Secure Messages, Video Visits, and Burnout Among Primary Care Providers in the Veterans Health Administration: National Survey Study.

Background: Telehealth use, including video visits and secure messages, expanded significantly in Veterans Health Administration (VHA) primary care during the COVID-19 pandemic. However, primary care provider (PCP) burnout also increased during this period. Each modality may have affected primary care workloads differently (either by substituting for or complementing in-person visits) and thereby had varying effects on PCP burnout.

Kidney Health and Gender-Affirming Hormone Therapy for Transgender and Gender Diverse Individuals.

This review examines the effects of gender-affirming hormone therapy (GAHT) on kidney health in transgender and gender diverse (TGD) populations, which face significant challenges in accessing medical care. GAHT, typically involves estrogen therapy for transgender women and transfeminine individuals, testosterone therapy for transgender men and transmasculine individuals, and therapy regimens for individuals who are nonbinary or identify with another gender not culturally assigned to their sex assigned at birth. Hormone therapy influences biomarkers such as creatinine and cystatin C, which are used in estimating glomerular filtration rate (eGFR).

Medical Post-Traumatic Stress Disorder Symptoms in Children and Adolescents with Chronic Inflammatory Arthritis: Prevalence and Associated Factors.

Youth with chronic rheumatologic diseases undergo medical experiences that can lead to post-traumatic stress disorder (PTSD). Understudied in pediatric rheumatology, medical PTSD can be significantly distressing and impairing. This study explored the prevalence of medical PTSD symptoms in youth with chronic inflammatory arthritis and associated factors, including pain, disease activity, mental health history, and anxiety sensitivity.

Limitations of Currently Available Sarcoma Prediction Tools in a Large Contemporary Upper Extremity Soft Tissue Sarcoma Cohort.

Soft tissue sarcomas (STS) of the upper extremity (UE) are rare but can lead to devastating outcomes. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, Sarculator, and PERSARC predict local recurrence (LR), distant metastases (DM), and overall survival (OS) in extremity STS. We retrospectively reviewed 211 UE STS patients (2012-2022) at a single tertiary center, recording demographics, tumor factors, treatments, and outcomes.

The Effect of Sex, Race/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study.

Introduction: Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers.

Methods: Patients with primary hip OA seen in 2002 at two tertiary academic centers were included.

Adapting depression collaborative care models to increase uptake of computerized cognitive behavioral therapy at the VA: A pilot randomized controlled trial.

Objective: To examine the feasibility, acceptability, and potential health effects of computerized cognitive behavioral therapy-enhanced collaborative care (cCBT-CC) versus usual primary care (UC).

Background: Internet-based cCBT can effectively treat depression but is not widely used, including in the Veterans Health Administration where it was freely available for veterans. We adapted pre-existing depression collaborative care models using implementation and user-centered design strategies to facilitate cCBT implementation.

Biomimetic, Suturable, and Extensible Electrospun Scaffolds for Lower Urinary Tract Surgical Reconstruction.

Common autologous tissue sources used for the repair or replacement of lower urinary tract (LUT) organs include the inner cheek (buccal), small and large bowels, and foreskin. These sources have limited availability, introduce the risk of donor site complications, and differ mechanically and biologically from LUT tissue. To address this, fibrous composite scaffolds with varying ratios of two naturally derived polymers-gelatin methacryloyl and an elastin-like peptide-are fabricated via electrospinning and photo-crosslinking.

Pediatric Fracture Epidemiology in an Orthopaedic Urgent Care Setting.

Background: Epidemiological data for pediatric fracture are limited, especially specific to the United States. Recent cohort studies from emergency departments and orthopaedic surgery clinics potentially skew data to more severe diagnoses. This retrospective cross-sectional study aims to update the epidemiology of pediatric fracture patients who presented to a pediatric orthopaedic urgent care center in an urban location.

Virtual reality-based cognitive assessment: An exploratory pilot study including patients with cancer-related cognitive impairment.

