Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: This real-world study confirmed the efficacy and safety of the interleukin (IL)-23 inhibitors guselkumab and risankizumab in patients with psoriatic arthritis (PsA).

Major finding: Mean Disease Activity Index for PsA (DAPSA) score was 43.6 at baseline and reduced significantly at 4 (36.8), 16 (23.6), and 24 (20.5) weeks of treatment (all P < .001). At 24 weeks, 29.2% and 16.7% of patients reported low disease activity and remission, respectively. None of the patients discontinued treatment due to safety concerns.

Study details: Findings are from a single-center retrospective study including 59 patients with moderate-to-severe plaque psoriasis who received guselkumab or risankizumab, of which 24 patients had concomitant PsA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vaiopoulos AG et al. Real-world data show high efficacy of IL23 inhibitors guselkumab and risankizumab in psoriatic arthritis and difficult-to-treat areas. Int J Dermatol. 2023;62:1404-1413 (Sep 25). doi: 10.1111/ijd.16849

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: Intestinal permeability as well as fecal and plasma metabolomic profiles significantly affected the clinical response to fecal microbial transplantation (FMT) or sham transplantation in patients having peripheral moderate-to-high psoriatic arthritis (PsA) despite receiving methotrexate for ≥3 months.

Major finding: Lactulose-to-mannitol ratio was higher at week 26 (0.027 vs 0.012; P = .013), indicating greater small intestinal permeability; moreover, fecal (P < .0001) and plasma (P = .005) metabolomic profiles differed in patients who needed vs did not need treatment intensification after undergoing an FMT or sham transplantation.

Study details: This exploratory study of the FLORA trial included 31 patients who had peripheral moderate-to-high PsA despite ≥3 months of methotrexate treatment and were randomly assigned to undergo either gastroscopic-guided single-donor FMT (n = 15) or sham transplantation (n = 16).

Disclosures: This study was supported by Sygeforsikringen “danmark” and other sources. Three authors declared receiving financial support, grants, or lectureship awards from various sources.

Source: Kragsnaes MS et al. Small intestinal permeability and metabolomic profiles in feces and plasma associate with clinical response in patients with active psoriatic arthritis participating in a fecal microbiota transplantation trial: Exploratory findings from the FLORA trial. ACR Open Rheumatol. 2023 (Sep 22). doi: 10.1002/acr2.11604

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: In patients with psoriatic arthritis (PsA), year-long treatment with interleukin-17 inhibitors (IL-17i) and IL-23(p19) inhibitors (IL23-[19]i), led to comparable drug survival and clinical response outcomes as tumor necrosis factor inhibitor (TNFi) treatment.

Major finding: At 12 months, the drug withdrawal rates for IL-17i (hazard ratio [HR] 1.36; 95% CI 0.59-3.14) and IL23-(19)i (HR 0.56; 95% CI 0.10-3.24) were comparable with those for TNFi. Moreover, the proportion of patients who achieved ≥50% improvement in the American College of Rheumatology scores was similar across the IL-17i, IL-23(19)i, and TNFi groups (19%, 29%, and 19%, respectively).

Study details: Findings are from a target trial emulation study including 109 patients with PsA who presented with peripheral manifestations and initiated either TNFi (n = 75), IL-7i (n = 26), or IL-23(19)i (n = 8).

Disclosures: This study was supported by the Danish Rheumatism Association and other sources. Some authors declared serving as speakers or consultants for or receiving research grants, fees, or other support from various sources.

Source: Stisen ZR et al. Tolerability and comparative effectiveness of TNF-, IL-17-, and IL-23(p19) inhibitors in psoriatic arthritis: A target trial emulation study. Rheumatology (Oxford). 2023 (Sep 15). doi: 10.1093/rheumatology/kead488

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

Disclosures: This study was sponsored by UCB Pharma. Four authors declared being employees and shareholders of UCB Pharma. The other authors declared ties with several sources, including UCB Pharma.

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

Disclosures: This study was sponsored by UCB Pharma. Four authors declared being employees and shareholders of UCB Pharma. The other authors declared ties with several sources, including UCB Pharma.

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

Key clinical point: Bimekizumab led to sustained improvements in clinical response up to week 52 and had a consistent safety profile in patients with active psoriatic arthritis (PsA) who were naive to biologic disease-modifying antirheumatic drugs (bDMARD).

Major finding: At week 16, 43.9% of patients receiving bimekizumab achieved ≥50% improvement in the American College of Rheumatology scores (ACR50), with the response being maintained until week 52 (54.5%). Among patients who switched from placebo to bimekizumab at week 16, a similar proportion (53.0%) achieved ACR50 at week 52. No new safety signals were observed.

Study details: Findings are from the phase 3 BE OPTIMAL study including 852 bDMARD-naive patients with active PsA who were randomly assigned to receive bimekizumab, adalimumab, or placebo.

Disclosures: This study was sponsored by UCB Pharma. Four authors declared being employees and shareholders of UCB Pharma. The other authors declared ties with several sources, including UCB Pharma.

Source: Ritchlin CT et al. Bimekizumab treatment in biologic DMARD-naïve patients with active psoriatic arthritis: 52-week efficacy and safety results from the phase III, randomised, placebo-controlled, active reference BE OPTIMAL study. Ann Rheum Dis. 2023;82:1404-1414 (Sep 11). doi: 10.1136/ard-2023-224431

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

GLASGOW – ChatGPT failed to pass the U.K.’s National Primary Care examinations in a new study, highlighting how artificial intelligence (AI) does not necessarily match human perceptions of medical complexity.

ChatGPT also provided novel explanations – it frequently “hallucinates” – by describing inaccurate information as if they were facts, according to Shathar Mahmood, BA, a fifth-year medical student at the University of Cambridge, England, who presented the findings at the annual meeting of the Royal College of General Practitioners. The study was published in JMIR Medical Education earlier this year.

“Artificial intelligence has generated impressive results across medicine, and with the release of ChatGPT there is now discussion about these large language models taking over clinicians’ jobs,” Arun James Thirunavukarasu, MB BChir, of the University of Oxford, England, and Oxford University Hospitals NHS Foundation Trust, who is the lead author of the study, told this news organization.

Performance of AI on medical school examinations has prompted much of this discussion, often because performance does not reflect real-world clinical practice, he said. “We used the Applied Knowledge Test instead, and this allowed us to explore the potential and pitfalls of deploying large language models in primary care and to explore what further development of medical large language model applications is required.”

The researchers investigated the strengths and weaknesses of ChatGPT in primary care using the Membership of the Royal College of General Practitioners Applied Knowledge Test. The computer-based, multiple-choice assessment is part of the U.K.’s specialty training to become a general practitioner (GP). It tests knowledge behind general practice within the context of the United Kingdom’s National Health Service.

The researchers entered a series of 674 questions into ChatGPT on two occasions, or “runs.” “By putting the questions into two separate dialogues, we hoped to avoid the influence of one dialogue on the other,” Ms. Mahmood said. To validate that the answers were correct, the ChatGPT responses were compared with the answers provided by the GP self-test and past articles.
 

