Journals
2026 EN
Emerson Catherine · Klas Anna · Gibson Peter R.
+3 more
ABSTRACT Aims Fatigue in IBD is pervasive, with very few intervention options available to patients. Research has indicated that psychological therapies are a promising strategy for managing IBD fatigue. However, no such intervention is available to date. This study aimed to evaluate the opinion of patients and health professionals on a potential psychological intervention for IBD fatigue. Methods and Results A total of seven patients (Crohn's disease = 5, ulcerative colitis = 2) and seven health professionals participated in semi‐structured interviews. Results were derived by using a template analysis, revealing four key themes and associated subthemes: (1) it's a trade‐off; (2) buy‐in, trust and credibility; (3) accountability; and (4) accessibility and equity. Important factors identified were a self‐led online intervention, where patients can converse with other patients. Patients determined a facilitator with IBD‐specific knowledge to be important. Health professionals were concerned with the cost‐effectiveness and duration of an intervention, whereas patients were less concerned about the financial cost if there is perceived benefit to the intervention. Conclusion Findings indicate the need to balance support with accessibility for patients. The lack of consensus of who can deliver an intervention by health professionals is significant and underscores the need for mental health care to be integrated into IBD health services. Nurses were recommended as an alternative to mental health professionals. However, the nurses interviewed emphasized the impact this would pose on their workloads. As such, there needs to be a diversity of supporting staff in IBD health care teams to ensure that future psychological interventions are feasible.
Wiley Publishing Asia Pty Ltd
Journals
2026 EN
Chater Faris · Kopczynska Maja · Saeidinejad Mahdi
+4 more
ABSTRACT Objectives The success of anti‐TNFα agents has changed the landscape of treatment for inflammatory bowel diseases (IBD). One major limitation to this success is the secondary loss of response (sLOR) phenomenon. Combination therapy with immunomodulating agents has been shown to be effective in reducing the sLOR process. The primary aim of this study was to evaluate the rates of sLOR to anti‐TNFα therapy in IBD patients on mono versus combination therapy, using real‐world data. Methods This was a retrospective study of 200 patients with IBD treated with anti‐TNFα agents from 2000 to 2023. Data was collected on patient demographics, IBD phenotype, drug therapy, clinical and biochemical response to treatment. Results Overall, there was no significant difference in median duration of response for infliximab (IFX) vs. adalimumab (ADA) (15 months, IQR 7–30 vs. 17 months, IQR 8–31; p = 0.53). In total, 41/200 (20.6%) of patients developed sLOR. Rates of sLOR were similar between IFX (23/106, 21.7%) and ADA (18/94, 19.1%, p = 0.76). Combination therapy (used in 69/200, 34.8% patients) was associated with a significantly lower risk of sLOR compared with monotherapy (HR 0.41, 95% CI: 0.19–0.87; p = 0.020). This effect was observed in patients receiving IFX ( p = 0.0095), whilst no significant difference was seen with ADA ( p = 0.15). Safety outcomes were comparable between both groups, with no signal for increased risk of infection or malignancy with combination therapy. Conclusion Combination therapy significantly reduced sLOR compared with monotherapy. There was no significant difference in sLOR between IFX and ADA.
Wiley Publishing Asia Pty Ltd
Journals
2026 EN
Kim Juliann L. · Forster Catherine S. · Allan Jessica M.
+4 more
Abstract Background In medicine, professional experiences and work environment can impact physician satisfaction and well‐being. Little is known about these experiences in pediatric hospital medicine. Objective The objective of this study was to examine self‐reported factors associated with professional experience, career development, and career satisfaction, and to compare aspects of these domains between men and women. Methods This was a cross‐sectional survey study of 1096 pediatric hospitalists performed in 2021. Our survey tool included novel and previously published questions. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associations between variables and career satisfaction. Results Five hundred and sixty‐five respondents (52.3% response rate) completed the survey with 70.6% women. Over three‐quarters (77.4%) reported career satisfaction, and 71.9% would choose Pediatric Hospital Medicine (PHM) again. Work‐life balance was positively associated with career satisfaction, while perception of gender‐specific bias decreased career satisfaction. Satisfaction with mentoring was reported by 88% of respondents with a mentor. Positive aspects of professional experience included peer relationships and support. However, 29.7% experienced gender discrimination, 26.5% were treated with disrespect by colleagues, and 40% perceived gender biases in the professional environment—women more than men on most measures. Conclusion Satisfaction with career, peer relationships, and mentoring was high; however, opportunities to improve the professional experience exist, including addressing potential mentorship gaps and discrimination. This study adds insights into career satisfaction in PHM.
