A Retrospective Chart Review

[Posted 5/Mar/2026]

AUDIENCE: Hospice & Palliative Nursing, Nephrology

KEY FINDINGS: Hospice-eligible patients frequently have renally cleared medications prescribed and at doses too high for their renal function. Analgesics, over-the-counter antihistamines, anticoagulants, anticholinergics have potential for significant adverse effects and higher vigilance is needed.

BACKGROUND: Hospice-eligible patients are vulnerable to adverse medication effects given their advanced illnesses and general older age. It is not known how often medications are not renal dose adjusted in hospice-eligible patients and which are frequently problematic. This study aims to identify commonly prescribed medications with significant renal clearance that are dosed too high and patient characteristics that increase the likelihood of occurrence.

DETAILS: This is a retrospective chart review of adult patients admitted to hospice care. Data collected included clinical/demographic data, renally cleared medications taken at time of hospice admission, and calculated renal function using several formulas. Descriptive statistics and binomial logistic regression were used to analyze data. Of 283 included charts, 27% had >=1 medication dosed too high for renal function. The most common medications prescribed and not renal dose adjusted included tramadol, gabapentin, duloxetine, loratadine, cetirizine, famotidine, apixaban, rivaroxaban, metformin, trospium, and most antimicrobials. Increasing serum creatinine values and increasing number of renally cleared medications were associated with a higher likelihood of a medication dosed too high [OR, 1.702, 95% CI (1.257, 2.305), P < 0.001] and [OR, 1.856, 95% CI (1.517, 2.271), P < 0.001] respectively. Residing at home vs a facility was associated with a reduced likelihood of having a medication dosed too high [OR, 0.30, 95% CI (0.134, 0.673), P = 0.003.].

Copyright © SAGE Publications. All rights reserved.

Source: Latuga, N. M. and Levy, K. Medications Not Dosed Within Recommended Range for Renal Function in Patients With Chronic Kidney Disease Identified upon Hospice Admission: A Retrospective Chart Review. American Journal of Hospice and Palliative Medicine. 2026; 43(3): 234-241. Published: March, 2026. DOI: 10.1177/10499091251323284.

A Randomized Controlled Comparative Study

[Posted 19/May/2026]

AUDIENCE: General Surgery, Family Medicine

KEY FINDINGS: Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.

BACKGROUND: Oral isotretinoin is the standard therapy for severe acne. However, scarring may persist. Fractional microneedling radiofrequency (FMRF) improves both inflammatory lesions and scars with minimal downtime. In this study, we compare isotretinoin monotherapy and concurrent isotretinoin and FMRF for active acne regarding clinical outcomes. The GAGS scores of isotretinoin and FMRF were significantly lower than those of isotretinoin monotherapy from weeks 12-44 (-79.69% vs. -60.34% at week 44, respectively; p < 0.001). Isotretinoin and FMRF showed significantly greater lesion count reductions than isotretinoin monotherapy at follow-up visits from weeks 12-44. Isotretinoin and FMRF showed significantly lower hemoglobin levels than isotretinoin monotherapy at weeks 32 and 44 (p = 0.029 and p < 0.001, respectively). Skin surface roughness improved substantially and persistently from week 12-44.

DETAILS: In this parallel two-group comparative study, patients received either low-dose isotretinoin monotherapy for 20 weeks (n = 34) or low-dose isotretinoin concurrently with 5 monthly FMRF sessions (n = 36). Outcomes were assessed at baseline and weeks 12, 20, 24, 32, and 44. The primary endpoints were Global Acne Grading System (GAGS) scores and inflammatory/non-inflammatory lesion counts. Secondary endpoints were hemoglobin indices and skin roughness.

Copyright © Wiley Periodicals LLC. All rights reserved

Source: Disphanurat, W., Leeyangyuen, P,, and Srisantithum, B. Efficacy of Low-Dose Oral Isotretinoin Combined With Fractional Microneedle Radiofrequency Versus Low-Dose Oral Isotretinoin Monotherapy in the Treatment of Moderate-To-Severe Acne Vulgaris: A Randomized Controlled Comparative Study. Lasers in Surgery and Medicine. 2026; 58(4): 321-330. Published: April, 2026. DOI: 10.1002/lsm.70120.

[Posted 6/May/2026]

AUDIENCE: Neurology, Psychiatry

KEY FINDINGS: The FDA approval of Auvelity for agitation in Alzheimer’s dementia represents a clinically meaningful advancement, introducing the first non-antipsychotic pharmacologic option for this challenging condition. Supported by randomized clinical trials demonstrating both symptomatic improvement and relapse prevention, Auvelity offers a promising alternative for managing agitation while potentially avoiding risks associated with antipsychotics. Careful patient selection and monitoring remain essential given its safety profile.

