on the diagnostic criteria, which may benefit from refinement.