Docs 1, AI 0

Overall performance of the algorithm was good across both runs (59.94% and 60.39%); 83.23% of questions produced the same answer on both runs.

But 17% of the answers didn’t match, Ms. Mahmood reported, a statistically significant difference. “And the overall performance of ChatGPT was 10% lower than the average RCGP pass mark in the last few years, which informs one of our conclusions about it not being very precise at expert level recall and decision-making,” she said.

Also, a small percentage of questions (1.48% and 2.25% in each run) produced an uncertain answer or there was no answer.
 

Say what?

Novel explanations were generated upon running a question through ChatGPT that then provided an extended answer, Ms. Mahmood said. When the accuracy of the extended answers was checked against the correct answers, no correlation was found. “ChatGPT can hallucinate answers, and there’s no way a nonexpert reading this could know it is incorrect,” she said.

Regarding the application of ChatGPT and similar algorithms to clinical practice, Ms. Mahmood was clear. “As they stand, [AI systems] will not be able to replace the health care professional workforce, in primary care at least,” she said. “I think larger and more medically specific datasets are required to improve their outputs in this field.”

Sandip Pramanik, MBcHB, a GP in Watford, Hertfordshire, England, said the study “clearly showed ChatGPT’s struggle to deal with the complexity of the exam questions that is based on the primary care system. In essence, this in indicative of the human factors involved in decision-making in primary care.”

The applied knowledge test is designed to test the knowledge required to be a generalist in the primary care setting, and as such, there are lots of nuances reflecting this within the questions, Dr. Pramanik said.

“ChatGPT may look at these in a more black and white way, whereas the generalist needs to be reflective of the complexities involved and the different possibilities that can present rather than take a binary ‘yes’ or ‘no’ stance,” he said. “In fact, this highlights a lot about the nature of general practice in managing uncertainty, and this is reflected in the questions asked in the exam,” he remarked. He noted, “Being a generalist is about factoring in human emotion and human perception as well as knowledge.”

Ms. Mahmood, Dr. Thirunavukarasu, and Dr. Pramanik have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

The enteric nervous system (ENS), which is regarded as our second brain, is the part of the autonomic nervous system that controls the digestive tract. Housed along the entire length of the digestive tract, it is made up of more than 100 million neurons. It plays a central role in controlling the regulation of gastrointestinal motility, absorption of nutrients, and control of the intestinal barrier that protects the body from external pathogens.

Braak’s hypothesis suggests that the digestive tract could be the starting point for Parkinson’s disease. The fact that nearly all patients with Parkinson’s disease experience digestive problems and have neuropathological lesions in intrinsic and extrinsic innervation of the gastrointestinal tract suggests that Parkinson’s disease also has a gastrointestinal component.

Besides the ascending pathway formulated by Braak, a descending etiology in which gastrointestinal symptoms are present in early stages when neurological signposts have not yet been noticed is supported by evidence from trials. These gastrointestinal symptoms then represent a risk factor. Links have also been described between a history of gastrointestinal symptoms and Alzheimer’s disease and cerebrovascular diseases (CVD), thus justifying studies on a larger scale.
 

Large combined study

The authors have conducted a combined case-control and cohort study using TriNetX, a national network of medical records based in the United States. They identified 24,624 patients with idiopathic Parkinson’s disease in the case-control analysis and compared them with control subjects without neurological disease. They also identified subjects with Alzheimer’s disease and CVD, to study previous gastrointestinal signs. Secondly, 18 cohorts with each exposure (various gastrointestinal symptoms, appendectomy, vagotomy) were compared with their negative controls (NC) for the development of Parkinson’s disease, Alzheimer’s disease, or CVD in 5 years.

Gastroparesis, dysphagia, and irritable bowel syndrome (IBS) without diarrhea or constipation were shown to have specific associations with Parkinson’s disease (vs. NC, Alzheimer’s disease, and CVD) in both case-controls (odds ratios all P < .0001) and cohort analyses (relative risks all P < .05). While functional dyspepsia, IBS with diarrhea, diarrhea, and fecal incontinence were not specific to Parkinson’s disease, IBS with constipation and intestinal pseudo-obstruction showed specificity to Parkinson’s disease in the case-control (OR, 4.11) and cohort (RR, 1.84) analyses. Appendectomy reduced the risk of Parkinson’s disease in the cohort study (RR, 0.48). Neither inflammatory bowel disease nor vagotomy was associated with Parkinson’s disease.
 

A ‘second brain’

This broad study attempted to explore the gut-brain axis by looking for associations between neurological diagnoses and prior gastrointestinal symptoms and later development of Parkinson’s disease. After adjustment to account for multiple comparisons and acknowledgment of the initial risk in patients with Alzheimer’s disease and CVD, only dysphagia, gastroparesis, IBS without diarrhea, and isolated constipation were significantly and specifically associated with Parkinson’s disease.

Numerous literature reviews mention that ENS lesions are responsible for gastrointestinal disorders observed in patients with Parkinson’s disease. Tests on gastrointestinal autopsy and biopsy specimens have established that alpha synuclein clusters, which are morphologically similar to Lewy bodies in the CNS, are seen in the vagus nerve and in the ENS in most subjects with Parkinson’s disease. However, these studies have not shown any loss of neurons in the ENS in Parkinson’s disease, and the presence of alpha synuclein deposits in the ENS is not sufficient in itself to explain these gastrointestinal disorders.

It therefore remains to be determined whether vagal nerve damage alone can explain gastrointestinal disorders or whether dysfunction of enteric neurons without neuronal loss is occurring. So, damage to the ENS from alpha synuclein deposits would be early and would precede damage to the CNS, thus affording evidence in support of Braak’s hypothesis, which relies on autopsy data that does not allow for longitudinal monitoring in a single individual.

Appendectomy appeared to be protective, leading to additional speculation about its role in the pathophysiology of Parkinson’s disease. Additional mechanistic studies are therefore needed to establish causality and confirm the gut-brain axis or the role of dysbiosis and of intestinal permeability problems.

In conclusion, this large, first-of-its-kind multicenter study conducted on a national scale shows that early gastrointestinal symptoms (dysphagia, gastroparesis, constipation, and IBS without diarrhea) are associated with an increased risk of Parkinson’s disease, as is suggested by Braak’s hypothesis. Subject to future longitudinal mechanistic studies, early detection of these gastrointestinal disorders could aid in identifying patients at risk of Parkinson’s, and it could then be assumed that disease-modifying treatments could, at this early stage, halt progression of the disease linked to toxic clusters of alpha synuclein.

This article was translated from JIM, which is part of the Medscape professional network.

A version of this article first appeared on Medscape.com.

The enteric nervous system (ENS), which is regarded as our second brain, is the part of the autonomic nervous system that controls the digestive tract. Housed along the entire length of the digestive tract, it is made up of more than 100 million neurons. It plays a central role in controlling the regulation of gastrointestinal motility, absorption of nutrients, and control of the intestinal barrier that protects the body from external pathogens.

