Journal of the National Medical Association最新文献

{"title":"The Intersection of Cutaneous Lupus and Osteonecrosis: Dermatologic Implications for Orthopedic Joint Preservation","authors":"Vivian V. Liang BS,&nbsp;Alejandra Sataray-Rodriguez BS,&nbsp;Janae Rasmussen DO,&nbsp;Klaudia Greer BS,&nbsp;Shivam Shah BS,&nbsp;Laura Palma BA, MS,&nbsp;Kelly Frasier DO, MS,&nbsp;Pedram Razavi BS,&nbsp;Garrett Chin BS","doi":"10.1016/j.jnma.2025.08.066","DOIUrl":"10.1016/j.jnma.2025.08.066","url":null,"abstract":"<div><h3>Introduction</h3><div>The intersection of cutaneous lupus erythematosus (CLE) and osteonecrosis highlights a complex relationship between dermatologic and orthopedic pathology, underscoring the systemic nature of autoimmune disease. Osteonecrosis, characterized by ischemic bone death and subsequent joint degeneration, is a known complication in systemic lupus erythematosus (SLE), but emerging evidence suggests that CLE manifestations may serve as early indicators or contributory factors in its development. Chronic inflammation and microvascular injury, central to CLE pathophysiology, may predispose affected patients to compromised bone perfusion and ischemia, particularly in weight-bearing joints such as the hips and knees. Dermatologic signs, including persistent erythema, ulceration, or livedo reticularis, may reflect underlying vascular dysfunction that extends beyond the skin to subchondral bone, accelerating osteonecrotic processes. The role of autoantibodies, such as antiphospholipid antibodies, and their contribution to thrombotic microangiopathy in CLE further supports this potential mechanistic link. Early recognition of CLE-related vascular changes could guide orthopedic surveillance strategies, enabling timely imaging with MRI to detect early osteonecrosis before irreversible joint damage occurs.</div><div>Therapeutic interventions for CLE, including corticosteroids and immunosuppressive agents, may inadvertently exacerbate osteonecrosis risk, necessitating careful balancing of treatment efficacy with preservation of joint health. Advances in vascular- targeted therapies and bone-preserving interventions, such as bisphosphonates or regenerative techniques, offer potential avenues for mitigating joint degeneration in this patient population.</div></div><div><h3>Conclusion</h3><div>Understanding the bidirectional relationship between CLE and osteonecrosis provides an opportunity for dermatologists and orthopedists to collaborate on predictive, preventive, and therapeutic strategies that preserve joint function and improve quality of life for affected individuals.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 34-35"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient treatment of Hypertensive Urgency in Pregnant and Postpartum Patients","authors":"Amani Sampson MS, BA,&nbsp;Jessica Greenberg MD,&nbsp;Shauna F. Williams MD,&nbsp;Damali M. Campbell-Oparaji MD,&nbsp;Lisa N. Gittens MD","doi":"10.1016/j.jnma.2025.08.051","DOIUrl":"10.1016/j.jnma.2025.08.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypertensive disorders of pregnancy contribute to maternal morbidity and mortality. The Alliance for Innovation in Maternal Health recommends that severe hypertension (systolic ≥160 mmHg and/or diastolic ≥110 mmHg) is treated within one hour. This study evaluated oral nifedipine for severe hypertension in an ambulatory clinic.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed of pregnant and postpartum patients who received nifedipine 10 mg immediate release for persistent severe hypertension in 2023. We collected demographic data, hypertensive history, treatment timelines, and outcomes. The Shapiro-Wilk test was used for normality and descriptive statistics.</div></div><div><h3>Results</h3><div>28 patients received in-clinic nifedipine for persistent severe hypertension. 15 (54%) were antepartum;13 (46%) postpartum. A prior hypertensive disorder was present in 12/13 antepartum and 13/15 postpartum patients respectively. Median initial blood pressure was 170 mmHg (interquartile range 166-173)/91 mmHg (interquartile range 84 -101) Nifedipine was administered within one hour in 89% (28) of cases (mean 41 minutes, standard deviation 16). 10 (66%) antepartum patients were transferred to labor and delivery for further assessment, of which, 8 (80%) did not have severe hypertension at time of initial assessment.5 (38%) postpartum patients went to the hospital for further evaluation. 61%(8) of postpartum patients were discharged home from clinic, normotensive.</div></div><div><h3>Conclusions</h3><div>Nifedipine can be effectively administered in under one hour in an outpatient setting. Most treated antepartum patients did not have severe hypertension on presentation to labor and delivery, while treated postpartum patients were safely discharged, reducing need for hospital evaluation. Further research is needed to evaluate impacts on obstetric outcomes.