BACKGROUND: The U.S. Food and Drug Administration today approved an expanded use for Auvelity (dextromethorphan hydrobromide and bupropion hydrochloride) extended-release tablets to treat agitation associated with dementia due to Alzheimer's disease in adults. The drug is the first FDA-approved treatment for this condition that is not an antipsychotic. FDA initially approved Auvelity in 2022 to treat major depressive disorder in adults.

DETAILS: "This approval represents a significant advancement in our ability to help patients and families dealing with one of the most challenging aspects of Alzheimer's disease," said FDA Commissioner Marty Makary, M.D., M.P.H. "With today's action, patients and their families have access to an additional important treatment for complications of this devastating disease."

Agitation is a common and distressing symptom in patients with Alzheimer's disease dementia, characterized by excessive motor activity, or verbal or physical aggression. It can significantly impact quality of life for patients and caregivers.

"Auvelity was found to be efficacious for treating agitation in Alzheimer's disease in two randomized trials and now represents an additional option to address one of the most difficult sequelae of the disease, especially as it progresses,” said Tracy Beth Hoeg, M.D., Ph.D., Acting Director of the FDA's Center for Drug Evaluation and Research. "We hope this approval will provide meaningful benefit to patients, their families, and caregivers."

The first randomized study (NCT 03226522) was a five-week trial in which participants received either Auvelity or a placebo. The primary endpoint was the change from baseline to week five in the total score of the Cohen-Mansfield Agitation Inventory (CMAI), a survey that assesses the frequency of manifestations of agitated behaviors in elderly patients, based on caregiver reports. Auvelity was significantly superior to placebo in The Cohen-Mansfield Agitation Inventory score improvements.

The second randomized study (NCT 04947553) was a withdrawal study in participants who responded to Auvelity. Upon reaching a sustained clinical response to Auvelity, patients were randomly assigned to continue treatment with Auvelity or switch to placebo. The primary endpoint was time to relapse. Participants who continued Auvelity treatment had a significantly longer time to relapse of agitation symptoms compared to patients receiving the placebo.

The most common side effects include dizziness, upset stomach, headache, diarrhea, drowsiness, dry mouth, sexual dysfunction, and uncontrolled sweating. Auvelity has a Boxed Warning about increased risk of suicidal thoughts and behaviors in adolescents and young adults taking antidepressants. Health care providers should monitor patients for clinical worsening and emergence of suicidal thoughts and behaviors, especially during initial treatment. The medicine can cause seizures, with risk increasing with dose. It can also cause elevated blood pressure and hypertension, and may activate mania or hypomania (irritable mood) in susceptible patients.

Before starting Auvelity, health care providers should assess blood pressure, screen for personal or family history of bipolar disorder, and determine if patients are taking other medications containing bupropion or dextromethorphan.

The FDA granted breakthrough therapy designation and priority review designation for this action. The approval of Auvelity for agitation associated with dementia due to Alzheimer's disease was granted to Axsome Therapeutics.

Source: FDA Approves First Non-Antipsychotic Drug to Treat Agitation Associated with Dementia. FDA. Published: April 30, 2026.

A Randomized Controlled Trial

[Posted 5/May/2026]

AUDIENCE: Endocrinology, Internal Medicine

KEY FINDINGS:

• Incorporating geriatric principles into CGM significantly reduces hypoglycemia in older adults with T1D.
• Glycemic control (HbA1c) is maintained without deterioration.
• Benefits are consistent regardless of prior CGM experience.
• Personalized, simplified diabetes care strategies are crucial in elderly populations.
• The intervention is economically viable from a healthcare perspective.

BACKGROUND: Older adults with type 1 diabetes (T1D) are at increased risk of hypoglycemia due to age-related physiological changes, comorbidities, and challenges in self-management. Continuous glucose monitoring (CGM) has demonstrated benefits in glycemic control; however, its effectiveness when combined with geriatric-specific care principles has not been well established. This study evaluates whether integrating geriatric-focused strategies with CGM (enhanced CGM, or eCGM) improves outcomes in this high-risk population.

DETAILS: This was a randomized controlled trial involving older adults (>=65 years) with T1D and high risk of hypoglycemia. Participants were assigned to either:

• CGM enhanced with geriatric principles (individualized glycemic targets, simplified regimens, and functional assessment), or
• Standard CGM use without geriatric-focused adjustments.

The intervention emphasized tailoring diabetes management to cognitive, functional, and overall health status. The primary outcome measured was reduction in time spent in hypoglycemia over a follow-up period of 6 months.

Result:

• Median reduction in hypoglycemia:
• Intervention group: -2.6%
• Control group: -0.3%
• Median difference: -2.3% (95% CI -3.7% to -1.3%; P 0.001)
• Improvement observed in both:
• CGM-naïve participants: -2.8% (95% CI -5.6% to -0.8%)
• Existing CGM users: -1.2% (95% CI -2.7% to -0.1%)
• HbA1c levels remained similar between groups:
• 7.5% vs 7.3%
• The intervention was cost-effective with an incremental cost-effectiveness ratio of $71,623 per quality-adjusted life-year.