Braak’s hypothesis suggests that the digestive tract could be the starting point for Parkinson’s disease. The fact that nearly all patients with Parkinson’s disease experience digestive problems and have neuropathological lesions in intrinsic and extrinsic innervation of the gastrointestinal tract suggests that Parkinson’s disease also has a gastrointestinal component.

Besides the ascending pathway formulated by Braak, a descending etiology in which gastrointestinal symptoms are present in early stages when neurological signposts have not yet been noticed is supported by evidence from trials. These gastrointestinal symptoms then represent a risk factor. Links have also been described between a history of gastrointestinal symptoms and Alzheimer’s disease and cerebrovascular diseases (CVD), thus justifying studies on a larger scale.
 

Large combined study

The authors have conducted a combined case-control and cohort study using TriNetX, a national network of medical records based in the United States. They identified 24,624 patients with idiopathic Parkinson’s disease in the case-control analysis and compared them with control subjects without neurological disease. They also identified subjects with Alzheimer’s disease and CVD, to study previous gastrointestinal signs. Secondly, 18 cohorts with each exposure (various gastrointestinal symptoms, appendectomy, vagotomy) were compared with their negative controls (NC) for the development of Parkinson’s disease, Alzheimer’s disease, or CVD in 5 years.

Gastroparesis, dysphagia, and irritable bowel syndrome (IBS) without diarrhea or constipation were shown to have specific associations with Parkinson’s disease (vs. NC, Alzheimer’s disease, and CVD) in both case-controls (odds ratios all P < .0001) and cohort analyses (relative risks all P < .05). While functional dyspepsia, IBS with diarrhea, diarrhea, and fecal incontinence were not specific to Parkinson’s disease, IBS with constipation and intestinal pseudo-obstruction showed specificity to Parkinson’s disease in the case-control (OR, 4.11) and cohort (RR, 1.84) analyses. Appendectomy reduced the risk of Parkinson’s disease in the cohort study (RR, 0.48). Neither inflammatory bowel disease nor vagotomy was associated with Parkinson’s disease.
 

A ‘second brain’

This broad study attempted to explore the gut-brain axis by looking for associations between neurological diagnoses and prior gastrointestinal symptoms and later development of Parkinson’s disease. After adjustment to account for multiple comparisons and acknowledgment of the initial risk in patients with Alzheimer’s disease and CVD, only dysphagia, gastroparesis, IBS without diarrhea, and isolated constipation were significantly and specifically associated with Parkinson’s disease.

Numerous literature reviews mention that ENS lesions are responsible for gastrointestinal disorders observed in patients with Parkinson’s disease. Tests on gastrointestinal autopsy and biopsy specimens have established that alpha synuclein clusters, which are morphologically similar to Lewy bodies in the CNS, are seen in the vagus nerve and in the ENS in most subjects with Parkinson’s disease. However, these studies have not shown any loss of neurons in the ENS in Parkinson’s disease, and the presence of alpha synuclein deposits in the ENS is not sufficient in itself to explain these gastrointestinal disorders.

It therefore remains to be determined whether vagal nerve damage alone can explain gastrointestinal disorders or whether dysfunction of enteric neurons without neuronal loss is occurring. So, damage to the ENS from alpha synuclein deposits would be early and would precede damage to the CNS, thus affording evidence in support of Braak’s hypothesis, which relies on autopsy data that does not allow for longitudinal monitoring in a single individual.

Appendectomy appeared to be protective, leading to additional speculation about its role in the pathophysiology of Parkinson’s disease. Additional mechanistic studies are therefore needed to establish causality and confirm the gut-brain axis or the role of dysbiosis and of intestinal permeability problems.

In conclusion, this large, first-of-its-kind multicenter study conducted on a national scale shows that early gastrointestinal symptoms (dysphagia, gastroparesis, constipation, and IBS without diarrhea) are associated with an increased risk of Parkinson’s disease, as is suggested by Braak’s hypothesis. Subject to future longitudinal mechanistic studies, early detection of these gastrointestinal disorders could aid in identifying patients at risk of Parkinson’s, and it could then be assumed that disease-modifying treatments could, at this early stage, halt progression of the disease linked to toxic clusters of alpha synuclein.

This article was translated from JIM, which is part of the Medscape professional network.

A version of this article first appeared on Medscape.com.

The enteric nervous system (ENS), which is regarded as our second brain, is the part of the autonomic nervous system that controls the digestive tract. Housed along the entire length of the digestive tract, it is made up of more than 100 million neurons. It plays a central role in controlling the regulation of gastrointestinal motility, absorption of nutrients, and control of the intestinal barrier that protects the body from external pathogens.

Braak’s hypothesis suggests that the digestive tract could be the starting point for Parkinson’s disease. The fact that nearly all patients with Parkinson’s disease experience digestive problems and have neuropathological lesions in intrinsic and extrinsic innervation of the gastrointestinal tract suggests that Parkinson’s disease also has a gastrointestinal component.

Besides the ascending pathway formulated by Braak, a descending etiology in which gastrointestinal symptoms are present in early stages when neurological signposts have not yet been noticed is supported by evidence from trials. These gastrointestinal symptoms then represent a risk factor. Links have also been described between a history of gastrointestinal symptoms and Alzheimer’s disease and cerebrovascular diseases (CVD), thus justifying studies on a larger scale.
 

Large combined study

The authors have conducted a combined case-control and cohort study using TriNetX, a national network of medical records based in the United States. They identified 24,624 patients with idiopathic Parkinson’s disease in the case-control analysis and compared them with control subjects without neurological disease. They also identified subjects with Alzheimer’s disease and CVD, to study previous gastrointestinal signs. Secondly, 18 cohorts with each exposure (various gastrointestinal symptoms, appendectomy, vagotomy) were compared with their negative controls (NC) for the development of Parkinson’s disease, Alzheimer’s disease, or CVD in 5 years.

Gastroparesis, dysphagia, and irritable bowel syndrome (IBS) without diarrhea or constipation were shown to have specific associations with Parkinson’s disease (vs. NC, Alzheimer’s disease, and CVD) in both case-controls (odds ratios all P < .0001) and cohort analyses (relative risks all P < .05). While functional dyspepsia, IBS with diarrhea, diarrhea, and fecal incontinence were not specific to Parkinson’s disease, IBS with constipation and intestinal pseudo-obstruction showed specificity to Parkinson’s disease in the case-control (OR, 4.11) and cohort (RR, 1.84) analyses. Appendectomy reduced the risk of Parkinson’s disease in the cohort study (RR, 0.48). Neither inflammatory bowel disease nor vagotomy was associated with Parkinson’s disease.
 

A ‘second brain’

This broad study attempted to explore the gut-brain axis by looking for associations between neurological diagnoses and prior gastrointestinal symptoms and later development of Parkinson’s disease. After adjustment to account for multiple comparisons and acknowledgment of the initial risk in patients with Alzheimer’s disease and CVD, only dysphagia, gastroparesis, IBS without diarrhea, and isolated constipation were significantly and specifically associated with Parkinson’s disease.