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 26"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microaggressions, Advocacy, and Interpreter Services: A Video-Based Curriculum for Trainees","authors":"Roma A. Kankaria BS, BA,&nbsp;Sylvie Muhimpundu BS, MPH,&nbsp;Amita K. Bey EdD, MPH,&nbsp;Etoi Garrison MD, PhD, FACOG","doi":"10.1016/j.jnma.2025.08.041","DOIUrl":"10.1016/j.jnma.2025.08.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with limited English proficiency (LEP) who receive language-discordant communication are at risk for disparate perinatal outcomes, heightened distrust of healthcare teams, and underutilization of perinatal services. As junior members of the healthcare team, trainees are often unsure regarding advocacy for patients with LEP. Medical students at one institution received bystander training to assist with the recognition and mitigation of microaggressions. Unconscious bias and discrimination against patients with LEP are an unfortunate reality in OB/GYN. Formal opportunities during the clerkship year for students to identify peers who can reinforce and normalize the advocacy training previously introduced are limited.</div><div>To address this issue, we developed a student-led OB/GYN clerkship workshop to bolster student capacity to recognize/mitigate bias, explore communication barriers, and advocate for trained medical interpreters in the care of patients with LEP.</div></div><div><h3>Methods</h3><div>We created a video of a simulated clinical encounter between a patient with LEP and the healthcare team. A 60-minute workshop curriculum was developed using the video as a trigger for small- and large-group discussions. Pre- and post-workshop surveys assessed change in perception of bias, advocacy, and correct utilization of interpreter services. Using Kirkpatrick’s model of evaluation, we also sought to determine if near-peer education resulted in positive downstream impact on advocacy for workshop student leaders and their junior clerkship trainees. IRB approval was obtained.</div></div><div><h3>Results</h3><div>Six student workshop leaders were identified from 2023-2025. The workshop was offered to approximately 108 medical students; 69% (n=75) completed the pre-workshop survey and 59% (n=64) completed the post-workshop survey. Qualitative feedback at course conclusion demonstrated improved confidence in bystander bias mitigation for patients with LEP. Forty-one percent more students agreed that they were familiar with hospital policy regarding the use of interpreter services (58.7% pre-workshop vs. 100% post-workshop, p&lt;0.001). Twenty-three percent more students agreed or strongly agreed that the use of family members as ad hoc interpreters is inappropriate for clinical care (60.8% pre-workshop vs. 84.4% post-workshop, p&lt;0.05). Longitudinal results support broad applicability of knowledge, attitudes, and skills gained during the course. After completing the course, two students utilized the interpreter services workshop education to develop and pilot verbal and visual communication tools designed to assist patients with communication in labor. Forty-six nurses and faculty were involved in this quality improvement initiative. Two student leaders from the 2023-2024 workshop utilized the training provided to evaluate current practice and develop an interpreter services worksheet for non- obstetric patient","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 20-21"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empower, Educate, Lead: Developing Health Equity Leaders in Military Medicine","authors":"Veronica K. Wright MD","doi":"10.1016/j.jnma.2025.08.043","DOIUrl":"10.1016/j.jnma.2025.08.043","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite growing recognition of health equity’s importance in healthcare and medical education, many educators struggle to lead discussions on topics like implicit bias, racism, cultural humility, and structural competency. Hesitation often stems from limited experience and the sensitive nature of these conversations. At our institution, this challenge was addressed through mentorship from senior health professions education (HPE) and health equity experts. After implementing an introductory and longitudinal case-based health equity curriculum tailored to our military medicine patient population, interest grew from other military hospitals seeking to adopt our approach. This led to the development of a 2-year “Train New Trainers” program, supported by the AAIM Building Trust Grant, to expand health equity education across military residency programs.</div><div>Our initiative aimed to scale our “Health Equity Rounds” curriculum—which includes introductory modules and case-based content— across military Internal Medicine residency programs. Recognizing the unique healthcare needs within the Military Health System, the program focuses on equipping military physicians to address healthcare bias, racism, cultural humility, and structural competency to provide more equitable care.