Journals
2026 EN
Vick Judith B. · Kelly Matthew · McArthur Amanda
+2 more
Abstract Background Against medical advice (AMA) discharges are associated with adverse clinical outcomes and can be stigmatizing to patients. Most prior work has described patient characteristics associated with AMA discharges, with little attention to interpersonal clinician–patient dynamics that culminate in a discharge being designated AMA. Objective To describe clinical documentation about patients whose hospitalizations ended in an AMA discharge, attending to both what was written and how it was written. Methods We performed a qualitative description using inductive thematic analysis of 185 free‐text notes from hospitalizations administratively identified as ending with an AMA discharge from Internal Medicine services at an urban academic medical center in the mid‐Atlantic region in 2017. Results Common features of notes regarding patients leaving AMA included documentation of: (1) the clinician becoming aware of the patient leaving before planned discharge, (2) the patient's reasons for leaving, (3) the clinical team's response to a patient's decision to leave, (4) the patient's capacity, and (5) insinuation of the patient's character flaws. While some note writers conveyed neutrality, we found extensive evidence of adversarial relationships with patients with unnecessary details and language that could stigmatize patients and bias future readers. Conclusions Many notes documenting AMA discharges contain stigmatizing language, with writers frequently taking a defensive or paternalistic stance toward their interactions with patients. Our findings reflect a lack of clarity about what should be documented in the medical record regarding the events surrounding this type of contentious discharge.
Journals
2026 EN
Moolla Haroon · Kassanjee Reshma · Euvrard Jonathan
+11 more
Abstract Introduction Viral suppression estimates are essential for monitoring the performance of HIV programmes. South Africa introduced dolutegravir (DTG)‐based antiretroviral therapy (ART) in 2019. We sought to generate updated estimates of viral suppression in South African adults on ART and investigate predictors of viral non‐suppression. Methods This retrospective cohort study used data from seven South African cohorts participating in the International epidemiology Databases to Evaluate AIDS collaboration. Three main analyses were performed using a viral suppression threshold of 1000 HIV RNA copies/ml. In the first analysis, we fitted a logistic regression model using the full data from the study period (2005−2023). Then, in two causal analyses, we used logistic regression with inverse probability weighting to assess the effects of starting ART on DTG‐based regimens (as opposed to starting on non‐DTG‐based ART) and switching to DTG while virally suppressed (compared to remaining on non‐DTG‐based ART). In sensitivity analyses, we reduced the suppression threshold to 400 copies/ml and excluded those with missing baseline CD4+ cell count measurements. Results There were 380,720 participants contributing 2,090,912 person‐years of observation. Most participants were female (64.7%), and the median age at ART initiation was 35.0 years (interquartile range 28.9−42.3). Viral suppression increased over time, reaching 95.9% in 2023. Twenty‐one percent of participants either started ART on DTG‐based regimens (7.1%) or switched to DTG‐based regimens from a virally suppressed state (14.0%). DTG‐based ART was protective against viral non‐suppression in both causal models, with adjusted odds ratios of 0.54 (95% confidence interval [CI] 0.48−0.61) and 0.36 (95% CI 0.32−0.39) for those initiating ART on DTG and those switching to DTG, respectively. A history of ART interruption was strongly associated with viral non‐suppression, with adjusted odds ratios ranging from 2.49 to 4.55. The odds of non‐suppression decreased with increasing age, increasing duration on ART and increasing baseline CD4+ cell count. Results were consistent across sensitivity analyses. Conclusions DTG‐based regimens improve viral suppression among both ART‐naïve individuals and those transitioning while suppressed. ART interruptions pose a risk to the sustained success of ART programmes and may further impede efforts to recover from the impacts of recent funding cuts.
