Citations

Abstract Introduction The Hunger Vital Sign (HVS) is a two‐item, validated food insecurity screener recommended by the American Academy of Pediatrics. Given its brevity, HVS could be useful in assessing food insecurity in pregnant populations, for whom high‐quality nutrition and food access is essential. However, the HVS has not been evaluated in obstetric settings. Thus, we aimed to evaluate the performance of the HVS compared to the gold standard, the 18‐item US Household Food Security Survey Module (HFSSM) among low‐income, urban pregnant people. Methods We conducted a prospective study at a multi‐hospital tertiary health system (September 2023 to April 2024) in the United States. English‐ or Spanish‐speaking individuals from zip codes in which ≥10% of households were under the federal poverty line or who had publicly funded antenatal care completed a 20‐min self‐administered survey, which included the HFSSM and HVS. Food insecurity was defined as marginal, low, or very low food insecurity on the HFSSM; the prevalence of food insecurity was assessed and evaluated by participant characteristics. A positive screen on the HVS was defined as a “often true” or “sometimes true” to either item. Descriptive statistics were performed to characterize the performance of the HVS compared to the HFSSM. Results Of 713 potentially eligible participants based on medical record review, 192 (27%) completed an eligibility screener and were found to be eligible. Of these, 171 (89%) completed the survey. Nearly half (41%) of participants ( n = 70; of whom 74% received publicly funded care) screened positive for food insecurity on the HFSSM. HVS sensitivity was 83%, while specificity was 96%. The positive predictive value of the HVS was 94% and negative predictive value was 89%. Conclusion The two‐item HVS had relatively high accuracy for detecting food insecurity in this low‐income, urban obstetric population. Incorporating this brief screener into prenatal care may enable efficient, clinically useful food insecurity detection and intervention to address this need.

Abstract Objective Despite being safe and effective, surgery for pediatric epilepsy is underutilized. Social determinants of health (SDoH) are important to consider when examining this treatment gap. This study examined the potential systemic inequities at three different stages in the journey toward epilepsy surgery across the Pediatric Epilepsy Research Consortium (PERC). Methods Any youth in the PERC prospective surgery database (≤18 years) was eligible and included if sociodemographic factors were also available. We examined if there were differences in disparity factors in: (1) referral to Phase I evaluation, (2) offering of surgery, and (3) completion of surgery. Results Of 1309 patients, the majority were male (53%, p = .04), White (82.2%, p < .001), not Hispanic or Latino (84.3%, p < .001), and privately insured (56.3%, p < .001). Of the youth who were offered surgical treatment ( n = 1103, 84.3%), there were no significant differences in race/ethnicity or sex. Those with a structural lesion were more likely to be offered surgery, and historically marginalized youth were more likely to have a lesion. Of patients who completed surgery ( n = 927, 84.0%), White patients were 1.88 times (95% confidence interval [CI]: 1.14–3.04) more likely than Black patients to complete surgery ( p = .01). Significance Youth who began surgery evaluation are not representative of the demographics of those with epilepsy in the United States, with greater representation of White, non‐Hispanic male individuals. In addition, youth who began surgery evaluation disproportionally have private insurance. At the next stage of offering surgery, there were no differences based on SDoH. However, there is evidence that underrepresented youth that were magnetic resonance negative were less likely to be referred for surgical workup and that Black youth were less likely to undergo surgery. Therefore, efforts to provide equitable opportunity for all youth with refractory epilepsy should be concentrated at the referral for surgery evaluation point of care; however, additional efforts are also needed at later stages.

ABSTRACT Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disorder leading to kidney failure. Recent advancements in artificial intelligence (AI) are transforming the diagnosis, risk stratification, management and prognostication in ADPKD by enabling more accurate assessments and individualized care. AI-powered imaging tools enhance the measurement of total kidney volume (TKV), improving the precision and efficiency of monitoring disease progression and more reliable assessment of therapeutic response. Machine learning algorithms can integrate genetic, imaging and clinical data to predict kidney function decline, facilitating personalized treatment strategies. In addition, AI is being used to identify genetic variants and to refine genotype–phenotype relationships, offering deeper insights into disease variability. AI-enabled monitoring technologies can support longitudinal tracking of TKV measurements obtained through magnetic resonance imaging or computed tomography, thereby improving clinical decision-making and management. Furthermore, AI can optimize clinical trial design by improving patient selection, prediction of treatment responses and safety monitoring. Despite these promising developments, integrating AI into the clinical practice remains controversial and may pose several challenges. This review highlights the emerging clinical applications of AI in ADPKD, emphasizing its potential to advance precision medicine and improve patient outcomes.