Numerous literature reviews mention that ENS lesions are responsible for gastrointestinal disorders observed in patients with Parkinson’s disease. Tests on gastrointestinal autopsy and biopsy specimens have established that alpha synuclein clusters, which are morphologically similar to Lewy bodies in the CNS, are seen in the vagus nerve and in the ENS in most subjects with Parkinson’s disease. However, these studies have not shown any loss of neurons in the ENS in Parkinson’s disease, and the presence of alpha synuclein deposits in the ENS is not sufficient in itself to explain these gastrointestinal disorders.

It therefore remains to be determined whether vagal nerve damage alone can explain gastrointestinal disorders or whether dysfunction of enteric neurons without neuronal loss is occurring. So, damage to the ENS from alpha synuclein deposits would be early and would precede damage to the CNS, thus affording evidence in support of Braak’s hypothesis, which relies on autopsy data that does not allow for longitudinal monitoring in a single individual.

Appendectomy appeared to be protective, leading to additional speculation about its role in the pathophysiology of Parkinson’s disease. Additional mechanistic studies are therefore needed to establish causality and confirm the gut-brain axis or the role of dysbiosis and of intestinal permeability problems.

In conclusion, this large, first-of-its-kind multicenter study conducted on a national scale shows that early gastrointestinal symptoms (dysphagia, gastroparesis, constipation, and IBS without diarrhea) are associated with an increased risk of Parkinson’s disease, as is suggested by Braak’s hypothesis. Subject to future longitudinal mechanistic studies, early detection of these gastrointestinal disorders could aid in identifying patients at risk of Parkinson’s, and it could then be assumed that disease-modifying treatments could, at this early stage, halt progression of the disease linked to toxic clusters of alpha synuclein.

This article was translated from JIM, which is part of the Medscape professional network.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

VANCOUVER – With treatment with a bisphosphonate following sequential use of teriparatide (Forteo) and denosumab (Prolia) for premenopausal women with idiopathic osteoporosis, bone mineral density (BMD) was maintained over the first year following denosumab cessation, according to results from a small, nonrandomized extension of a phase 2 study.

Bisphosphonates are recommended for patients after they have completed a course of denosumab because cessation of the bone resorption blocker is known to increase bone turnover markers, decrease BMD, and raise the risk of vertebral fractures. Although there is evidence to support this treatment sequence for postmenopausal women, there was no evidence regarding premenopausal women with idiopathic osteoporosis, said Adi Cohen, MD, who presented the results of the study at the annual meeting of the American Society for Bone and Mineral Research.

In the extension study, neither length of treatment with denosumab nor transition to menopause affected BMD results. Weekly doses of alendronate (ALN) better suppressed C-terminal telopeptide (CTX) than did zoledronic acid (ZOL) and led to better maintenance of BMD than did a single dose of ZOL. The researchers suggested that single-dose ZOL may not prevent bone loss for an entire year.

It is too early to call the results practice changing, said Dr. Cohen, professor of medicine and endocrinology at Columbia University Irving Medical Center, New York, but she noted, “It’s important just to provide information about how sequences of osteoporosis medications might be used in a rare but certainly understudied group of premenopausal women with osteoporosis who need treatment, and these data hopefully will help make some treatment decisions.”

In the early 2000s, researchers initially believed that premenopausal women with low BMD had experienced some kind of temporary event and that they would likely improve on their own over time. “I think we now recognize that whatever it is that causes this is an ongoing issue and that this is a problem they’re going to have to deal with for the rest of their lives. This is something that they have to stay on top of,” said coauthor Elizabeth Shane, MD, who is a professor of medicine at CUIMC.

However, there are no practice guidelines for the management of osteoporosis in premenopausal women, according to Dr. Shane. She noted that there is controversy as to whether to treat women with low bone density who do not have a history of fractures. “I think that there’s pretty much agreement that anybody who has a lot of fractures has an early-onset form of osteoporosis. The controversy is what to do about the person who just has a low bone density and hasn’t yet fractured and what is the utility of trying to treat them at that point and perhaps prevent a fracture. I don’t think we have enough data to address that,” Dr. Shane said.

Still, the research has provided some clarity in her own practice. “I think if somebody would come to my office who had very low bone density, I would probably treat them. If they have fractures, I would definitely treat them. I think that our work has provided a framework for people to approach that,” she said.

The study was an extension of a sequential treatment approach that began with 2 years of teriparatide (20 mcg daily) followed by an extension study of 2–3 years of treatment with denosumab (60 mg every 6 months). Seven months after the last dose of denosumab, patients underwent 1 year of treatment with ALN (70 mg weekly; n = 18) or a single dose of ZOL (5 mg IV; n = 6), according to patient choice.

The original phase 2 study started with 41 women. At 24 months, teriparatide treatment led to BMD increases of 13% in the lumbar spine (LS), 5% in the total hip (TH), and 5% in the femoral neck (FN). There was a 2% decline in BMD in the forearm (distal radius [DR]). A group of 32 of the women participated in an extension study and took denosumab for 12 months. Of those patients, 29 continued to take it for another 12 months. At 12 months, BMD increased 5% in the LS, 3% in the TH, 3% in the FN, and 1% in the DR (P < .05 for all). At 24 months, BMD rose by 22%, 10%, and 10% at the first three of those locations. BMD in the DR remained stable, compared with the baseline after taking teriparatide.

The bisphosphonate phase of the extension study included 24 women (mean age, 43 years). The mean body mass index of the patients was 23.0 kg/m². The patients had experienced a mean of 3.0 fractures in adulthood, and 38% of patients had a history of vertebral fracture.

Over 12 months of follow-up, the researchers found no statistically significant difference in BMD in the LS, TH, or FN, compared with bisphosphonate extension baseline. There was also no statistically significant change in serum CTX. There was evidence that, among patients with higher rates of bone turnover, there were higher rates of LS and FN bone loss during bisphosphonate treatment.

Among patients taking ZOL, at 12 months there was a statistically significant rise in CTX levels, but not among patients taking ALN. There were no new vertebral fractures among any participants during the bisphosphonate extension period.

The results represent critical data for an understudied population, according to Yumie Rhee, MD, PhD, who was comoderator of the session in which the study was presented. “They are showing that by using a bisphosphonate [patients] have this just slight decrease, but within error, so it’s maintaining the BMD, at least. I think it’s very important. It will be fascinating to see next year’s follow-up,” said Dr. Rhee, a professor of endocrinology at Yonsei University College of Medicine in Seoul, South Korea. “The problem with premenopausal osteoporosis is that we don’t have good evidence. Even though this study is very small, we’re just following that data, all of us.”

Comoderator Maria Zanchetta, MD, a professor of osteology at the Institute of Diagnostics and Metabolic Research, Universidad del Salvador, Buenos Aires, agreed. “We know what to do when we stop denosumab in postmenopausal women. We didn’t have any work about what to do when we stopped in premenopausal women. You can think that probably it’s going to be the same, but this is the first time you have the evidence that if you give bisphosphonate, you will maintain BMD.”

Limitations to the study include its small size and the lack of a placebo-treated control group. In addition, the bisphosphonate extension was not randomized.

