Citations

ABSTRACT Background Cytomegalovirus (CMV) infection is among the most common infections after solid organ transplantation and leads to high rates of morbidity and mortality. With the proliferation of large, claims‐based datasets, there is a need to assess the validity of ICD‐10‐CM codes in identifying CMV infection. Methods We conducted a retrospective cohort study of solid organ transplant recipients (SOTRs) from a regional health system who underwent first transplantation between January 1, 2016, and June 30, 2025, had at least 30 days of post‐transplant follow‐up, and had known donor/recipient CMV serostatus. We performed cross‐sectional and time‐to‐event analyses comparing the test performance of B25 ICD‐10‐CM codes in identifying CMV infection, clinically significant CMV infection (csCMVi), CMV disease, and CMV DNA reaching various thresholds. Results Of 8169 SOTRs, 3084 (37.8%) had B25 coded during follow‐up. In addition, 4287 (52.5%) developed CMV infection, 2356 (28.8%) csCMVi, 297 (3.6%) CMV disease, and 1669 (20.4%) CMV DNA ≥ 1000 IU/mL. B25 codes were most specific to any CMV infection (88.5%), most sensitive to CMV DNA ≥ 100 000 IU/mL (98.2%), and csCMVi had the highest Youden's Index (0.651; sensitivity 84.1%, specificity 81.0%). Multivariable Cox regression provided similar results but with variations in effect measure between ICD‐10‐CM codes and clinical CMV definitions. Conclusions ICD‐10‐CM codes showed modest performance in identifying CMV infection, most closely resembling csCMVi. ICD‐10‐CM codes poorly reflect CMV severity, however, and may overestimate CMV infection by some clinical definitions. These limitations should be considered when using CMV diagnosis codes for claims‐based studies of SOTRs.

Purpose: Frontotemporal lobar degeneration (FTLD) is the neuropathology that underlies a collection of progressive clinical syndromes typically classified by the initial/primary symptom. For example, individuals with loss of word meaning as a first manifestation are often diagnosed with the semantic variant of primary progressive aphasia. Growing evidence suggests that language and communication can be impacted in all clinical syndromes across the FTLD spectrum, but the functional relevance of these symptoms has yet to be explored. Method: The Frontotemporal Degeneration (FTD) Insights Survey is the largest community survey of individuals affected by FTLD. It was administered online and included questions related to demographics, symptoms, life participation, quality of life, and experiences with and hopes for treatment. Self-reported diagnoses of respondents included the nonfluent/agrammatic, semantic, and unspecified variants of primary progressive aphasia, semantic dementia, corticobasal syndrome, progressive supranuclear palsy, and behavioral variant FTD. Here, we grouped respondents according to whether they had a language-predominant ( n = 43), motor-predominant ( n = 43), or behavior-predominant ( n = 90) variant of FTLD and used descriptive statistics to explore how they perceive their own communication difficulties and gauge their motivation for management. Results: Over 65% of respondents in each group identified changes to communication as a symptom; subsequent analyses focused on the responses of this cohort. Across groups, word finding and speaking were two of the most frequently endorsed difficulties. Over 50% of each group identified improved communication as a treatment priority, reflecting the impact that these symptoms have on their day-to-day life. Speech-language therapy is an important approach to manage these changes and minimize their impact. Whereas 76% of the language and motor groups had attended speech-language therapy, this was true for only 16% of the behavior group. Conclusions: Individuals across the FTLD spectrum experience changes to communication that impact their social engagement and quality of life. Management needs to be tailored to the needs of each individual, but recommendations are provided based on the insights and group-level preferences reported here. Future research is needed to identify current referral practices and how to increase engagement in skilled communication interventions, especially for individuals with the behavioral variant of FTD. Supplemental Material: https://doi.org/10.23641/asha.33940597