Introduction: Cancer-related cognitive impairment (CRCI), or "chemo brain," can adversely affect quality of life and potentially survival for patients with cancer. CRCI can especially impact older adults with cancer. Cognitive assessment remains challenging in a busy oncology practice, and virtual reality (VR) based assessment is an emerging option.

Auditor Models to Suppress Poor AI Predictions Can Improve Human-AI Collaborative Performance.

Objective: Healthcare decisions are increasingly made with the assistance of machine learning (ML). ML has been known to have unfairness - inconsistent outcomes across subpopulations. Clinicians interacting with these systems can perpetuate such unfairness by overreliance.

Developing and studying an outcome-focused measure of mental healthcare quality based on patient-reported symptoms in the USA: a study protocol.

Introduction: Various psychological, cognitive, behavioural, medication and neurostimulation treatments can improve the outcomes of people with depressive and anxiety disorders. However, in usual practice, there is large variability in treatment delivery and treatments are poorly characterised. The effectiveness and quality of mental health services in the community are not accurately monitored and are poorly understood.

Burnout Among Primary Care Practitioners and Staff in VA Clinics Using Virtual Contingency Staffing.

Importance: Primary care practitioners (PCPs) and staff in Veterans Health Administration (VHA) clinics with staffing shortages have reported higher rates of burnout that may be associated with higher workloads. Introducing PCPs through the Clinical Research Hub (CRH) virtual contingency staffing program into these clinics may help reduce burnout but may also disrupt workflows and increase burnout.

Objective: To understand how rates of burnout among VHA PCPs and staff vary by staffing level and CRH program use.

Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study.

Background: School masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.

Objective: To evaluate the impact of school masking policy de-adoption (mask-lifting) on SARS-CoV-2 incidence rates, hospitalizations, and deaths in the surrounding community.

Methods: : Retrospective observational study with an event study design, a difference-in-difference method; a target trial emulation (TTE) framework was applied as a secondary analysis.

The Association Between Adverse Childhood Experiences and Health-Related School Absenteeism: Results From a National Survey of Youth.

Objective: Adverse childhood experiences (ACEs) and school absenteeism are both linked to poor health and educational outcomes. However, little is known about whether ACEs contribute to school absenteeism for health reasons. We examined the association between ACEs and health-related school absenteeism in a nationally representative sample.

Correlation Between Technology and Improved Outcomes in Youth With Type 1 Diabetes Mellitus: Prospective Study Examining Outcomes for Patients With Depression and Those With Public Insurance.

Background: Adherence to type 1 diabetes mellitus (T1DM) treatment regimens decreases during adolescence. While comorbid depression and health insurance disparities are individually known to potentiate this risk, technological devices for T1DM appear to be protective.

Objective: We examined whether technology use impacted the association between depression and poorer health outcomes in T1DM.

Gait and health-related quality of life outcomes following proximal femoral tumor resection and reconstruction with tensioning of the abductor musculotendinous unit.

Background: Although proximal femoral tumors are common, there is little information on outcomes following proximal femoral tumor resection and endoprosthetic reconstruction with reattachment of the hip abductors on tension. The objective of this study is to determine the effect of this surgery on gait and health-related quality of life.

Methods: Participants ≥18 years old and ≥ 2 years after proximal femoral resection with endoprosthetic reconstruction and reattachment of hip abductors on tension were compared to controls in this cross-sectional study.

Enhancement of Fairness in AI for Chest X-ray Classification.

The use of artificial intelligence (AI) in medicine has shown promise to improve the quality of healthcare decisions. However, AI can be biased in a manner that produces unfair predictions for certain demographic subgroups. In MIMIC-CXR, a publicly available dataset of over 300,000 chest X-ray images, diagnostic AI has been shown to have a higher false negative rate for racial minorities.

A Retrospective Analysis Assessing Paravalvular Leak and Pacemaker Implantation Using TEE and Non-Contrast CT for CKD Patients Compared With CT Angiography for Annular Sizing Pre-TAVR.