The studies were funded by the U.S. Food and Drug Administration and Amgen. Dr. Cohen and Dr. Shane received research funding from Amgen. Dr. Rhee and Dr. Zanchetta have disclosed no relevant financial relationships.

A version of this article appeared on Medscape.com.

VANCOUVER – With treatment with a bisphosphonate following sequential use of teriparatide (Forteo) and denosumab (Prolia) for premenopausal women with idiopathic osteoporosis, bone mineral density (BMD) was maintained over the first year following denosumab cessation, according to results from a small, nonrandomized extension of a phase 2 study.

Bisphosphonates are recommended for patients after they have completed a course of denosumab because cessation of the bone resorption blocker is known to increase bone turnover markers, decrease BMD, and raise the risk of vertebral fractures. Although there is evidence to support this treatment sequence for postmenopausal women, there was no evidence regarding premenopausal women with idiopathic osteoporosis, said Adi Cohen, MD, who presented the results of the study at the annual meeting of the American Society for Bone and Mineral Research.

In the extension study, neither length of treatment with denosumab nor transition to menopause affected BMD results. Weekly doses of alendronate (ALN) better suppressed C-terminal telopeptide (CTX) than did zoledronic acid (ZOL) and led to better maintenance of BMD than did a single dose of ZOL. The researchers suggested that single-dose ZOL may not prevent bone loss for an entire year.

It is too early to call the results practice changing, said Dr. Cohen, professor of medicine and endocrinology at Columbia University Irving Medical Center, New York, but she noted, “It’s important just to provide information about how sequences of osteoporosis medications might be used in a rare but certainly understudied group of premenopausal women with osteoporosis who need treatment, and these data hopefully will help make some treatment decisions.”

In the early 2000s, researchers initially believed that premenopausal women with low BMD had experienced some kind of temporary event and that they would likely improve on their own over time. “I think we now recognize that whatever it is that causes this is an ongoing issue and that this is a problem they’re going to have to deal with for the rest of their lives. This is something that they have to stay on top of,” said coauthor Elizabeth Shane, MD, who is a professor of medicine at CUIMC.

However, there are no practice guidelines for the management of osteoporosis in premenopausal women, according to Dr. Shane. She noted that there is controversy as to whether to treat women with low bone density who do not have a history of fractures. “I think that there’s pretty much agreement that anybody who has a lot of fractures has an early-onset form of osteoporosis. The controversy is what to do about the person who just has a low bone density and hasn’t yet fractured and what is the utility of trying to treat them at that point and perhaps prevent a fracture. I don’t think we have enough data to address that,” Dr. Shane said.

Still, the research has provided some clarity in her own practice. “I think if somebody would come to my office who had very low bone density, I would probably treat them. If they have fractures, I would definitely treat them. I think that our work has provided a framework for people to approach that,” she said.

The study was an extension of a sequential treatment approach that began with 2 years of teriparatide (20 mcg daily) followed by an extension study of 2–3 years of treatment with denosumab (60 mg every 6 months). Seven months after the last dose of denosumab, patients underwent 1 year of treatment with ALN (70 mg weekly; n = 18) or a single dose of ZOL (5 mg IV; n = 6), according to patient choice.

The original phase 2 study started with 41 women. At 24 months, teriparatide treatment led to BMD increases of 13% in the lumbar spine (LS), 5% in the total hip (TH), and 5% in the femoral neck (FN). There was a 2% decline in BMD in the forearm (distal radius [DR]). A group of 32 of the women participated in an extension study and took denosumab for 12 months. Of those patients, 29 continued to take it for another 12 months. At 12 months, BMD increased 5% in the LS, 3% in the TH, 3% in the FN, and 1% in the DR (P < .05 for all). At 24 months, BMD rose by 22%, 10%, and 10% at the first three of those locations. BMD in the DR remained stable, compared with the baseline after taking teriparatide.

The bisphosphonate phase of the extension study included 24 women (mean age, 43 years). The mean body mass index of the patients was 23.0 kg/m². The patients had experienced a mean of 3.0 fractures in adulthood, and 38% of patients had a history of vertebral fracture.

Over 12 months of follow-up, the researchers found no statistically significant difference in BMD in the LS, TH, or FN, compared with bisphosphonate extension baseline. There was also no statistically significant change in serum CTX. There was evidence that, among patients with higher rates of bone turnover, there were higher rates of LS and FN bone loss during bisphosphonate treatment.

Among patients taking ZOL, at 12 months there was a statistically significant rise in CTX levels, but not among patients taking ALN. There were no new vertebral fractures among any participants during the bisphosphonate extension period.

The results represent critical data for an understudied population, according to Yumie Rhee, MD, PhD, who was comoderator of the session in which the study was presented. “They are showing that by using a bisphosphonate [patients] have this just slight decrease, but within error, so it’s maintaining the BMD, at least. I think it’s very important. It will be fascinating to see next year’s follow-up,” said Dr. Rhee, a professor of endocrinology at Yonsei University College of Medicine in Seoul, South Korea. “The problem with premenopausal osteoporosis is that we don’t have good evidence. Even though this study is very small, we’re just following that data, all of us.”

Comoderator Maria Zanchetta, MD, a professor of osteology at the Institute of Diagnostics and Metabolic Research, Universidad del Salvador, Buenos Aires, agreed. “We know what to do when we stop denosumab in postmenopausal women. We didn’t have any work about what to do when we stopped in premenopausal women. You can think that probably it’s going to be the same, but this is the first time you have the evidence that if you give bisphosphonate, you will maintain BMD.”

Limitations to the study include its small size and the lack of a placebo-treated control group. In addition, the bisphosphonate extension was not randomized.

The studies were funded by the U.S. Food and Drug Administration and Amgen. Dr. Cohen and Dr. Shane received research funding from Amgen. Dr. Rhee and Dr. Zanchetta have disclosed no relevant financial relationships.

A version of this article appeared on Medscape.com.

VANCOUVER – With treatment with a bisphosphonate following sequential use of teriparatide (Forteo) and denosumab (Prolia) for premenopausal women with idiopathic osteoporosis, bone mineral density (BMD) was maintained over the first year following denosumab cessation, according to results from a small, nonrandomized extension of a phase 2 study.

Bisphosphonates are recommended for patients after they have completed a course of denosumab because cessation of the bone resorption blocker is known to increase bone turnover markers, decrease BMD, and raise the risk of vertebral fractures. Although there is evidence to support this treatment sequence for postmenopausal women, there was no evidence regarding premenopausal women with idiopathic osteoporosis, said Adi Cohen, MD, who presented the results of the study at the annual meeting of the American Society for Bone and Mineral Research.

In the extension study, neither length of treatment with denosumab nor transition to menopause affected BMD results. Weekly doses of alendronate (ALN) better suppressed C-terminal telopeptide (CTX) than did zoledronic acid (ZOL) and led to better maintenance of BMD than did a single dose of ZOL. The researchers suggested that single-dose ZOL may not prevent bone loss for an entire year.

