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  1. Article ; Online: Patient and Clinician Perspectives: To Create a Better Future for Chronic Kidney Disease, We Need to Talk About Our Kidneys.

    Kushner, Pamela R / DeMeis, Jane / Stevens, Petrina / Gjurovic, Ana Marija / Malvolti, Elmas / Tangri, Navdeep

    Advances in therapy

    2024  Volume 41, Issue 4, Page(s) 1318–1324

    Abstract: Chronic kidney disease (CKD) affects more than one in ten people worldwide. However, results from the REVEAL-CKD study suggest that it is often not diagnosed. Many patients are therefore unaware that they have CKD, putting them at increased risk of ... ...

    Abstract Chronic kidney disease (CKD) affects more than one in ten people worldwide. However, results from the REVEAL-CKD study suggest that it is often not diagnosed. Many patients are therefore unaware that they have CKD, putting them at increased risk of disease progression and complications. Empowering patients with knowledge about CKD will allow them to become active participants in their own care, driving improvements in diagnosis rates and changing patient outcomes for the better. In this article, we provide patient and clinician perspectives on the importance of early CKD diagnosis and management. We present an overview of the tests commonly used to diagnose CKD in clinical practice, as well as actionable suggestions for patients, clinicians, and health policymakers that could help improve disease detection and treatment. Navdeep Tangri, a nephrologist and epidemiologist at the University of Manitoba, and Jane DeMeis, a patient living with chronic kidney disease, discuss how results from the REVEAL-CKD study highlight the need for change to improve management of chronic kidney disease. Video Abstract (MP4 141866 KB).
    MeSH term(s) Humans ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy ; Renal Insufficiency, Chronic/complications ; Disease Progression ; Early Diagnosis ; Kidney
    Language English
    Publishing date 2024-03-05
    Publishing country United States
    Document type Review ; Video-Audio Media ; Journal Article
    ZDB-ID 632651-1
    ISSN 1865-8652 ; 0741-238X
    ISSN (online) 1865-8652
    ISSN 0741-238X
    DOI 10.1007/s12325-024-02794-0
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  2. Article ; Online: Binocular Home Treatment for Amblyopia: Gains Stable for One Year.

    Wygnanski-Jaffe, Tamara / Moshkovitz, Avital / Kushner, Burton J / Belkin, Michael / Yehezkel, Oren

    American journal of ophthalmology

    2024  Volume 262, Page(s) 199–205

    Abstract: ... post-treatment, improvement in amblyopic eye VA was maintained vs baseline (0.27 ± 0.14 logMAR, P< .0001 ... with no change vs the end-of-treatment visit (P > .05). At 1 year there was a partial reduction ... in the amblyopic eye VA gain of 0.085±0.1 logMAR compared to end-of-treatment (P = .001), but the residual gain ...

    Abstract Purpose: To report the long-term outcomes of a noninferiority randomized controlled trial (RCT) with a binocular eye-tracking-based home treatment (CureSight; NovaSight, Ltd.) in patients with amblyopia.
    Design: Prospective, multicenter, nonrandomized, long-term follow-up observational study of an RCT.
    Methods: Forty-three children 4 to <9 years of age with anisometropic, small-angle strabismic, or mixed-mechanism amblyopia were initially treated for 16 weeks (NCT05185076) with CureSight. In this planned observational follow-up study, 38 patients with no additional amblyopia treatment were evaluated at 12 weeks post-treatment, and 27 were evaluated at 1-year post-treatment. The main outcome measures were visual acuity (VA), stereoacuity, and amblyopia recurrence at 12- and 52-week post-treatment.
    Results: At 12-week post-treatment, improvement in amblyopic eye VA was maintained vs baseline (0.27 ± 0.14 logMAR, P< .0001), with no change vs the end-of-treatment visit (P > .05). At 1 year there was a partial reduction in the amblyopic eye VA gain of 0.085±0.1 logMAR compared to end-of-treatment (P = .001), but the residual gain of 0.20±0.14 logMAR compared to baseline was statistically significant (P < .0001). Gains in stereoacuity and binocular VA were maintained vs baseline at both 12-weeks and 1-year post-treatment (P < .0001), with no change vs end-of-treatment (P > .05). Amblyopia recurrence (a worsening of ≥2 logMAR levels compared with end-of-treatment) occurred in 2/38 patients at 12-weeks post-treatment (5.3%), and in 5/27 patients at 1-year post-treatment (20.4%).
    Conclusions: VA and stereopsis gains following binocular treatment with CureSight were maintained at 1 year without additional treatment.
    Language English
    Publishing date 2024-02-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80030-2
    ISSN 1879-1891 ; 0002-9394
    ISSN (online) 1879-1891
    ISSN 0002-9394
    DOI 10.1016/j.ajo.2024.02.004
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  3. Article ; Online: Fluorescein Mapping in Vulvar Paget Disease.

