Citations

Background Individuals with intellectual and developmental disabilities experience substantial disparities across the cancer care continuum, including delayed diagnosis, limited access to supportive resources, and heightened psychosocial distress. These challenges are intensified in high-acuity settings where care models are not adapted to their developmental and cognitive needs. Methods We describe an interdisciplinary, patient-centered approach to the care of a 34-year-old patient with developmental delay and metastatic adenocarcinoma. Key strategies emphasized education, preparation, and communication tailored to her cognitive abilities. Collaboration with her family informed effective strategies to reduce distress and improve compliance. Results Tailored interventions – including simplified communication, visual supports, and continuity of providers – improved the patient’s coping, reduced distress, and enabled completion of comprehensive oncologic evaluation and treatment. Conclusions This case demonstrates that structured, interdisciplinary, patient-centered approaches to care can mitigate disparities and support equitable, compassionate care for individuals with intellectual and developmental disabilities facing serious illness.

Background: Overweight and obesity are rising globally. During perimenopause years, declining estrogen and changes in body composition increase visceral fat and insulin resistance, increasing cardiometabolic risk. Objective: To estimate trends in overweight and obesity among U.S. women aged 40–64 years, examine variations by age and state, and project prevalence to 2050. Design: Secondary analysis of publicly available body mass index (BMI) data accessed through the Global Burden of Disease (GBD) Health Data Exchange, using pooled cross-sectional estimates and hierarchical logistic growth modeling.This sub‑study is not part of the official GBD analysis. Methods: Harmonized data from the GBD Health Data Exchange integrated National Health Interview Survey, National Health and Nutrition Examination Survey (NHANES), and Behavioral Risk Factor Surveillance System microdata (1990–2021) for nonpregnant women aged 40–64 years, with calibration of self-reported BMI to measured NHANES data. BMI categories followed WHO cutoffs. Weighted estimates were age-standardized, and hierarchical logistic models projected state-specific trends to 2050. The pooled sample included 150,842 women, representing about 90 million weighted person-years. All data were de-identified and publicly available; ethics approval and consent were not required. Results: Combined overweight/obesity prevalence increased from 49.2% (95% uncertainty interval (UI) 45.8–52.2; 17.7 million (95% UI 16.5–18.8 million)) in 1990 to 74.2% (95% UI 68.8–79.1; 33.4 million (95% UI 31.0–35.6 million)) in 2021, and projected to reach 83.4% (95% UI 75.5–88.3; 41.7 million (95% UI 37.8–44.2 million)). In 2021, rates ranged from 68.3% in Colorado to 82.8% in Mississippi. Conclusion: Overweight and obesity among midlife women have increased sharply with a continuing shift from overweight to obesity. Menopause-specific preventive strategies and policies promoting physical activity and healthy diet are critical to slow future increases.

Extramedullary presentations of multiple myeloma (MM) involving the central nervous system (CNS) carry a dismal prognosis. Although historically rare, management of extramedullary disease—including CNS manifestations—has become increasingly clinically relevant as advances in systemic therapies have prolonged control of medullary disease. CNS manifestations may occur across a variety of clinical settings and at different time points throughout the disease course. Common symptoms include visual changes, headaches, loss of sensation, confusion, and seizures. MRI identifies leptomeningeal enhancement and/or parenchymal lesions in approximately 90% of cases, and lumbar puncture with cerebrospinal fluid testing for clonal plasma cell populations is confirmatory. Encouragingly, the incorporation of novel therapeutic agents has improved historically poor outcomes in CNS MM. Novel immunotherapeutic approaches using CAR T-cell therapy and bispecific T-cell–engaging antibodies have recently demonstrated significant efficacy in consolidating responses. Multimodality treatment strategies incorporating intrathecal chemotherapy, systemic novel agents, radiation therapy, and immunotherapy hold promise for achieving more durable responses in this devastating manifestation of MM.

Abstract Purpose: Knowledge of prognostic factors and long-term survival in patients with diffuse hemispheric glioma, H3 G34–mutant (DHG, H3 G34), remains limited in this tumor with a poor prognosis. Experimental Design: This retrospective, multi-institutional study investigated prognostic variables for patients with DHG, H3 G34, and their association with progression-free survival (PFS) and overall survival (OS). Uni- and multivariable Cox proportional hazard models were applied with multiple imputed datasets. Results: A total of 153 patients (142 G34R, 9 G34V, 2 via DNA methylation) were included. The median age at diagnosis was 17 years (range, 2–45). Initial gross/near total resection (GTR/NTR) was achieved in 43% of patients. Radiation was given in 91% (85% focal irradiation), and initial chemotherapy was given in 87% [70% temozolomide-based (TMZ), 25% TMZ/lomustine, 5% non-TMZ]. Median OS was 24 months [interquartile range (IQR), 22–28] with a median PFS of 14 months (IQR, 12–19). Twelve patients (8%) were found to be long-term survivors (≥5 years). Exploratory multivariable analysis showed that adjuvant radiotherapy [HR, 0.076; 95% confidence interval (CI), 0.033–0.17] and achieving GTR/NTR compared with < NTR (HR, 0.51; 95% CI, 0.33–0.78) were associated with improved PFS. Multivariable analysis showed improved OS with increasing age at diagnosis (HR, 0.70; 95% CI, 0.57–0.87), initial radiotherapy (HR, 0.38; 95% CI, 0.15–0.96), and initial GTR/NTR compared with < NTR (HR, 0.60; 95% CI, 0.37–0.97). Conclusions: This cohort highlights prognostic factors for patients with DHG, H3 G34, and describes relapse patterns and therapy approaches. Clinical trials and prospective registries are needed to improve outcomes.