It is too early to call the results practice changing, said Dr. Cohen, professor of medicine and endocrinology at Columbia University Irving Medical Center, New York, but she noted, “It’s important just to provide information about how sequences of osteoporosis medications might be used in a rare but certainly understudied group of premenopausal women with osteoporosis who need treatment, and these data hopefully will help make some treatment decisions.”

In the early 2000s, researchers initially believed that premenopausal women with low BMD had experienced some kind of temporary event and that they would likely improve on their own over time. “I think we now recognize that whatever it is that causes this is an ongoing issue and that this is a problem they’re going to have to deal with for the rest of their lives. This is something that they have to stay on top of,” said coauthor Elizabeth Shane, MD, who is a professor of medicine at CUIMC.

However, there are no practice guidelines for the management of osteoporosis in premenopausal women, according to Dr. Shane. She noted that there is controversy as to whether to treat women with low bone density who do not have a history of fractures. “I think that there’s pretty much agreement that anybody who has a lot of fractures has an early-onset form of osteoporosis. The controversy is what to do about the person who just has a low bone density and hasn’t yet fractured and what is the utility of trying to treat them at that point and perhaps prevent a fracture. I don’t think we have enough data to address that,” Dr. Shane said.

Still, the research has provided some clarity in her own practice. “I think if somebody would come to my office who had very low bone density, I would probably treat them. If they have fractures, I would definitely treat them. I think that our work has provided a framework for people to approach that,” she said.

The study was an extension of a sequential treatment approach that began with 2 years of teriparatide (20 mcg daily) followed by an extension study of 2–3 years of treatment with denosumab (60 mg every 6 months). Seven months after the last dose of denosumab, patients underwent 1 year of treatment with ALN (70 mg weekly; n = 18) or a single dose of ZOL (5 mg IV; n = 6), according to patient choice.

The original phase 2 study started with 41 women. At 24 months, teriparatide treatment led to BMD increases of 13% in the lumbar spine (LS), 5% in the total hip (TH), and 5% in the femoral neck (FN). There was a 2% decline in BMD in the forearm (distal radius [DR]). A group of 32 of the women participated in an extension study and took denosumab for 12 months. Of those patients, 29 continued to take it for another 12 months. At 12 months, BMD increased 5% in the LS, 3% in the TH, 3% in the FN, and 1% in the DR (P < .05 for all). At 24 months, BMD rose by 22%, 10%, and 10% at the first three of those locations. BMD in the DR remained stable, compared with the baseline after taking teriparatide.

The bisphosphonate phase of the extension study included 24 women (mean age, 43 years). The mean body mass index of the patients was 23.0 kg/m². The patients had experienced a mean of 3.0 fractures in adulthood, and 38% of patients had a history of vertebral fracture.

Over 12 months of follow-up, the researchers found no statistically significant difference in BMD in the LS, TH, or FN, compared with bisphosphonate extension baseline. There was also no statistically significant change in serum CTX. There was evidence that, among patients with higher rates of bone turnover, there were higher rates of LS and FN bone loss during bisphosphonate treatment.

Among patients taking ZOL, at 12 months there was a statistically significant rise in CTX levels, but not among patients taking ALN. There were no new vertebral fractures among any participants during the bisphosphonate extension period.

The results represent critical data for an understudied population, according to Yumie Rhee, MD, PhD, who was comoderator of the session in which the study was presented. “They are showing that by using a bisphosphonate [patients] have this just slight decrease, but within error, so it’s maintaining the BMD, at least. I think it’s very important. It will be fascinating to see next year’s follow-up,” said Dr. Rhee, a professor of endocrinology at Yonsei University College of Medicine in Seoul, South Korea. “The problem with premenopausal osteoporosis is that we don’t have good evidence. Even though this study is very small, we’re just following that data, all of us.”

Comoderator Maria Zanchetta, MD, a professor of osteology at the Institute of Diagnostics and Metabolic Research, Universidad del Salvador, Buenos Aires, agreed. “We know what to do when we stop denosumab in postmenopausal women. We didn’t have any work about what to do when we stopped in premenopausal women. You can think that probably it’s going to be the same, but this is the first time you have the evidence that if you give bisphosphonate, you will maintain BMD.”

Limitations to the study include its small size and the lack of a placebo-treated control group. In addition, the bisphosphonate extension was not randomized.

The studies were funded by the U.S. Food and Drug Administration and Amgen. Dr. Cohen and Dr. Shane received research funding from Amgen. Dr. Rhee and Dr. Zanchetta have disclosed no relevant financial relationships.

A version of this article appeared on Medscape.com.

A teledermatology clinic pioneered by clinicians at George Washington University, Washington, to provide care for underserved populations will serve as a model for four other teledermatology clinics, according to a press release from the university.

Four institutions will receive grants to implement the George Washington University model, which involved partnering with a local organization to provide an entry point for individuals in areas with limited access to medical care, with support from Pfizer Global Medical Grants.

“Targeting those who lack access to quality-based care for inflammatory dermatologic conditions, including atopic dermatitis (AD) and others, the grants will reach communities in Miami-Dade County, Fla., Los Angeles County, Calif., rural communities in Oregon, and downtown Philadelphia,” according to the announcement. GW’s Teledermatology Free Clinic was conceived in the wake of the COVID-19 pandemic, which further highlighted disparities in access to dermatologic care, Adam Friedman, M.D., professor and chair of dermatology at George Washington University, said in the press release.

GW implemented its clinic for residents in underserved areas of Washington, D.C., in partnership with the Rodham Institute and the Temple of Praise Church. “We set up a free clinic at the church through which patients were integrated into the GW medical records system, provided instruction on telemedicine best practices, exposed to comprehensive education about AD and underwent a free telemedicine visit with a member of the department of dermatology,” Dr. Friedman explained.

Most participants – 70% – did not have a dermatologist, 94% were extremely satisfied with the experience, and 90% reported that the clinic had a significant impact on the management of their AD, according to the results of a recently published postengagement survey.

The following are the recipients of the “Quality Improvement Initiative: Bridging the Inflammatory Dermatosis Care Divide with Teledermatology Grant Program”:

• Scott Elman, MD, assistant professor of clinical dermatology and medical director of outpatient dermatology at the University of Miami and his team will create a clinic in partnership with Lotus House, a resource center and residential facility serving homeless women and infants, with focus on interventions in both English and Spanish.
• Nada Elbuluk, MD, associate professor of clinical dermatology and director of the Skin of Color and Pigmentary Disorders Program, at the University of Southern California, will lead a team to expand the role of two programs she created, Derm RISES, which targets inner city students, and Dermmunity, a community-based program that provides dermatology education to underserved communities in the Los Angeles area.
• Alex Ortega-Loayza, MD, associate professor of dermatology at Oregon Health & Science University and his team will partner with the Oregon Rural Practice-based Research Network to implement their teledermatology program at five clinics that serve different portions of rural and underserved communities across Oregon.
• Jules Lipoff, MD, clinical associate professor of dermatology, Temple University, Philadelphia, will lead a pilot program to establish a telemedicine dermatology clinic with Philadelphia FIGHT, a federally qualified health center in downtown Philadelphia where many patients lack high-speed Internet, and patients will be allowed direct access to telemedicine dermatology appointments within the primary care facility. The clinic’s patient population includes patients living with HIV, people who identify as LGBTQ+ and those who identify as trans or with a gender not matching their sex assigned at birth.