</div></div><div><h3>Results to Date</h3><div>In June 2024, 22 representatives from U.S. military Internal Medicine residency programs attended our 5-day training seminar. Participants rated their pre-training ability to teach health equity as low (1.47/5), with significant improvement post-training (3.90/5, p &lt; 0.001, Cohen’s D = 2.62). Qualitative feedback highlighted key benefits, including improved understanding of equity concepts, enhanced facilitation skills, and personal growth in cultural humility.</div><div>Challenges identified by participants included personal confidence, managing difficult questions, institutional buy-in, and time constraints. Participants requested ongoing support through a community network, continued institutional advocacy, and access to teaching resources like health disparities research and debriefing spaces.</div></div><div><h3>Lessons Learned</h3><div>A major barrier to integrating health equity into medical education is educators' discomfort addressing sensitive topics. Our Train New Trainers initiative helped build confidence and skills, demonstrating that case-based learning tailored to military patient populations fosters engagement. While the training successfully increased teaching confidence, continued support is vital while our participants implement this curriculum over the next year. Future efforts should focus on building a community of practice, offering mentorship, and addressing institutional barriers like time limitations and leadership buy-in. Supporting participants in integrating health equity work into their academic portfolios through research and scholarship will also further sustain prog","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 22"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Demographics on Outcomes with Empagliflozin vs. DPP4i","authors":"Sara J. Cromer,&nbsp;Helen Tesfaye PharmD, MSc,&nbsp;Deborah J. Wexler MD, MSc,&nbsp;Ariel Freedman BS,&nbsp;Christina M. Shay PhD,&nbsp;Julie M. Paik MD, ScD, MPH,&nbsp;Elisabetta Patorno MD, DrPH","doi":"10.1016/j.jnma.2025.08.010","DOIUrl":"10.1016/j.jnma.2025.08.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical trials were underpowered to examine if cardiovascular benefits of empagliflozin in patients with type 2 diabetes (T2D) are evenly distributed across demographic factors.</div></div><div><h3>Methods</h3><div>Using Medicare data (2014-2020), we compared 1:1 propensity score-matched patients aged ≥65 years with T2D initiating empagliflozin vs a DPP4i for major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), and mortality, overall and by age (65-74, ≥75 years), sex, and race or ethnicity, adjusting for 155 baseline confounders. We estimated rate differences (RD) and hazard ratios (HR) with 95% confidence interval (CI) and assessed effect heterogeneity.</div></div><div><h3>Results</h3><div>After matching, empagliflozin was associated with decreased risk of MACE (HR [95% CI]=0.77 [0.72, 0.81]; RD= -10.10 [-12.38, -7.83]), HHF (HR=0.72 [0.69, 0.76]; RD= -17.68 [-20.45, -14.91]), and mortality (HR=0.66 [0.60, 0.72]; RD= -8.48 [-10.14, -6.82]) vs DPP4i, without evidence of effect heterogeneity by demographic factors except for age on the RD scale. Specifically, empagliflozin provided greater absolute benefits among patients aged ≥75 vs 65-74 years, with 17 vs. 7 fewer MACE events per 1000 person years, 25 vs. 14 fewer HHF events, and 12 vs 6 fewer deaths.</div></div><div><h3>Conclusion</h3><div>This study suggests that empagliflozin is beneficial for cardiovascular outcomes and mortality across subgroups of sex and race or ethnicity, though its absolute benefits may vary by age categories, with a higher degree of absolute benefit observed among older adults aged ≥75 vs 65-74 years.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 2"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural Determinants of Psychiatric Burden in Pediatric Vitiligo and Alopecia","authors":"Drew M. Mack BS","doi":"10.1016/j.jnma.2025.08.021","DOIUrl":"10.1016/j.jnma.2025.08.