Vinay Mehta, MD: Board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Credit: Allergy & Asthma Associates of Southern California

 can present uniquely in patients with skin of color, making timely recognition and effective management more challenging for clinicians. Classic signs such as erythema or inflammation may appear muted, harder to detect, or altogether different on darker skin tones, contributing to under-diagnosis, delayed treatment, and increased risk of pigmentary changes or scarring.

In this Q&A, Vinay Mehta, MD, a board-certified allergist/immunologist with Allergy & Asthma Associates of Southern California, discusses practical steps clinicians can take to better identify and manage AD in patients with skin of color. He highlights why traditional training materials often fall short, why dyspigmentation can be a critical clinical clue, and how simple adjustments, such as using alternative lighting or referencing more inclusive photo atlases, can sharpen diagnostic confidence.

How can clinicians more accurately recognize atopic dermatitis in patients with skin of color, given that erythema and inflammation may appear differently?

 One of the things I think would be helpful is to have atlas pictures. When in medical school and in residency and fellowship, we're used to seeing pictures, and I know there have been some initiatives to include more photos of patients of skin of color.

Erythema can be difficult to appreciate in patients who have darker skin, so what I typically do is I'll turn off the light. I'll use a flashlight so there's a better contrast, so I can better appreciate the erythema [and] dyspigmentation [hyperpigmentation and hypopigmentation]. These are often hallmarks of atopic dermatitis in patients of darker skin tone, which we sometimes don't recognize. [Another key distinction is] more extensor surfaces involvement.

We definitely need more training. We definitely need more examples, photos. I think that's helpful. Perhaps using social media. It's helpful to have real patients [with] skin [of] color, who have atopic dermatitis to just share their story. That will be very helpful in increasing awareness.

What practical steps can dermatologists take to improve diagnostic confidence and avoid underdiagnosis of atopic dermatitis in darker skin tones?

 I would like to see more studies. The more studies we have, the more information we have, the more we'll be able to appreciate some of the nuances and also see if certain molecules target better [in] this population compared to our typical white population.

What are the most effective strategies for building trust and improving adherence among patients of color with chronic skin conditions like atopic dermatitis?

 Listening through [stories] is very important to develop trust. Shared decision-making is also important. You really have to listen to their concerns… [to] understand their perspective, understand what is important to them.

: Can you discuss additional barriers to treating atopic dermatitis in patients with skin of color?

 There's health disparities in terms of access, especially in the minority population, in terms of what health insurance they have, in terms of access to care, and access to specialists.

Sometimes there may also be language barriers, particularly in the immigrant population. There may be cultural barriers as well, and so I think it's important to really spend time [with the patient].

Getting that trust [is important]. Once they trust you as a health care provider, it really improves adherence, and that goes a long way. These are chronic diseases, and there's no quick fix. Some of these therapies…have to be continued long term, and so that really requires good communication and a good relationship between the patient and the provider.

How can clinicians address pigmentation changes, scarring, and other post-inflammatory effects that are particularly concerning for patients with skin of color?

 Unfortunately, with atopic dermatitis, we do see that. We do see the pigmentation changes, hyperpigmentation or hypopigmentation. Perhaps in this case…start patients on systemic therapy, not wait until they have the scarring. In other words, move them from topicals to a systemic therapy, whether it's the biologic or an [oral JAK inhibitor] or something else. Move them quickly to prevent some of those side effects, those pigmentary changes.

This transcript has been edited for clarity.

Articles

Atopic dermatitis (AD) presents unique challenges in patients with skin of color due to differences in the appearance of erythema and inflammation, often leading to under-diagnosis and delayed treatment. Clinicians can improve diagnostic accuracy by using alternative lighting and inclusive photo atlases. Building trust through shared decision-making and addressing health disparities are crucial for effective management. Early intervention with systemic therapies can help prevent pigmentary changes and scarring. Enhanced training and research are needed to better understand and manage AD in diverse populations.

Board-certified allergist shares how clinicians can better recognize and prevent atopic dermatitis in patients with skin of color, addressing pigmentation.

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Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

How to Recognize and Treat Atopic Dermatitis in Patients with Skin of Color

Brandon Yan, MD, is a resident physician at the University of California.