Background And Aims: Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for many patients with severe aortic stenosis. Proper pre-procedure sizing of the aortic annulus is crucial in preventing post-TAVR complications. This is typically performed with CT angiography, but the use of contrast is controversial in patients with chronic kidney disease (CKD).

Early Results of the New Pamira ICD Lead.

Introduction: A new implantable cardioverter-defibrillator (ICD) lead with a polyurethane cover added for improved long-term reliance was investigated in a post-market study.

Methods: The prospective BIO|MASTER Pamira study is designed to evaluate the new Pamira ICD lead in patients undergoing de-novo ICD or cardiac resynchronization therapy (CRT-D) implantation. We report first data from implantation and 6-month follow-up.

Poor clinical outcomes among hospitalized obese patients with COVID-19 are related to inflammation and not respiratory mechanics.

Introduction: The coronavirus disease 2019 (COVID-19) has infected millions of people worldwide resulting in high morbidity and mortality. Obesity is known to cause metabolic derangements and precipitate worse outcomes from viral pneumonia, potentially secondary to increased inflammation and/or altered respiratory mechanics.

Aim Of The Study: Our study's aim was to examine the relationships among BMI, systemic inflammation, and respiratory mechanics in determining clinical outcomes.

Validating the Sino-Nasal Outcome Test (SNOT-22) in comparison to the Sino-Nasal 5 Questionnaire (SN-5) in a pediatric population.

Objective: To assess test-retest reliability, validity, responsiveness, and clinical interpretability of the SNOT-22 in identifying pediatric patients with CRS from healthy, non-CRS patients by comparing SNOT-22 and SN-5 across multiple visits.

Study Design: Prospective cohort; all pediatric patients between the ages of 6-17, or under the age of 6 but fully verbal, who presented for care between January 2022 through March 2024.

Setting: Tertiary care academic institution's pediatric otolaryngology clinic.

Organization and structure of intensive care management of adult congenital heart disease in the United States.

Background: The growing number of adults with congenital heart disease has led to the formation of dedicated centers to provide specialized care. There is a paucity of published data on the organization, staffing, and resources available when adult congenital heart disease (ACHD) patients are hospitalized in intensive care settings. This study aims to describe the delivery of intensive care for ACHD patients in the United States and identify key differences between accredited centers or those pending accreditation and non-accredited Adult Congenital Heart Association (ACHA) centers.

Characteristics Associated with Lung Function Trajectories: An Analysis of the SPIROMICS Cohort.

Discovering the biological basis of progression in chronic obstructive pulmonary disease (COPD), especially of rapid decline (RD) in forced expiratory volume in 1 second, is essential to the development of precision therapies. First, we sought to define baseline characteristics of RD (⩾100 ml/yr), relative to participants with stable-to-improved (S/I) status or with intermediate decline (D)-categories based on spirometric data from the Framingham Offspring cohort. Second, we sought to examine these categories as predictors of longitudinal COPD outcomes, adjusting for baseline characteristics.

Injectable Estradiol Dosing Regimens in Transgender and Nonbinary Adults Listed as Male at Birth.

Context: Many transgender and nonbinary (TGNB) individuals assigned male at birth (AMAB) seek hormone therapy to achieve physical and emotional changes. Standard therapy includes estradiol, with or without an antiandrogen. Our clinical observations suggest that currently recommended injectable estradiol dosing may lead to supratherapeutic estradiol levels.

Establishment of a Standard Technique for Determining Laser Flare Photometry Values during Assessment of Intraocular Inflammation.

Purpose: The purposes of this study were to determine whether 2 laser flare photometry (LFP) devices produce similar results using various statistical techniques for determining a single, final LFP value for anterior chamber protein level; to determine whether a traditional technique adequately addresses outlier measurements; and to identify a simpler technique that produces LFP values similar to the traditional technique.

Design: Prospective cross-sectional study.

Participants: Patients at a tertiary referral center who have histories of uveitis in 1 or both eyes.