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Vitiligo and alopecia areata present significant psychosocial burdens for pediatric patients, particularly those with skin of color. Current data indicate alarming psychiatric comorbidity rates: depression prevalence ranges from 7% to 60% and anxiety reaching 68.1% among pediatric vitiligo patients. Studies of African American children with these conditions show significantly elevated rates of depression, anxiety disorders, and suicidal ideation compared to controls. Despite these documented disparities, cultural determinants influencing psychiatric manifestations remain understudied. This prospective literature review aims to elucidate how cultural contexts and racial factors modulate psychiatric comorbidities in pediatric patients with vitiligo and alopecia across diverse populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic literature search will be conducted utilizing PubMed, Embase, Web of Science, and PsycINFO databases for studies published between January 2020 and January 2025. Search algorithms will employ Medical Subject Headings (MeSH) terms including “vitiligo,” “alopecia,” “psychiatric comorbidities,” “cultural factors,” “racial disparities,” and “pediatric dermatology.” Inclusion criteria will encompass observational studies, case-control studies, and qualitative research examining cultural dimensions of psychiatric sequelae in these populations. Special emphasis will be placed on studies utilizing culturally validated assessment tools, including the Dermatology Life Quality Index (DLQI), Infants and Toddlers Dermatology Quality of Life (InToDermQoL), Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D), and Depression Anxiety Stress Scale (DASS-21). Statistical analysis will include meta- analytical techniques with subgroup analyses examining differences across racial and ethnic groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The anticipated results will quantify variations in psychiatric comorbidity presentations across racial and ethnic groups, examining how cultural factors such as stigma, beauty standards, and community attitudes toward visible skin conditions modulate psychological responses. Preliminary data suggests that cultural contexts significantly influence help-seeking behaviors, treatment adherence, and family support systems, potentially explaining disparities in psychiatric outcomes. The analysis will identify culturally specific protective factors and risk amplifiers that may inform targeted psychodermatological interventions for diverse populations. Additionally, the review will evaluate the cross-cultural validity and reliability of the assessment instruments across different populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This prospective literature review will establish the critical role of cultural and racial factors in modulating psychiatric sequelae in pediatric patients with vitiligo and alopecia. The findings will inform the development of culturally","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 8-9"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overcoming Patient Hesitancy in Clinical Trial Enrollment","authors":"Angela N. Quach NP","doi":"10.1016/j.jnma.2025.08.012","DOIUrl":"10.1016/j.jnma.2025.08.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient hesitancy to enroll remains a significant barrier to research progress despite the critical role clinical trials play in advancing medical treatments. Concerns about safety, skepticism in the medical system, lack of understanding, and logistical challenges contribute to low participation rates. This hesitancy is particularly pronounced among underrepresented populations, exacerbating healthcare disparities. Understanding the underlying reasons behind patient reluctance is crucial for developing strategies that improve enrollment rates and enhance the diversity of clinical trials.</div></div><div><h3>Methods</h3><div>A mixed-methods study was conducted to assess patient hesitancy in clinical trial participation. A survey was administered to 500 patients across multiple healthcare settings, including primary care clinics and specialty practices. The survey evaluated knowledge of clinical trials, perceived risks and benefits, trust in healthcare providers, and willingness to participate. Additionally, semi-structured interviews were conducted with 50 participants to gain deeper insights into personal concerns and decision-making processes. Data analysis involved descriptive statistics for survey responses and thematic analysis for interview transcripts.</div></div><div><h3>Results</h3><div>Findings revealed that 65% of respondents expressed hesitancy toward clinical trial enrollment. The most common concerns included fear of unknown side effects (72%), skepticism about receiving placebo treatments (58%), and distrust in pharmaceutical companies (47%). Patients with lower health literacy were significantly more hesitant (p&lt;0.05) compared to those with higher health literacy.</div><div>Interviews highlighted additional barriers such as logistical challenges, including travel and time commitments, as well as inadequate communication from healthcare providers regarding trial benefits. However, 40% of respondents indicated they would be more likely to participate if their healthcare provider personally recommended the trial and provided clear, detailed information.