Purpose: Delirium is a serious underrecognized health condition in hospitalized older adults. The current qualitative study used dimensional analysis to increase understanding of the clinical reasoning processes used by acute care nurses to assess for delirium. Method: Ten focus groups with experienced medical, surgical, and intensive care nurses ( N = 39) from quaternary, community, and academic medical centers discussed their application of clinical reasoning processes to assess/detect delirium symptoms. Transcripts were inductively analyzed. Trustworthiness was checked with a subset of participants ( n = 12). Results: Findings illustrate how nurses apply clinical reasoning to recognize and respond to delirium symptoms and navigate clinical and social structures to maintain patient safety. Clinical context and social structures are important conditions influencing nurse reasoning and judgment. Conclusion: Further process improvement and research efforts should explore strategies to enhance interdisciplinary shared knowledge within a supportive environment to improve the detection and care to lessen the severity and duration of delirium for vulnerable patients.

Background: Reoperative metabolic and bariatric surgery (MBS), consisting of revision and conversion surgery, carries higher morbidity and mortality compared with primary procedures, yet robust long-term data are limited. Methods: A retrospective review was conducted of all patients 18 years of age or older who underwent first-time reoperative MBS between 2000 and 2024 at a single large quaternary referral center. Data were stored securely and analyzed in R (v4.4.2) using standard descriptive statistics and group tests ( t tests/Wilcoxon/Kruskal-Wallis; χ²/Fisher). Sparse late-complication data precluded pairwise tests. Results: Three hundred sixty patients, 86% female, mean age 50 years, underwent reoperative MBS. Conversion to Roux-en-Y gastric bypass (49%) was the most common surgery. The majority were performed for weight recidivism (37%). Length of stay, estimated blood loss, length of surgery, complication rates, readmission rates, and reintervention rates varied by type of reoperative MBS performed and indication. Most early complications were Clavien-Dindo 2, and most late complications were Clavien-Dindo 3b for all approaches. There was one procedure-related death in the study following an open conversion. Conclusion: In this 24-year single-center cohort, weight recidivism was the most frequent indication for reoperation and was associated with improved perioperative outcomes and durable long-term weight loss. As the landscape of bariatric surgery continues to evolve, we recommend early referral to centers with reoperative MBS expertise.

ABSTRACT Background Diabetic ketoacidosis (DKA) is a severe diabetes complication managed with fluids, insulin and electrolyte correction. This review evaluates the debated effectiveness of bicarbonate therapy on DKA outcomes. Methods Following PRISMA guidelines, we systematically reviewed studies on bicarbonate therapy in DKA. We searched PubMed, Google Scholar, the Cochrane Library and ClinicalTrials.gov (as of August 2024), including studies on patients with DKA. Meta‐analysis was conducted using RevMan. Bias risk was assessed with the Newcastle‐Ottawa Scale (NOS) for cohort studies, Cochrane's ROB‐2 for RCTs and the Joanna Briggs Institute (JBI) Scale for case series. Prospero ID: CRD42024581810. Results Eight studies, including 646 patients, met the inclusion criteria. Participants' mean ages spanned from approximately 9.7 years to 45.8 years. Bicarbonate therapy did not significantly improve pH levels (mean difference = −0.02, 95% CI [−0.13, 0.09], p = 0.7), time to resolution of acidosis (mean difference = 0.09 h, 95% CI [−2.6, 2.79], p = 0.95) or potassium levels (mean difference = −0.10, 95% CI [−0.49, 0.29], p = 0.61). Bicarbonate therapy was associated with a marginally longer duration of hospital stay (mean difference = 13.63 h, 95% CI [0.23, 27.03], p = 0.05), although the overall effect size was small. No significant difference was observed in the incidence of hypoglycemia (odds ratio = 2.62, 95% CI [0.59, 11.63], p = 0.20). High heterogeneity was observed across most outcomes, mainly due to variability in study protocols and patient populations. Conclusion Bicarbonate therapy provided no meaningful clinical benefit in the routine management of DKA and was associated with potential harm, including worsened hyperglycemia. Consistent with current guidelines, its use should be restricted to cases of severe acidemia (pH < 6.9). Further high‐quality studies are needed to clarify its role in extreme acidosis and to explore alternative buffering strategies.