Journals
2026 EN
Cano Aline · Chen Xiaoyi · Khemiri Azza
+22 more
ABSTRACT The importance of early diagnosis of inherited metabolic diseases (IMDs) is well known, as it allows early intervention to prevent or reduce complications and improve prognosis, since many of these disorders are treatable. However, diagnosis can still be delayed, and many patients remain undiagnosed. Reducing diagnosis delays is a primary goal of the French Ministry of Health and Prevention (Rare Disease Department). This article describes a national initiative coordinated by the French network for IMD, “Filière G2m.” Sixty‐seven IMD experts from various reference and competence centers in France drafted one‐page summaries dedicated to specific diseases or groups of diseases in the field of IMDs, covering the full spectrum of IMDs. These documents include keywords summarizing clinical signs which, when considered alongside data from routine biological or imaging tests, should suggest the diagnosis of an IMD. A total of 48 summaries have been drafted and are available on the Filière G2m website. To assess the accuracy and relevance of the diagnostic fact sheets, we selected 4 IMDs and compared their content with the clinical profiles of patients followed at Necker—Enfants Malades Hospital, using Natural Language Processing tools to automatically extract patient phenotypes from medical records (Dr Warehouse). We found a strong alignment between the fact sheets and the real‐world clinical data from these patients. This tool will enable patients to recognize themselves in an IMD. General practitioners will use these documents alongside diagnostic aid software. It may also support new artificial intelligence‐based technologies to identify undiagnosed patients in hospital databases.
Journals
2026 EN
Renault Gilles · Chinchilla Lenin · Massengo Lourdes
+7 more
Objectives O ‐GlcNAcylation plays a key regulatory role in hepatic physiology, and its disruption leads to fibrosis in liver‐specific OGT knockout mice (OGT LKO ), making this model valuable for studying advanced metabolic dysfunction‐associated steatohepatitis (MASH). Our objective is to demonstrate that shear wave elastography (SWE) is a suitable non‐invasive tool to characterize and follow this mouse model of liver injury. Methods We weekly monitored non‐invasively liver fibrosis progression in OGT LKO mice from 5 to 8 weeks of age, using SWE on both a high‐frequency preclinical ultrasound system (VevoF2), and a clinical reference system (Aixplorer) and assuming the liver as homogeneous, isotropic and purely elastic. Stiffness measurements were then confronted with ex vivo liver histological scoring and major gene transcripts associated with the development of the pathology. Results Weekly liver stiffness measurements demonstrated a progressive increase, correlating strongly with histological fibrosis scores ( R 2 > 0.78) and fibrosis‐related gene expression (Col3a1, Col6a1). The high‐resolution imaging capability of the VevoF2 allowed precise anatomical exploration while delivering SWE measurements consistent with the clinical device (Pearson r = 0.92). Conclusion Our study confirms that following liver stiffness fibrosis by SWE in a mouse model of liver injury is a valuable tool that correlates with ex vivo findings. This approach facilitates a better understanding of disease progression and therapeutic evaluation in preclinical models of MASH.