Copyright © American Diabetes Association. All rights reserved.

Source: Munshi, M. N., Slyne, C., Adam, A., et al. Continuous Glucose Monitoring With Geriatric Principles in Older Adults With Type 1 Diabetes and Hypoglycemia: A Randomized Controlled Trial. Diabetes Care . 2024; 48(5): 694-702. Published: September, 2024. DOI: 10.2337/dc24-1069.

[Posted 24/Apr/2026]

AUDIENCE: Hospice & Palliative Nursing, Oncology

KEY FINDINGS: This cohort study suggests that health care professionals may use advanced disease diagnosis or patient-reported symptom scores to trigger timely specialist palliative care referrals, which may reduce suffering and improve experiences at end of life for adolescent and young adult patients with cancer.

BACKGROUND: Adolescents and young adults are a unique cancer population that require tailored cancer care. Although literature suggests insufficient palliative care for these individuals, the utilization and context surrounding medical assistance in dying (MAID) in adolescent and young adult patients with cancer is unexplored. Purpose of this study is to describe MAID utilization and experiences among adolescent and young adult patients with cancer.

DETAILS: This mixed-methods, retrospective cohort study included all patients in Alberta, Canada, diagnosed with a first primary cancer between age 15 and 39 years who received MAID for cancer before age 45 years from 2016 to 2022. The analysis was performed from May 2024 to February 2026. Descriptive statistics summarized patient, cancer, supportive care, and MAID characteristics. Symptom complexity and burden in the year before death, using the Edmonton Symptom Assessment System-revised (ESAS-r) were modelled. Qualitative thematic analysis of long-hand medical charting of health care professionals was conducted to understand the context leading to MAID. Integration of quantitative and qualitative findings was undertaken using a joint display. Overall, 34 adolescent and young adult patients (median [range] age, 33.44 [15.79-39.10] years) with cancer received MAID, with provisions peaking in 2020. Eighteen were female individuals (52.9%), 31 (91.2%) lived in an urban zone, 10 (29.4%) had children, and more than half received at least 3 types of cancer treatment. The median (range) time from advanced cancer diagnosis to provision was 1.1 (0.1-14.5) years, yet half of individuals received specialist palliative care less than 3 months prior to death. Symptom burden significantly increased over the year before death for all domains, with rapid rises visually observed beginning around month 5 prior to MAID. Overall, 10 of 14 (71.4%) reported high symptom complexity in the last month of life, with symptom scores highest for tiredness, poor well-being, pain, and drowsiness. Twenty-four of 30 (80%) reported a loss of ability to engage in activities making life meaningful at MAID provision. Qualitative themes offered context into the patient experience and included social isolation, previous experience with cancer death, wanting control, and achieving death acceptance. Finally, the joint display showed points of convergence between quantitative and qualitative results.

Copyright © American Medical Association. All Rights Reserved.

Source: Muth, E., Maseja, N., Harper, A., et al. Medical Assistance in Dying Use Among Adolescent and Young Adult Patients With Cancer. JAMA Oncology. Published: April 16, 2026. DOI: 10.1001/jamaoncol.2026.0700

A Multicenter Cohort Study

[Posted 1/Apr/2026]

AUDIENCE: Endocrinology, Internal Medicine

KEY FINDINGS: A 30-unit increase in GGT over time was associated with a substantially higher risk of developing type 2 diabetes in children with MASLD. Together with AST, GGT may provide clinicians with concrete, routinely available parameters to monitor for early risk stratification. Further validation in independent cohorts is needed to confirm these findings and inform clinical application.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children and is linked to type 2 diabetes. This study evaluates whether longitudinal changes in liver chemistries - γ-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) - can serve as biomarkers of increased type 2 diabetes risk in children with MASLD.

DETAILS: This multicenter longitudinal cohort study followed 1,035 children with biopsy-confirmed MASLD, without type 2 diabetes at baseline, for a mean of 3.9 years. Liver chemistries were measured annually, and type 2 diabetes was diagnosed based on fasting glucose, HbA1c, and clinical diagnosis. Extended Cox models with inverse probability weighting were used to evaluate associations between liver enzyme trajectories and type 2 diabetes risk. The cumulative incidence of type 2 diabetes was 12.3%. Increases in GGT (hazard ratio [HR] 1.55; 95% CI 1.34-1.80), AST (HR 1.31; 95% CI 1.20-1.43), and ALT (HR 1.13; 95% CI 1.07-1.20) were associated with a higher risk of developing type 2 diabetes in the independent models. In the mutual model with all three liver chemistries, only GGT and AST remained significant.

Copyright © American Diabetes Association. All rights reserved.

Source: Thai, N. Q. N., Chun, L. F., Newton, K. P., et al. Longitudinal Analysis of Liver Chemistry Trajectories and Risk of Type 2 Diabetes in Children With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Multicenter Cohort Study. Diabetes Care . 2026; 598-606. 49(4): Published: April, 2026. DOI: 10.2337/dc25-1532