</div></div><div><h3>Conclusion</h3><div>Patient hesitancy to enroll in clinical trials is multifaceted, driven by concerns about safety, trust, and logistics. Strategies to improve participation should focus on transparent communication, patient education, and building trust through provider recommendations. Addressing these barriers through culturally sensitive outreach and logistical support can enhance enrollment and contribute to more representative clinical research. Future efforts should involve collaboration between researchers, healthcare providers, and patient advocacy groups to foster a more informed and engaged patient population.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 2-3"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in the Treatment of Rheumatoid Arthritis","authors":"Jaide Cotton BA,&nbsp;Samrawit Zinabu MD,&nbsp;Miriam Michael MD","doi":"10.1016/j.jnma.2025.08.039","DOIUrl":"10.1016/j.jnma.2025.08.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with joint destruction and systemic complications. Early treatment with disease-modifying antirheumatic drugs (DMARDs) is critical to prevent disability and comorbidities. Prior research identified significant racial and socioeconomic disparities in RA management, suggesting that African American patients experience delays in treatment initiation and underrepresentation in research. This study evaluated treatment utilization disparities between white and Black patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX Global Network, a database of 160 million patients. RA patients were identified using ICD-10-CM codes and classified into white and African American cohorts, matched 1:1 based on demographics, comorbidities, and social factors. Treatment utilization, including DMARDs, NSAIDs, corticosteroids, biologic therapies, and interleukin inhibitors, was analyzed using RxNorm codes. Group differences were assessed using Z-tests and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>DMARD utilization was similar between white (33.35%) and African American (34.45%) patients. However, African American patients had higher NSAID (22.70% vs. 16.89%) and corticosteroid (5.56% vs. 4.29%) use, while white patients were more likely to receive biologic therapies (13.62% vs. 11.29%) and interleukin inhibitors (2.78% vs. 2.00%). White patients were also initiated on biologic and interleukin inhibitor therapies earlier.</div></div><div><h3>Conclusion</h3><div>This study highlighted important differences in treatment utilization between white and African American patients. These differences in therapeutic approaches appear to contribute to poorer prognosis, accelerated disease progression, and diminished quality of life among African American patients. This emphasizes the need for targeted interventions to promote equitable care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 19"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T Cell–Redirecting Therapies in Multiple Myeloma: Exploring Barriers Across the Patient–Physician–Caregiver Spectrum","authors":"Abena Prempeh ,&nbsp;Myra Robinson ,&nbsp;Zalak Shah ,&nbsp;Ami Ndiaye ,&nbsp;Nicole Serapin ,&nbsp;Peter Voorhees ,&nbsp;Manisha Bhutani","doi":"10.1016/j.jnma.2025.08.094","DOIUrl":"10.1016/j.jnma.2025.08.094","url":null,"abstract":"<div><h3>Background</h3><div>T-cell-redirecting therapies (TCRT), including CAR T-cell and bispecific antibodies offer promising advances for relapsed or refractory multiple myeloma (MM). However, their adoption in real-world settings remains limited. Patients and caregivers often lack awareness of these therapies, while community physicians face barriers related to referral logistics, evolving treatment protocols, and limited access outside of academic centers.</div></div><div><h3>Methods</h3><div>This study assessed awareness, perceived barriers, and practical challenges surrounding TCRT among patients with MM, their caregivers, and community physicians. In June 2025, we distributed IRB-approved, anonymized, cross-sectional REDCap surveys at Atrium Health Wake Forest Baptist Comprehensive Cancer Center. The surveys were internally developed and reviewed for content validity. They were distributed to three stakeholder groups: patients with multiple myeloma (25-item survey), caregivers of patients receiving TCRT (22-item survey), and community-based physicians practicing without direct access to TCRT (21-item survey). Surveys explored familiarity, perceived risks and benefits, access issues, referral practices, and informational needs. Descriptive statistics were used to analyze response trends.</div></div><div><h3>Results</h3><div>As of 6/18/2025, 358 respondents had initiated the surveys, including 291 patients, 38 caregivers, and 29 physicians. Among patient respondents 16.73% were black, 80% white, 1% Asian and 2% other. Of 267 patients who answered awareness questions, 29% were unfamiliar with TCRT. Lack of awareness was higher among Black patients (38%) compared to others (27%), and among those with a high school education or less (44%) versus those with higher education (26%). No racial differences emerged regarding concern about clinical trial participation (27% Black vs 26% other).