    Wagar, Matthew K / Zhang, Ran Catherine / Weisman, Paul / Spencer, Ryan J / Kushner, David M

    Obstetrics and gynecology

    2023  Volume 141, Issue 3, Page(s) 608–612

    Abstract: Background: Vulvar Paget disease often requires extensive and, in some cases, multiple resections to treat. A fluorescein-mapping procedure followed by a staged vulvectomy may be an effective technique to tailor resection and identify clinically occult ... ...

    Abstract Background: Vulvar Paget disease often requires extensive and, in some cases, multiple resections to treat. A fluorescein-mapping procedure followed by a staged vulvectomy may be an effective technique to tailor resection and identify clinically occult lesions.
    Technique: We describe a two-step procedure; first, intravenous fluorescein sodium is injected, and the vulva is illuminated with a Wood's lamp. Representative biopsies are obtained and correlated on final pathology with the extent of disease to develop a final plan for excision. Second, using fluorescein to identify the confirmed areas of disease, the appropriate excisional procedure is performed once mapping biopsy pathology is known.
    Experience: We describe our experience with eight patients with vulvar Paget disease undergoing fluorescein mapping biopsies and staged vulvectomy. Using intravenous fluorescein sodium, all patients were found to have Paget disease beyond the visible margins of their gross lesions. No patients experienced a recurrence of Paget disease within a median follow-up time of 32 months, comparable with other directed methods of surgical resection.
    Conclusion: We report a technique for the injection of fluorescein sodium for the visualization of vulvar Paget disease capable of providing accurate surgical margins and identification of occult satellite lesions with a high degree of safety and a favorable cost profile. This staged approach to vulvectomy could offer improved accuracy of resection for vulvar Paget disease with few drawbacks.
    MeSH term(s) Female ; Humans ; Fluorescein ; Vulvar Neoplasms/diagnosis ; Vulvar Neoplasms/surgery ; Vulva/surgery ; Vulva/pathology ; Paget Disease, Extramammary/diagnosis ; Paget Disease, Extramammary/surgery ; Paget Disease, Extramammary/pathology ; Biopsy ; Neoplasm Recurrence, Local/pathology
    Chemical Substances Fluorescein (TPY09G7XIR)
    Language English
    Publishing date 2023-02-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207330-4
    ISSN 1873-233X ; 0029-7844
    ISSN (online) 1873-233X
    ISSN 0029-7844
    DOI 10.1097/AOG.0000000000005084
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  4. Article ; Online: Symptomatic Accessory Ossicles of the Foot and Ankle.

    Moon, Jee / Graham, Ryan / Kushner, Daniel / Ling, Stephen / Jonnagaladda, Padmaja / Ali, Sayed

    Current problems in diagnostic radiology

    2023  Volume 52, Issue 4, Page(s) 300–311

    Abstract: Accessory ossicles are small noncalcified, calcified or ossified structures found throughout the body, often noted as incidental findings. Specifically in the foot and ankle, there are at least 24 different ossicles described the majority of which are ... ...

    Abstract Accessory ossicles are small noncalcified, calcified or ossified structures found throughout the body, often noted as incidental findings. Specifically in the foot and ankle, there are at least 24 different ossicles described the majority of which are incidental. However, there are accessory ossicles that can be symptomatic, leading to significant pain and discomfort. While many of the symptomatic ossicles have been described in the literature, there are several that are under-recognized or under-reported for example, os interphalangeus and os calcaneus secundarius syndromes. This manuscript will review common and uncommon accessory ossicles including painful os peroneum, os naviculare, os calcaneus secundarius, os trigonum and os interphalangeus syndromes as well as medial sesamoiditis, with attention to the clinical and imaging findings and with an outline of the current management.
    MeSH term(s) Humans ; Ankle ; Bone Diseases ; Calcaneus ; Syndrome ; Foot Diseases ; Ankle Joint ; Foot
    Language English
    Publishing date 2023-03-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 198954-6
    ISSN 1535-6302 ; 0363-0188
    ISSN (online) 1535-6302
    ISSN 0363-0188
    DOI 10.1067/j.cpradiol.2023.03.009
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  5. Article ; Online: Evidence for an alcohol-related "harm paradox" in individuals with internalizing disorders: Test and replication in two independent community samples.