Abstract Cancer occurs in ∼1 per 1000 pregnancies; thousands of patients may require radiation procedures for diagnosis and treatment each year in the United States alone. This rare but high-risk scenario, coupled with fear of radiation, has created ambiguity in the ideal management of pregnant patients. Without a comprehensive guide for the use of radiation in imaging and treatment for pregnant cancer patients, it is difficult for providers to offer optimal patient-centered care without introducing disparities. The goal of this paper is to provide guidance on the use of radiation for screening, diagnosis, staging, and treatment of cancer, while highlighting gaps in existing knowledge and guidelines. The intention is that physicians, medical physicists, and patients could use this document as a resource for shared decision-making, ensuring safe and effective practice. A team of physicians and medical physicists with expertise in imaging, radiotherapy, and maternal fetal medicine was assembled, along with a patient advocate and lawyer. Existing guidelines and recent literature were reviewed. Authors also drew from their experience where published guidance was lacking. The resulting document discusses best practice to guide use of radiation for cancer, as well as patient-centered care management and legal considerations. Overall, it is possible to safely and effectively deliver radiation to pregnant patients in numerous circumstances. Use of radiation or other modalities should be discussed through shared decision-making with the physician and patient, contextualizing the maternal and fetal risk from treatments. Healthcare providers should support wide access to reproductive healthcare to allow equitable, evidence-based, patient-centered healthcare.

Abstract Background Polycystic ovary syndrome (PCOS) affects 10% to 13% of individuals assigned female at birth (AFAB), although a greater prevalence is reported in transgender/gender diverse individuals (TGD) (23.8-38.8%). Testosterone therapy (TT) in TGD individuals is linked to worsening cardiovascular risk factors (CVRFs). Whether TT induces more adverse cardiometabolic changes in TGD with PCOS than TGD without PCOS remains uncertain. Objective To compare the effects of TT on CVRF in TGD with and without PCOS. Methods We retrospectively reviewed 373 records to identify 62 TGD with PCOS (withestablished guideline criteria) and 132 age-matched TGD without PCOS. Data included longitudinal anthropometric measurements, hormone and metabolic parameters, and CVRF before and after TT. Group comparison of PCOS vs without PCOS before and after TT was conducted via independent t-tests, Mann–Whitney-U, and Chi-square. Results At baseline, TGD with PCOS had significantly greater body mass index (BMI), obesity prevalence, and, after controlling for BMI, baseline metformin use. There were no significant differences between TGD with and without PCOS when comparing intra-participant changes after TT. Controlling for BMI, TGD with PCOS on TT exhibited significantly greater hyperlipidemia prevalence, alanine transaminase (ALT) levels, and bioavailable testosterone concentrations than TGD without PCOS on TT. Conclusion Greater baseline cardiometabolic risk was largely BMI-related in TGD with PCOS compared to TGD without PCOS. Only hyperlipidemia and elevated ALT were more prevalent during TT after adjusting for BMI. These findings support cardiometabolic monitoring during TT in all TGD individuals without significant increased risk with PCOS history.

ABSTRACT Objectives The purpose of this study is to compare the economics of in‐office tympanostomy tube placement using single use devices versus standard placement in the operating room (OR). Methods A retrospective chart review was completed for all pediatric patients who underwent in‐office tympanostomy tube placement (CPT 69433) along with insurance and date matched patients with placement in the OR (CPT 69436) between 12/1/21–3/1/24. Financial data were compared among the public vs. private insurance cohorts using the Wilcoxon rank‐sum test with a two‐sided significance level of 5%. Results One hundred and thirty‐six in‐office patients were identified, 102 private versus 34 public, and compared with 136 insurance and date matched OR patients. The average total payment for both privately insured patients, $647.14 in‐office versus $6873.45 in the OR, and publicly insured patients, $312.74 in‐office versus $2656.34 in the OR, was statistically significant. The average insurance payment for both privately insured patients, $301.58 in‐office versus $5445.73 in the OR, and publicly insured patients, $310.63 in‐office versus $2258.65 in the OR, was statistically significant. For the patient payment, public insurance usually has 0 copay and is therefore excluded. The patient payment of the private insurance cohort, $308.30 in‐office versus $670.61 in the OR, was not found to be statistically significant. Conclusion As expected, this study demonstrates significant reductions in overall cost with in‐office tympanostomy tube placement even with the added cost of single‐use devices compared to the standard placement in the OR, particularly for insurance companies, suggesting the potential benefit of providing reimbursement for these devices. Level of Evidence N/A.