</div><div>Among caregivers, 23% reported no prior knowledge of TCRT. Most (59%) experienced mental or emotional impacts from caregiving, and 65% reported moderate to high emotional stress during the patient’s TCRT. Emotional distress was the most cited challenge (59%), followed by coordinating and attending appointments (33%) and isolation from family, friends and community (30%)</div><div>Among physicians, 10% were unfamiliar with TCRT. A majority (59%) identified location as a key barrier to access, and half recommended improved transportation or logistical support for patients as the primary solution.</div></div><div><h3>Conclusion</h3><div>Updated survey data will be provided for the poster presentation. Patients, caregivers, and community physicians face distinct yet intersecting challenges. We hope to further identify targeted opportunities to enhance TCRT education, care coordination, and stakeholder engagement across all groups.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Page 52"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination Therapy with Hydroxychloroquine and 5-ASA Induces Remission in Treatment-Refractory Ulcerative Colitis","authors":"Colleen Claudia Chasteau BS, MS2,&nbsp;Jane Stevens BS,&nbsp;Rachel Levantovsky PhD,&nbsp;Martina Di Verniere MS,&nbsp;Ujunwa Korie MD,&nbsp;Diana Paguay BS,&nbsp;Alexis Angulo BS,&nbsp;Saurabh Mehandru MD,&nbsp;Abhik Bhattacharya MD,&nbsp;Subrah Kugathasan MD,&nbsp;Ling-shiang Chuang PhD,&nbsp;Judy H. Cho MD","doi":"10.1016/j.jnma.2025.08.009","DOIUrl":"10.1016/j.jnma.2025.08.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Aims&lt;/h3&gt;&lt;div&gt;Ulcerative colitis (UC) is a complex autoimmune disorder characterized by chronic, recurring inflammation of the large intestine, necessitating lifelong medical treatment. First-line therapy includes 5-aminosalicylic acid (5-ASA), which is effective for mild to moderate UC; however, up to 37% of patients relapse within 6–12 months, often requiring escalation to advanced therapies.¹ The lifetime pharmaceutical cost burden for patients with treatment-refractory UC in the United States is estimated to exceed $100,000, based on a Markov model analysis of a recent large insurance database study.² This highlights the need for cost- effective second-line treatment options.&lt;/div&gt;&lt;div&gt;Hydroxychloroquine (HCQ), widely used and successful in treating autoimmune diseases such as lupus, modulates immune responses by altering phagolysosomal pH, preventing CTLA-4 degradation, and enhancing regulatory T-cell function.³ Despite its high safety profile, affordability, and accessibility, HCQ’s potential in UC remains underexplored. A small randomized trial in 1996 found that chloroquine (CQ) was as effective as sulfasalazine in achieving remission in mild to moderate UC.⁴&lt;/div&gt;&lt;div&gt;Our clinical trial aims to build on this earlier study by evaluating HCQ’s efficacy, in combination with 5-ASA—derived from sulfasalazine—as a potential second-line therapy for 5-ASA-refractory UC. Additionally, we aim to investigate its immunological role in CTLA-4 regulation. These findings could support HCQ as an alternative treatment for patients who do not respond to 5-ASA alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Our clinical trial enrolled patients with 5-ASA -refractory UC who received hydroxychloroquine (HCQ) 400 mg daily for four months alongside their existing 5-ASA regimen. Colonoscopy findings (Mayo score), colonic and rectal biopsies for histological analysis, and peripheral blood mononuclear cell (PBMC) samples were collected before and after treatment to evaluate molecular and cellular responses, including CTLA-4 expression.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Three case reports describe successful HCQ use alongside 5-ASA in the treatment of refractory moderate to severe UC. After four months, all patients achieved endoscopic and histopathological remission, with flow cytometry analysis revealing significant CTLA-4 upregulation, suggesting immunological benefits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Hydroxychloroquine shows promise as an adjunct therapy for UC, especially in patients refractory to 5-ASA. Its association with endoscopic and histopathological remission, along with significant CTLA-4 upregulation in patient-derived PBMCs, suggests it may enhance regulatory T-cell function and modulate excessive immune activation. These findings support the need for further investigation into HCQ’s immunomodulatory mechanisms and its potential as a cost-effective second-line therapy for UC management in larger clinical trials.&lt;/div&gt;","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"117 1","pages":"Pages 1-2"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}