Journals
2026 EN
Martin Alynn M. · IsasiCatalá Emiliana · SalgadoCaxito Marília
+11 more
Abstract Vicuñas ( Vicugna vicugna ) and guanacos ( Lama guanicoe ) are the two species of wild South American camelids whose distributions range from Peru to northern Argentina and southern Peru to southern Argentina, respectively. Listed as critically endangered in the 1960s due to poaching, vicuña numbers had been gradually recovering; however, new concerns about population stability have arisen with recent observations of sarcoptic mange outbreaks in this species. Sarcoptic mange is an infectious skin disease caused by the microscopic burrowing mite, Sarcoptes scabiei , which infects nearly 150 mammalian species globally, including guanaco and vicuña. Wild camelid populations across Argentina, Bolivia, Chile, and Peru have been affected by sarcoptic mange, with the most severe outbreaks resulting in localized extirpation. Population declines have conservation and economic implications, as many local communities harvest vicuña and guanaco fiber for profit. We review the current literature on sarcoptic mange in wild camelids from Argentina, Bolivia, Chile, and Peru to establish a current state of knowledge on spatial prevalence, management, and therapeutics, and identify existing knowledge gaps. Critical next steps include 1) implementation of effective management strategies that limit the transmission of sarcoptic mange, 2) standardization of data collected during community capture (i.e., chaccu) events, 3) assessing the potential role of community captures in mite transmission, and 4) evaluation of treatment options and best practices for implementation. Further, there is a need for capacity building to improve disease diagnostics and surveillance in wild camelids. A multisectoral collaboration between governmental authorities, communities, academic institutions, and national and international organizations focusing on wild South American camelid conservation could contribute to building actions aimed at preventing future outbreaks and mitigating the current burden of sarcoptic mange disease.
Journals
2026 EN
Karom Jarod · Hunter Molly O. · Anderson Catherine
+2 more
ABSTRACT Objective To investigate the ancestral background of patients with idiopathic subglottic stenosis (iSGS) using genetic testing results. Methods A de‐identified survey collecting genetic testing service ancestry data results, in addition to self‐reported ancestry, personal autoimmune history, and any family history of iSGS, was distributed to members of the Facebook group “Living with Idiopathic Subglottic Stenosis.” Exclusion criteria included age < 18, non‐idiopathic stenosis or ANCA‐positive antibody status, and supraglottic or tracheobronchial location of stenosis. Results A total of 1242 participants (99.4% female) met inclusion criteria, with 62.4% residing in the US. Genetic testing service results were available in 377 patients, in which European ancestry was most reported (86.6%), specifically Northwestern Europe. By country, ancestry within the United Kingdom, Ireland, and Germany were most common (56%, 40%, and 39%, respectively), all of which are reported at an increased rate when comparing to the US Census. Self‐reported ancestry results displayed similar patterns ( p = 0.44). Autoimmune history was self‐reported in 170 patients (13.6%), and family history of iSGS was present in 5.0%; neither varied based on ancestry. Twenty‐four patients overall (1.9%) had predominantly non‐Caucasian/non‐European ancestry: 2.2% of the self‐reported cohort and 1.3% of the testing service result cohort. Conclusion A cohort of primarily North American patients with iSGS report higher rates of ancestry from Northwestern Europe than the US population at large. These findings support potential genetic contributions to disease development. Additionally, as a subset of patients were identified as non‐Caucasian within our cohort, further characterization of this “atypical” patient population should be performed to determine whether patients may be underdiagnosed worldwide. Level of Evidence 4.
Journals
2026 EN
Corman Jessica R. · Halvorson Halvor M. · Brucker Casey
+80 more
Abstract All organisms contain carbon, nitrogen, and phosphorus in widely ranging amounts and proportions. Integrating existing datasets enables quantification of this variation at global scales. Such efforts could leverage ecological stoichiometry theory, the study of elemental supply and imbalances in ecological interactions, to connect ecological drivers and taxonomic constraints to ecosystem structure and function. Towards this goal, we developed the Limnology Stoichiometric Traits of Organisms In their Chemical Habitats (Limno‐STOICH) database. The Limno‐STOICH database includes 51,576 observations of organismal elemental stoichiometry from >3100 rivers, lakes, wetlands, and other aquatic ecosystem sites on seven continents, derived from 190+ sources. It also includes extensive spatial and temporal metadata to link elemental stoichiometry with ecosystem type, trophic status, etc., and information on organismal data (body size, taxonomic classifications, stable isotope composition) and water physicochemical parameters. The Limno‐STOICH database sets the stage for significant applications across food web ecology, evolutionary ecology, biogeochemistry, and other disciplines.