    Anker, Justin J / Thuras, Paul / Shuai, Ruichong / Hogarth, Lee / Kushner, Matt G

    Alcohol (Hoboken, N.J.)

    2023  Volume 47, Issue 4, Page(s) 713–723

    Abstract: Background: Internalizing (anxiety and mood) disorders (INTD) commonly co-occur (are "comorbid") with alcohol use disorder (AUD). The literature suggests that excessive alcohol use aimed at coping with INTD symptoms is, at best, a partial explanation ... ...

    Abstract Background: Internalizing (anxiety and mood) disorders (INTD) commonly co-occur (are "comorbid") with alcohol use disorder (AUD). The literature suggests that excessive alcohol use aimed at coping with INTD symptoms is, at best, a partial explanation for the high comorbidity rates observed. We hypothesized that individuals with INTD experience greater susceptibility to developing AUD symptoms due to the partially shared neurobiological dysfunctions underlying both conditions. We probe this hypothesis by testing the prediction that, after accounting for the volume of alcohol intake, individuals with INTD experience higher levels of alcohol-related symptoms.
    Methods: Data from the National Epidemiological Survey on Alcohol-Related Conditions (NESARC) Wave 3 were used for the primary analyses, and NESARC Wave 1 data were used for independent replication analyses. Individuals who reported any alcohol use in the prior year were categorized as: (1) never having had an INTD diagnosis ("INTD-Never"); (2) having a remitted INTD diagnosis only ("INTD-Remitted"); or (3) having current INTD diagnosis ("INTD-Current"). Between-group contrasts of alcohol-related symptoms controlled for total alcohol intake (past year), drinking pattern (e.g., binging) and variables previously shown to mark exaggerated AUD symptoms relative to drinking amount (e.g., SES, gender, and family history).
    Results: With all covariates in the model, individuals in the INTD-Current group and the INTD-Remitted group reported significantly greater alcohol-related symptoms than those in the INTD-Never group but did not themselves differ in level of alcohol-related symptoms. These results were replicated in the NESARC 1 dataset.
    Conclusions: Individuals with INTD experience more alcohol-related symptoms than those who drink at the same level. While considering other explanations, we argue that this "harm paradox" is best explained by the view that INTD confers a neurobiologically mediated susceptibility to the development of AUD symptoms.
    MeSH term(s) Humans ; Alcoholism/diagnosis ; Alcoholism/epidemiology ; Alcohol-Related Disorders/diagnosis ; Alcohol-Related Disorders/epidemiology ; Alcohol Drinking/epidemiology ; Anxiety Disorders/epidemiology ; Comorbidity
    Language English
    Publishing date 2023-04-28
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2993-7175
    ISSN (online) 2993-7175
    DOI 10.1111/acer.15036
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  6. Article ; Online: Intraoperative Radiation Therapy for Relapsed or Refractory High-Risk Neuroblastoma: A 27-Year Experience.

    Conte, Brianna / Casey, Dana L / Tringale, Kathryn R / Honeyman, Joshua / Narayan, Nicole J C / LaQuaglia, Michael P / Gerstle, Justin Ted / Modak, Shakeel / Kushner, Brian H / Kramer, Kim / Wolden, Suzanne L

    Practical radiation oncology

    2024  

    Abstract: Purpose: To evaluate outcomes after intraoperative radiation therapy (IORT) in high-risk neuroblastoma (NB), including local control, overall survival, and toxicity.: Methods and materials: This was a single institution retrospective study of 92 ... ...