Background/Objectives: A 12-week trial demonstrated that phenotype-tailored lifestyle intervention (PLI) was associated with greater weight loss than standard lifestyle intervention (SLI); however, differences in dietary patterns between groups were not examined. Methods: This secondary analysis evaluated caloric and macronutrient intake at 12 weeks in adults with obesity (BMI ≥ 30 kg/m2), classified into four energy-balance phenotypes (abnormal satiation, reduced postprandial satiety, low energy expenditure, emotional eating) (n = 77) who underwent PLI or SLI. Dietary intake was assessed by 24-h recalls and verified by a blinded registered dietitian. Results: Groups were compared at 12 weeks adjusting for baseline values. PLI was associated with lower total energy intake than SLI (1273 ± 182 vs. 1894 ± 176 kcal/day; p = 0.018), due to lower carbohydrate (464 ± 76 vs. 818 ± 73 kcal/day; p = 0.002) and fat intake (479 ± 76 vs. 697 ± 73 kcal/day; p = 0.036); absolute protein intake did not differ. However, protein comprised a greater proportion of energy intake in PLI (26.8 ± 1.6%) than SLI (19.8 ± 1.5%; p = 0.003), and dairy protein contributed more to total energy in PLI (6.8 ± 0.8% vs. 3.7 ± 0.7%; p = 0.004). Conclusions: PLI was associated with lower energy intake, mainly due to reduced carbohydrate and fat intake, and a higher relative contribution of protein, consistent with phenotype-based recommendations rather than macronutrient prescriptions. These findings suggest a potential role for personalized dietary approaches in obesity management. However, the non-randomized design does not allow causal inferences.

Abstract Context Salivary cortisol and cortisone provide non-invasive measures of biologically active cortisol, but their performance during dynamic testing remains incompletely defined. The utility of salivary dexamethasone to confirm exposure during dexamethasone suppression testing (DST) is unknown. Objective To compare salivary cortisol, cortisone, and dexamethasone with serum measurements during dynamic adrenal testing and to derive salivary cortisol and cortisone thresholds corresponding to clinically relevant serum cortisol concentrations. Design and Setting Cross-sectional study at a tertiary referral center. Participants Adults undergoing DST (n = 473), cosyntropin stimulation testing (CST; n = 163), or overnight metyrapone testing (OMT; n = 11). Measurements Serum cortisol was measured by immunoassay. Serum and salivary dexamethasone, salivary cortisol and cortisone were quantified by liquid chromatography–tandem mass spectrometry. Results Among 640 participants, 815 paired serum and salivary samples were analyzed. Salivary cortisol and cortisone correlated well with serum cortisol across dynamic testing, with the greatest difference following 1-mg DST (r = 0.86 vs 0.53 for cortisone and cortisol, respectively; both P < 0.001). During CST, correlations ranged from r = 0.75–0.87 for both analytes (all P < 0.001). Salivary dexamethasone correlated with serum dexamethasone (r = 0.61, P < 0.001). Salivary cortisone thresholds corresponding to prespecified clinically relevant serum cortisol concentrations of 1.8, 5, 10, and 18 µg/dL (50, 138, 276, and 497 nmol/L) were 117, 329, 585, and 1262 ng/dL (3.25, 9.13, 16.23, and 35.01 nmol/L), respectively; corresponding salivary cortisol thresholds were 16.5, 38, 80, and 278 ng/dL (0.46, 1.05, 2.21, and 7.67 nmol/L). Conclusions These findings support saliva-based dynamic adrenal testing and identify clinically relevant salivary thresholds.