All four projects will complete postassessment surveys and quality assessment initiatives.

The GW clinic is ongoing, with plans for expansion and the establishment of additional programs with community partners in the Washington area, Dr. Friedman said in an interview.

“While these partnerships are in their infancy, I have high hopes that we will be able to impact even more individuals afflicted with dermatologic diseases and gain more insights into best practices for community engagement,” he added. “Many individuals who have come through our free clinic have followed up, by telehealth and/or in person at GW, depending on the clinical need to maintain continuity of care. In numerous cases, my impression is that this first point of contact is the key to ongoing treatment success, because it enables the access that may have been missing and engenders trust and confidence.”

A teledermatology clinic pioneered by clinicians at George Washington University, Washington, to provide care for underserved populations will serve as a model for four other teledermatology clinics, according to a press release from the university.

Four institutions will receive grants to implement the George Washington University model, which involved partnering with a local organization to provide an entry point for individuals in areas with limited access to medical care, with support from Pfizer Global Medical Grants.

“Targeting those who lack access to quality-based care for inflammatory dermatologic conditions, including atopic dermatitis (AD) and others, the grants will reach communities in Miami-Dade County, Fla., Los Angeles County, Calif., rural communities in Oregon, and downtown Philadelphia,” according to the announcement. GW’s Teledermatology Free Clinic was conceived in the wake of the COVID-19 pandemic, which further highlighted disparities in access to dermatologic care, Adam Friedman, M.D., professor and chair of dermatology at George Washington University, said in the press release.

GW implemented its clinic for residents in underserved areas of Washington, D.C., in partnership with the Rodham Institute and the Temple of Praise Church. “We set up a free clinic at the church through which patients were integrated into the GW medical records system, provided instruction on telemedicine best practices, exposed to comprehensive education about AD and underwent a free telemedicine visit with a member of the department of dermatology,” Dr. Friedman explained.

Most participants – 70% – did not have a dermatologist, 94% were extremely satisfied with the experience, and 90% reported that the clinic had a significant impact on the management of their AD, according to the results of a recently published postengagement survey.

The following are the recipients of the “Quality Improvement Initiative: Bridging the Inflammatory Dermatosis Care Divide with Teledermatology Grant Program”:

• Scott Elman, MD, assistant professor of clinical dermatology and medical director of outpatient dermatology at the University of Miami and his team will create a clinic in partnership with Lotus House, a resource center and residential facility serving homeless women and infants, with focus on interventions in both English and Spanish.
• Nada Elbuluk, MD, associate professor of clinical dermatology and director of the Skin of Color and Pigmentary Disorders Program, at the University of Southern California, will lead a team to expand the role of two programs she created, Derm RISES, which targets inner city students, and Dermmunity, a community-based program that provides dermatology education to underserved communities in the Los Angeles area.
• Alex Ortega-Loayza, MD, associate professor of dermatology at Oregon Health & Science University and his team will partner with the Oregon Rural Practice-based Research Network to implement their teledermatology program at five clinics that serve different portions of rural and underserved communities across Oregon.
• Jules Lipoff, MD, clinical associate professor of dermatology, Temple University, Philadelphia, will lead a pilot program to establish a telemedicine dermatology clinic with Philadelphia FIGHT, a federally qualified health center in downtown Philadelphia where many patients lack high-speed Internet, and patients will be allowed direct access to telemedicine dermatology appointments within the primary care facility. The clinic’s patient population includes patients living with HIV, people who identify as LGBTQ+ and those who identify as trans or with a gender not matching their sex assigned at birth.

All four projects will complete postassessment surveys and quality assessment initiatives.

The GW clinic is ongoing, with plans for expansion and the establishment of additional programs with community partners in the Washington area, Dr. Friedman said in an interview.

“While these partnerships are in their infancy, I have high hopes that we will be able to impact even more individuals afflicted with dermatologic diseases and gain more insights into best practices for community engagement,” he added. “Many individuals who have come through our free clinic have followed up, by telehealth and/or in person at GW, depending on the clinical need to maintain continuity of care. In numerous cases, my impression is that this first point of contact is the key to ongoing treatment success, because it enables the access that may have been missing and engenders trust and confidence.”

A teledermatology clinic pioneered by clinicians at George Washington University, Washington, to provide care for underserved populations will serve as a model for four other teledermatology clinics, according to a press release from the university.

Four institutions will receive grants to implement the George Washington University model, which involved partnering with a local organization to provide an entry point for individuals in areas with limited access to medical care, with support from Pfizer Global Medical Grants.

“Targeting those who lack access to quality-based care for inflammatory dermatologic conditions, including atopic dermatitis (AD) and others, the grants will reach communities in Miami-Dade County, Fla., Los Angeles County, Calif., rural communities in Oregon, and downtown Philadelphia,” according to the announcement. GW’s Teledermatology Free Clinic was conceived in the wake of the COVID-19 pandemic, which further highlighted disparities in access to dermatologic care, Adam Friedman, M.D., professor and chair of dermatology at George Washington University, said in the press release.

GW implemented its clinic for residents in underserved areas of Washington, D.C., in partnership with the Rodham Institute and the Temple of Praise Church. “We set up a free clinic at the church through which patients were integrated into the GW medical records system, provided instruction on telemedicine best practices, exposed to comprehensive education about AD and underwent a free telemedicine visit with a member of the department of dermatology,” Dr. Friedman explained.

Most participants – 70% – did not have a dermatologist, 94% were extremely satisfied with the experience, and 90% reported that the clinic had a significant impact on the management of their AD, according to the results of a recently published postengagement survey.

The following are the recipients of the “Quality Improvement Initiative: Bridging the Inflammatory Dermatosis Care Divide with Teledermatology Grant Program”:

• Scott Elman, MD, assistant professor of clinical dermatology and medical director of outpatient dermatology at the University of Miami and his team will create a clinic in partnership with Lotus House, a resource center and residential facility serving homeless women and infants, with focus on interventions in both English and Spanish.
• Nada Elbuluk, MD, associate professor of clinical dermatology and director of the Skin of Color and Pigmentary Disorders Program, at the University of Southern California, will lead a team to expand the role of two programs she created, Derm RISES, which targets inner city students, and Dermmunity, a community-based program that provides dermatology education to underserved communities in the Los Angeles area.
• Alex Ortega-Loayza, MD, associate professor of dermatology at Oregon Health & Science University and his team will partner with the Oregon Rural Practice-based Research Network to implement their teledermatology program at five clinics that serve different portions of rural and underserved communities across Oregon.
• Jules Lipoff, MD, clinical associate professor of dermatology, Temple University, Philadelphia, will lead a pilot program to establish a telemedicine dermatology clinic with Philadelphia FIGHT, a federally qualified health center in downtown Philadelphia where many patients lack high-speed Internet, and patients will be allowed direct access to telemedicine dermatology appointments within the primary care facility. The clinic’s patient population includes patients living with HIV, people who identify as LGBTQ+ and those who identify as trans or with a gender not matching their sex assigned at birth.