    Abstract Purpose: To evaluate outcomes after intraoperative radiation therapy (IORT) in high-risk neuroblastoma (NB), including local control, overall survival, and toxicity.
    Methods and materials: This was a single institution retrospective study of 92 pediatric patients with NB treated with IORT from 1995 to 2022. Each IORT application was considered a separate event for a total of 110 sites treated. Local failure was calculated using the cumulative incidence function and survival by Kaplan-Meier method from the day of surgery.
    Results: All patients had high-risk relapsed or treatment refractory disease. Median age was 6 years (range, 2-34 years). Median follow-up for all patients and surviving patients was 16 months and 4 years, respectively. All patients previously received chemotherapy, 93% had prior external beam radiation therapy to the site of IORT (median dose, 21.6 Gy; range, 10-36 Gy), and 94% had a prior surgery for tumor resection. The median IORT dose was 12 Gy (range, 8-18 Gy) and median area treated was 18 cm
    Conclusions: Our study represents the largest, most recent analysis of the efficacy and safety of IORT in patients with relapsed or refractory NB. Less than one-third of patients failed locally at 5 years, and achieving local control affected overall survival. Minimal toxicities directly related to IORT were observed. Overall, IORT is an effective and safe technique to achieve local control in high-risk relapsed or refractory neuroblastoma.
    Language English
    Publishing date 2024-02-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2655748-4
    ISSN 1879-8519 ; 1879-8500
    ISSN (online) 1879-8519
    ISSN 1879-8500
    DOI 10.1016/j.prro.2023.12.008
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  7. Article: Tenacious Proximal Fusion: The Scobee Phenomenon.

    Kushner, Burton J

    The American orthoptic journal

    2015  Volume 65, Page(s) 73–80

    Abstract: ... monocular occlusion were significant with P<0.001 and P=0.0049, respectively.: Conclusions: What has been ...

    Abstract Background and purpose: When patients with intermittent exotropia show an increase in their near deviation after prolonged monocular occlusion, they have been said to have tenacious proximal fusion (TPF). That term is not adequately descriptive, since this finding can occur without the patient having been allowed to fuse. The purpose of this study is to investigate the possibility that this phenomenon is mediated by the preponderance of binasal retinal disparity and uncrossed localization that occurs with near fixation.
    Patients and methods: Ten patients with intermittent exotropia who manifested TPF were measured at 6 m, 1/3 m, again at 1/3 m after 1 hour of monocular occlusion, and at 1/3 m with a peripheral crossed localization stimulating device (PCLSD) that simulated the retinal bitemporal disparity and peripheral crossed localization usually found with distance fixation.
    Results: For the ten patients, the mean measurement at distance was 28.3Δ±3.1, initially at near was 4Δ±3.9, at near after prolonged monocular occlusion was 25.3Δ±5.3, and at near with the PCLSD was 18.5Δ±4.1. The differences between the initial near measurement and the measurement with the PCLSD, and between the PCLSD and post-prolonged monocular occlusion were significant with P<0.001 and P=0.0049, respectively.
    Conclusions: What has been previously referred to as TPF in fact appears to be convergence induced by the preponderance of binasal retinal disparity and/or peripheral uncrossed localization typically found with near fixation. For simplicity, I propose the term TPF should be replaced with the "Scobee Phenomenon."
    MeSH term(s) Accommodation, Ocular ; Child ; Convergence, Ocular/physiology ; Exotropia/diagnosis ; Exotropia/physiopathology ; Female ; Fixation, Ocular/physiology ; Humans ; Male ; Prospective Studies ; Sensory Deprivation
    Language English
    Publishing date 2015
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219397-8
    ISSN 1553-4448 ; 0065-955X
    ISSN (online) 1553-4448
    ISSN 0065-955X
    DOI 10.3368/aoj.65.1.73
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  8. Article ; Online: Practical guidance for using the FreeStyle Libre flash continuous glucose monitoring in primary care.

    Unger, Jeff / Kushner, Pamela / Anderson, John E

    Postgraduate medicine

    2020  Volume 132, Issue 4, Page(s) 305–313

    Abstract: Use of continuous glucose monitoring (CGM) improves clinical outcomes in type 1 diabetes, and significant benefits been demonstrated in patients with type 2 diabetes, including improved glycemic control, better treatment adherence, and an increased ... ...

    Abstract Use of continuous glucose monitoring (CGM) improves clinical outcomes in type 1 diabetes, and significant benefits been demonstrated in patients with type 2 diabetes, including improved glycemic control, better treatment adherence, and an increased understanding of their treatment regimens. Currently, there are two types of CGM systems: real-time CGM (rtCGM) and flash CGM (FCGM). Retrospective analysis of CGM data allows patients and their clinicians to identify glycemic patterns that support and facilitate informed therapy decisions. With the increasing prevalence of diabetes, primary care physicians will be compelled to take on more responsibility for managing patients with diabetes. This article focuses on practical approaches and decision-making strategies for utilizing FCGM in primary care settings.
    MeSH term(s) Age Factors ; Blood Glucose Self-Monitoring/instrumentation ; Decision Making ; Diabetes Mellitus/blood ; Humans ; Longitudinal Studies ; Patient Preference ; Primary Health Care/organization & administration ; Retrospective Studies ; Wearable Electronic Devices
    Language English
    Publishing date 2020-03-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 410138-8
    ISSN 1941-9260 ; 0032-5481
    ISSN (online) 1941-9260
    ISSN 0032-5481
    DOI 10.1080/00325481.2020.1744393
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  9. Article ; Online: World Health Organization (WHO) risk level reductions in inpatients with alcohol use disorder and comorbid anxiety disorders.