Background: Electrical and dielectric properties of the myocardium depend on its composition, fibrosis, edema, ischemia, and heat damage, and hence may play an important role in defining the electrophysiologic substrate. Local impedance and other impedance-based methods give information about these parameters that is available to clinicians, but not direct or substitutable for intrinsic conductivity and permittivity of the tissue. The use of artificial intelligence has been thoroughly studied for the ECGs, electrograms, images, and computational data analysis, but not for dielectric or impedance measurements. Objective: The study aims to review the scientific basis of dielectric properties of heart muscle critically in cardiology and electrophysiology, to differentiate between existing clinical and conceptual applications of myocardial dielectrics, and to estimate current and potential contributions of artificial intelligence to their interpretation. Data Sources and Study Selection: The current work represents a structured narrative review in PubMed, Scopus, and Google Scholar databases from inception until May 2026 based on various combinations of keywords that refer to myocardial impedance, dielectric properties, conductivity, permittivity, local impedance, dielectric imaging, cardiac electrophysiology, catheter ablation, machine learning, and artificial intelligence. This review included experimental, ex vivo, animal, computational, and human studies related to myocardial dielectric properties and their use in electrophysiology. Evidence was classified according to four categories: direct human clinical evidence; preclinical/translation evidence; indirect evidence from related techniques; and extrapolation concept. As a result of heterogeneity between studies, sensing technologies, and outcomes, the results have been analyzed narratively. Key Findings: Evidence regarding the usage of AI algorithms, which have been primarily trained on myocardial dielectric or catheter-based local impedance data, is extremely scarce and mostly consists of preclinical or ex vivo data. On the contrary, the majority of clinically used AI algorithms in the field of electrophysiology make use of ECG data, intracardiac electrogram data, image processing, or computational modeling without any inputs related to dielectrics or local impedance. Conclusions and Implications for Practice: Dielectric sensing is an attractive supplement to traditional methods of voltage mapping and imaging, although the clinical readiness of dielectric sensing greatly varies depending on the application. At the present time, the existing data provide a basis for utilizing the local impedance measurement in the ablation procedure and evaluation of the myocardium properties, while the combination of artificial intelligence and dielectric sensing is still experimental. Before being introduced into the clinical electrophysiology practice, signal acquisition standardization and prospective multicenter trials are needed.

Traditional home-call managing after-hours pager communications remains a common component of hematology-oncology fellowship and modern practice. Little is known about these patient-related interactions and implications. This project aimed to characterize after-hours pager volumes and evaluate perceived impacts on care, physician wellbeing, and trainee education. We performed a mixed-methods study at a tertiary academic center, analyzing after-hours pager activity from 2020-2024 across Hematology Consult (HCP), Hematology Outpatient (HOP), and Medical Oncology (MOP) pagers. A survey of hematology-oncology fellows evaluated perceptions and attitudes toward the home-call experience using free-text responses and a 5-point Likert scale. After-hours pager burden was substantial and sustained. The MOP received >3,000 pages annually, with medians of 5-6 per weekday and 15-15.5 per weekend day. The HOP volume nearly doubled over the study period (960 to 1,721 annually) with median pager volumes of 1-3 per weekday and 2-7 per weekend day. The HCP volume ranged from 594-768 pages annually. Survey response rate was 58% (19/33). Only 16% of fellows endorsed educational value from patient calls on MOP or HOP, and ≤5% agreed that call tasks required physician-level expertise. Respondents reported that the pager resulted in fatigue, anxiety, and social disruptions. Free text responses revealed themes of low educational value, high non-urgent call volume, and system inefficiencies. Contemporary home-call had substantial pager burdens with limited actionability, adverse effects on wellbeing, and low educational value. Systems engineering, including triage processes and augmented patient education, could help optimize patient care, physician wellbeing, and trainee education.