All four projects will complete postassessment surveys and quality assessment initiatives.

The GW clinic is ongoing, with plans for expansion and the establishment of additional programs with community partners in the Washington area, Dr. Friedman said in an interview.

“While these partnerships are in their infancy, I have high hopes that we will be able to impact even more individuals afflicted with dermatologic diseases and gain more insights into best practices for community engagement,” he added. “Many individuals who have come through our free clinic have followed up, by telehealth and/or in person at GW, depending on the clinical need to maintain continuity of care. In numerous cases, my impression is that this first point of contact is the key to ongoing treatment success, because it enables the access that may have been missing and engenders trust and confidence.”

TOPLINE:

Endoscopic sleeve gastroplasty (ESG) is safe and effective for weight loss in adults with class I, II, or III obesity, according to real-world data from a large U.S. study.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 1,506 adults (85% female, 70% White) with severe obesity (501 class I, 546 class II, and 459 class III) who underwent ESG at seven academic and private U.S. centers from 2013 to 2022.
• Average percent total body weight loss (%TBWL) was evaluated at 6, 12, 18, and 24 months after the procedure.
• Weight loss and safety outcomes were evaluated according to obesity class.

TAKEAWAY:

• At 12 months, 83.2% of patients achieved ≥10% TBWL and 60.9% achieved ≥15% TBWL across all obesity classes.
• There was a significant difference in TBWL by baseline obesity class, with average weight loss significantly greater in class III than classes I and II at all time points. At 24 months, class III patients had mean TBWL of 20.4%, compared with 13.3% for class I and 13.6% for class II patients.
• As early as 6 months post-ESG, patients in all BMI classes were able to drop to the next lower BMI class and remained there through 2 years. However, ongoing improvement in BMI until the end of follow-up was seen only in class III patients. Notably, class III patients were significantly younger and taller than class I and class II patients.
• There were no differences in adverse events between obesity classes. Only 2.6% of patients had an adverse event requiring hospitalization. Most of these events (86%) were for symptom management and/or fluid replacement.

IN PRACTICE:

“Traditionally, ESG has been proposed as a treatment choice for patients with class I and II obesity because of its modest weight loss outcomes. However, our data show a %TBWL crossing 20% in patients with class III disease, which may push the envelope of perceived utility of ESG,” the authors write.

SOURCE:

The study, with first author Khushboo Gala, MBBS, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., was published online in Clinical and Translational Gastroenterology.

LIMITATIONS:

Limitations include the retrospective design, with outcomes only out to 2 years, and loss of follow-up, with only 339 of the 1506 patients evaluated at 2 years.

DISCLOSURES:

The study had no financial support. Several study authors reported ties to industry. The full list can be found with the original article.

A version of this article first appeared on Medscape.com.

TOPLINE:

Endoscopic sleeve gastroplasty (ESG) is safe and effective for weight loss in adults with class I, II, or III obesity, according to real-world data from a large U.S. study.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 1,506 adults (85% female, 70% White) with severe obesity (501 class I, 546 class II, and 459 class III) who underwent ESG at seven academic and private U.S. centers from 2013 to 2022.
• Average percent total body weight loss (%TBWL) was evaluated at 6, 12, 18, and 24 months after the procedure.
• Weight loss and safety outcomes were evaluated according to obesity class.

TAKEAWAY:

• At 12 months, 83.2% of patients achieved ≥10% TBWL and 60.9% achieved ≥15% TBWL across all obesity classes.
• There was a significant difference in TBWL by baseline obesity class, with average weight loss significantly greater in class III than classes I and II at all time points. At 24 months, class III patients had mean TBWL of 20.4%, compared with 13.3% for class I and 13.6% for class II patients.
• As early as 6 months post-ESG, patients in all BMI classes were able to drop to the next lower BMI class and remained there through 2 years. However, ongoing improvement in BMI until the end of follow-up was seen only in class III patients. Notably, class III patients were significantly younger and taller than class I and class II patients.
• There were no differences in adverse events between obesity classes. Only 2.6% of patients had an adverse event requiring hospitalization. Most of these events (86%) were for symptom management and/or fluid replacement.

IN PRACTICE:

“Traditionally, ESG has been proposed as a treatment choice for patients with class I and II obesity because of its modest weight loss outcomes. However, our data show a %TBWL crossing 20% in patients with class III disease, which may push the envelope of perceived utility of ESG,” the authors write.

SOURCE:

The study, with first author Khushboo Gala, MBBS, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., was published online in Clinical and Translational Gastroenterology.

LIMITATIONS:

Limitations include the retrospective design, with outcomes only out to 2 years, and loss of follow-up, with only 339 of the 1506 patients evaluated at 2 years.

DISCLOSURES:

The study had no financial support. Several study authors reported ties to industry. The full list can be found with the original article.

A version of this article first appeared on Medscape.com.

TOPLINE:

Endoscopic sleeve gastroplasty (ESG) is safe and effective for weight loss in adults with class I, II, or III obesity, according to real-world data from a large U.S. study.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 1,506 adults (85% female, 70% White) with severe obesity (501 class I, 546 class II, and 459 class III) who underwent ESG at seven academic and private U.S. centers from 2013 to 2022.
• Average percent total body weight loss (%TBWL) was evaluated at 6, 12, 18, and 24 months after the procedure.
• Weight loss and safety outcomes were evaluated according to obesity class.

TAKEAWAY:

• At 12 months, 83.2% of patients achieved ≥10% TBWL and 60.9% achieved ≥15% TBWL across all obesity classes.
• There was a significant difference in TBWL by baseline obesity class, with average weight loss significantly greater in class III than classes I and II at all time points. At 24 months, class III patients had mean TBWL of 20.4%, compared with 13.3% for class I and 13.6% for class II patients.
• As early as 6 months post-ESG, patients in all BMI classes were able to drop to the next lower BMI class and remained there through 2 years. However, ongoing improvement in BMI until the end of follow-up was seen only in class III patients. Notably, class III patients were significantly younger and taller than class I and class II patients.
• There were no differences in adverse events between obesity classes. Only 2.6% of patients had an adverse event requiring hospitalization. Most of these events (86%) were for symptom management and/or fluid replacement.

IN PRACTICE:

“Traditionally, ESG has been proposed as a treatment choice for patients with class I and II obesity because of its modest weight loss outcomes. However, our data show a %TBWL crossing 20% in patients with class III disease, which may push the envelope of perceived utility of ESG,” the authors write.

SOURCE:

The study, with first author Khushboo Gala, MBBS, division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., was published online in Clinical and Translational Gastroenterology.

LIMITATIONS:

Limitations include the retrospective design, with outcomes only out to 2 years, and loss of follow-up, with only 339 of the 1506 patients evaluated at 2 years.

DISCLOSURES:

The study had no financial support. Several study authors reported ties to industry. The full list can be found with the original article.

A version of this article first appeared on Medscape.com.