Abstract Purpose Professional identities impact professional boundaries and hierarchies, influencing how physicians approach collaboration. Despite the growing emphasis on developing students to become effective collaborators, little is known about how other health professionals (OHPs) shape students' professional identity formation (PIF). This study explored how interacting with OHPs during clinical care contributed to medical students' construction of what it means to be a physician. Methods For this constructivist grounded theory study, researchers conducted 20 semi‐structured interviews with medical students during clinical clerkships. Students drew rich pictures representing their interactions with OHPs and described these pictures during their interviews. Interviews were iteratively conducted and analysed, enabling the research team to theorize how interacting with OHPs contributed to medical students' PIF. Results Participants expressed a strong desire to contribute to patient care and described how interprofessional interactions provided opportunities to do so in ways aligned with their current capabilities. These opportunities were often more accessible than the roles and responsibilities of physicians, and participating alongside OHPs fostered participants' sense of their own developing capabilities and belonging on healthcare teams. Interactions with OHPs helped participants to see the expertise of OHPs and the value of collaborating with them in ways that shifted their focus away from becoming independent. Conceptually, participants' interactions with OHPs became both a mirror reflecting their present readiness to meaningfully contribute and a prism through which they could envision their future identities as physicians in new ways. Conclusions Interprofessional interactions influenced medical students' current and future professional identities, enabling students to see themselves as contributors on health care teams and highlighting collaboration and interdependence as core attributes of the physician profession. These findings highlight opportunities to amplify the impact of interprofessional interactions on the PIF of medical students and the need for research into how OHPs view their roles in these processes.

OBJECTIVE Epilepsy affects nearly 50 million individuals worldwide, with one-third of cases resistant to antiseizure medications. For these patients, surgical intervention offers a potential path to seizure freedom. While resective surgery has been the gold standard, laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative. The aim of this study was to evaluate the efficacy and safety of LITT versus resective surgery in patients with nontumoral epilepsy. METHODS A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus, including studies comparing seizure freedom rates, complications, and procedural outcomes between LITT and open surgery in nontumoral epilepsy. Eleven studies met the inclusion criteria, comprising 389 LITT and 557 open surgery patients with varying epilepsy etiologies, including temporal lobe epilepsy, focal cortical dysplasia, and tuberous sclerosis. Statistical analysis was performed using a random-effects model to assess seizure freedom, complications, and reoperation rates. RESULTS Open surgery demonstrated higher rates of complete seizure freedom, although not reaching significance (68.1% vs 53.7%, RR 0.81, p = 0.07). This outcome was sensitive to influential analysis and reached significance in the epileptogenic zone–directed resection subgroup analysis. Although adequate seizure freedom was comparable between the groups (LITT: 63.0% vs open: 74.0%, RR 0.90, p = 0.11), the open surgery group had higher rates of control in the pediatric and non–temporal lobe epilepsy subgroups. Complication rates were significantly higher in the open surgery group (30.0% vs 18.3%, RR 0.55, p < 0.01). LITT patients had significantly shorter hospital stays (3.4 vs 6.8 days, standardized mean difference −0.93, p < 0.01). Reoperation rates were comparable between groups (13.1% for LITT vs 13.4%, RR 1.59, p = 0.26). CONCLUSIONS While LITT offers a less invasive approach with reduced hospitalization and morbidity, open surgery remains slightly superior in achieving long-term seizure freedom. Patient selection remains critical, and further studies are needed to refine decision-making criteria based on epilepsy subtype and lesion characteristics.