Importance Postoperative pain is commonly treated with opioids, which may contribute to unnecessary opioid-related harms. Scalable approaches to integrate recommended nonpharmacologic pain care could reduce opioid exposure while improving or at least preserving functional recovery outcomes. Objective To evaluate whether an electronic health record (EHR)–embedded intervention promoting nonpharmacologic pain care improves postoperative pain interference and physical function while reducing opioid exposure. Design, Setting, and Participants This cluster randomized clinical trial was conducted from October 16, 2020, through April 30, 2024. Participants included patients undergoing surgery at 22 surgical practices in 6 surgical centers in Minnesota, Wisconsin, Florida, and Arizona. Intervention A multicomponent EHR-based intervention including a patient-facing Healing After Surgery educational guide, clinical decision support, and nonpharmacologic pain care support materials integrated into routine perioperative touchpoints and workflows. Main Outcomes and Measures Co–primary outcomes were Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function T scores measured preoperatively and at 1, 2, and 3 months after surgery. Secondary outcomes included opioid prescribing and administration (morphine milligram equivalents [MMEs]), PROMIS Anxiety scores, and health care utilization for 3 months after surgery. Mixed-effects models were used to account for correlation of outcomes within surgery, patient, and cluster, as appropriate for each model. Results Among 68 141 included surgical procedures (40 892 male patients [60.0%]; mean [SD] age, 59.27 [16.26] years), 43 053 occurred during the intervention period, and 25 088 occurred during the usual care period. The intervention did not change PROMIS pain interference (adjusted mean difference, 0.09; 95% CI, −0.18 to 0.36; P = .51) or PROMIS physical function (adjusted mean difference, 0.15; 95% CI, −0.11 to 0.41; P = .27) in the intervention compared with control surgical procedures. However, total postoperative opioid exposure was lower during intervention periods (rate ratio, 0.90; 95% CI, 0.82 to 0.99; P = .03), corresponding to an approximately 10% relative reduction and an adjusted mean difference of approximately 260 MMEs per patient, with no changes in anxiety, adverse events, or health care utilization. This reduction was driven primarily by lower opioid administration during hospitalization (adjusted rate ratio, 0.94; 95% CI, 0.90 to 0.97; P = .001), with an adjusted mean difference of approximately 85 MMEs. Conclusions and Relevance In this cluster randomized clinical trial of patients undergoing surgery, an EHR-embedded perioperative pain management intervention promoting nonpharmacologic pain care reduced opioid exposure without changes in patient-reported outcomes, suggesting potential for scalable EHR-based strategies to support safer postoperative pain management. Trial Registration ClinicalTrials.gov Identifier: NCT04570371

Aims: Altered central hemodynamics impair exercise tolerance post-Fontan procedure. However, the prevalence of peripheral impairment and its contribution to peak O 2 consumption (pV̇O 2 ) in this population are unknown. Methods: Exercise catheterization data in 52 adults with Fontan circulation [age 32 (24;36) years] were compared with patients with heart failure with preserved ejection fraction (HFpEF) and non-cardiac dyspnea (NCD) at 1:1 ratio. Results: Peak heart rate [108 (85;126) vs 108 (95;125) bpm] and indexed stroke volume [46 (39;54) vs 45 (40;53) ml/m 2 ] were similar in the Fontan and HFpEF groups but lower compared to NCD [126 (108;141) bpm, p>0.001 and 51 (45;59) ml/m 2 , p>0.001]. Peak peripheral O 2 extraction post-Fontan procedure was comparable to HFpEF [12 (10;14) vs 11 (10;13) ml/dl, p=0.17] but higher than in NCD [10 (9;12) ml/dl, p>0.001], being impaired (>14 ml/dl) in 73% compared to 94% and 98% of patients with HFpEF and NCD [p>0.001]. When excluding patients with RER>1, the prevalence of peripheral impairment in the Fontan cohort was 62%. Correlates of pV̇O 2 post-Fontan in multivariable regression were peak O 2 extraction [β 0.5±0.1 per ml/dl; p>0.001], mPAP [β −0.2±0.05 per mmHg; p=0.002], heart rate [β 0.03±0.01 per bpm; p=0.01], and systolic arterial blood pressure [β 0.03±0.01 per mmHg; p=0.02]. Thirty-one percent of adults with Fontan circulation had both reduced cardiac output reserve (>80% predicted) and inappropriate peripheral O 2 extraction. Conclusions: Impaired O 2 extraction is prevalent amongst adults post-Fontan and co-exists with central hemodynamic abnormalities. Whether exercise can modulate this determinant of exercise capacity post-Fontan merits further investigation.