    Stevenson, Brittany L / Anker, Justin / Thuras, Paul / Rinehart, Linda / Kushner, Matt G

    Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors

    2022  Volume 37, Issue 5, Page(s) 713–722

    Abstract: Objective: Studies have demonstrated that reduced drinking without total abstinence is associated with improved outcomes in outpatients with alcohol use disorder (AUD). We sought to examine this question in AUD inpatients who have comorbid anxiety ... ...

    Abstract Objective: Studies have demonstrated that reduced drinking without total abstinence is associated with improved outcomes in outpatients with alcohol use disorder (AUD). We sought to examine this question in AUD inpatients who have comorbid anxiety disorders, a common presentation in AUD.
    Method: This is a secondary analysis of data from a randomized controlled trial for
    Results: At 1-, 4-, and 12-months posttreatment, most patients reported abstinence (83, 63, and 60%), and 11, 25, and 26% reported drinking at a reduced level. Drinking reductions achieved at 1-month posttreatment were maintained at 12-month posttreatment by 74% of participants. Overall, the abstinent group reported the best psychological and functional outcomes at follow-ups, followed by the reduced group. Few differences were observed between reducers and nonreducers, but reducers reported significantly better alcohol dependence severity and alcohol-related problems than nonreducers.
    Conclusions: Though abstinence was associated with the best outcomes in this abstinence-based treatment sample, we conclude that reduced drinking is also associated with significant improvements in alcohol-related outcomes in inpatients with AUD and comorbid anxiety disorders.At 1-, 4-, and 12-months posttreatment, most patients reported abstinence (83, 63, and 60%), and 11, 25, and 26% reported drinking at a reduced level. Drinking reductions achieved at 1-month posttreatment were maintained at 12-month posttreatment by 74% of participants. Overall, the abstinent group reported the best psychological and functional outcomes at follow-ups, followed by the reduced group. Few differences were observed between reducers and nonreducers, but reducers reported significantly (PsycInfo Database Record (c) 2023 APA, all rights reserved).
    MeSH term(s) Humans ; Alcoholism/epidemiology ; Alcoholism/therapy ; Alcoholism/psychology ; Inpatients ; Aftercare ; Treatment Outcome ; Patient Discharge ; Alcohol Drinking/psychology ; Alcohol-Related Disorders/psychology ; Anxiety Disorders/epidemiology ; World Health Organization
    Language English
    Publishing date 2022-12-08
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2101111-4
    ISSN 1939-1501 ; 0893-164X
    ISSN (online) 1939-1501
    ISSN 0893-164X
    DOI 10.1037/adb0000895
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  10. Article: Efficacy and Safety of Tirzepatide in Adults With Type 2 Diabetes: A Perspective for Primary Care Providers.

    Kushner, Pamela / Anderson, John E / Simon, Jörg / Boye, Kristina S / Ranta, Kari / Torcello-Gómez, Amelia / Levine, Joshua A

    Clinical diabetes : a publication of the American Diabetes Association

    2023  Volume 41, Issue 2, Page(s) 258–272

    Abstract: This article reviews the efficacy and safety data of tirzepatide, a once-weekly, novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 (GLP-1) receptor agonist approved in the United States, the European Union, and other regions ... ...

    Abstract This article reviews the efficacy and safety data of tirzepatide, a once-weekly, novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 (GLP-1) receptor agonist approved in the United States, the European Union, and other regions for the treatment of type 2 diabetes. All doses of tirzepatide demonstrated superiority in reducing A1C and body weight from baseline versus placebo or active comparators. The safety profile of tirzepatide was consistent with that of the GLP-1 receptor agonist class, with mild to moderate and transient gastrointestinal side effects being the most common adverse events. With clinically and statistically significant reductions in A1C and body weight without increased risk of hypoglycemia in various populations, tirzepatide has demonstrated potential as a first-in-class treatment option for many people with type 2 diabetes.
    Language English
    Publishing date 2023-11-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1025953-3
    ISSN 0891-8929
    ISSN 0891-8929
    DOI 10.2337/cd22-0029
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