Addressing Post-Pandemic Cardiovascular Mortality Rate Increases, With Brandon Yan, MD

 mortality trends in the US from 1999 to 2023, highlighting an abrupt increase in the wake of the COVID-19 pandemic.

From 1999 to 2023, age-adjusted mortality rates (AAMR) for CVD decreased from 350.8 to 218.3 deaths per 100,000, falling by 33.5%. These rates reached their lowest point in 2019, at 214.6 per 100,000. However, since the pandemic, mortality rates switched back, rising to 233.3 per 100,000 in 2021.

 spoke with Brandon Yan, MD, resident physician at the University of California and lead report author, to discuss the stark shift in mortality trends and what can be done to curtail them.

“Years of decline have plateaued overall, and it’s a very concerning plateau indeed, and we are still only beginning to learn why we’re not seeing continued progress,” Yan told 

 are large components of what we’re seeing here.”

During the analysis, Yan and colleagues analyzed death certificate data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) database from the US Centers for Disease Control and Prevention, spotlighting the period from 1999 to 2023. CVD mortality was categorized into the following subtypes:

Conduction disorders and cardiac dysrhythmias

AAMRs were calculated using the 2000 US population as a standard, and CVD mortality was examined in 2 forms: underlying CVD cause or contributing CVD cause.

Yan and colleagues found that ischemic heart diseases saw a decline in mortality from 194.6 per 100,000 in 1999 to 88 in 2019, a decrease of 54.8%, but increased again to 92.8 in 2021 before declining again to 82.2 in 2023. Hypertensive diseases saw mortality double from 15.8 to 31.9 in 2023 and are now the fastest-growing underlying cause of cardiovascular death. Since 2022, hypertensive diseases have been the leading contributing cardiovascular cause of death.

Heart failure mortality initially declined from 20.3 in 1999 to 16.9 in 2011, but rose back to 21.6 in 2023, which was its highest recorded level. Cerebrovascular disease mortality fell from 61.6 in 1999 to 36.2 in 2013 but rose again to 37 in 2019 and to 39 in 2023. Finally, Yan and colleagues reported that aortic aneurysm and dissection mortality saw a 59% decrease during the study period alone.

Ultimately, Yan and colleagues noted that, while the immediate impact of the pandemic may have subsided, underlying trends that existed prior are still exerting influence. Ischemic heart disease mortality has begun to decrease again, responding to advancements in access to acute care and continuous efforts to manage risk factors. Through these methods, ischemic heart disease mortality has largely returned to its past levels despite sharp increases during the pandemic.

However, hypertensive disease mortality represents the opposite, having reached record heights and still rising. Yan and colleagues attribute this in part to lingering issues born of interrupted care during the pandemic, but also cite the struggle of addressing and maintaining chronic diseases.

The team called for public health interventions, spotlighting the importance of examining the long-term effects of the pandemic on chronic disease management. They also encouraged the strengthening of chronic disease surveillance and establishing easier and more equitable access to preventive care.

“I think we need a full-court press,” Yan said. “I would love for there to be a focus and investment in the prevention of heart disease from that population level. And I think a personalized approach is going to be very important as well. We’re seeing much more research on personalizing people’s risk factors for developing heart disease, atherosclerosis, and cardiovascular disease events. I think that’s going to be an important part of the equation as well.”

Editor's Note: Yan reports no relevant disclosures.

Yan BW, Arun AS, Curtis LH, et al. JACC Data Report. 

Journal of the American College of Cardiology

Wen J, Hu J, Zou G. Trends and differences in cardiovascular disease and alzheimer’s disease-related mortality among older adults in the United States, 1999 to 2023: A CDC wonder database analysis. 

American Heart Journal Plus: Cardiology Research and Practice

Videos

Yan discusses the reversion of 50-year trends in mortality and the steps needed to reduce these rates back to pre-pandemic levels.

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Cardiomyopathy

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The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

2025 Society of Dermatology Physician Associates (SDPA) Fall Conference

 in San Antonio, Texas, a poster was presented titled 'Expert consensus recommendations on dermoscopy proficiency standards for physician assistants: results of a modified Delphi survey.'

This article highlighted a new expert consensus report proposing the first formal set of dermoscopy proficiency expectations for physician assistants (PAs). The report was authored by such investigators as Peter A. Young, MPAS, PA-C. Young and colleauges' report touched on the long-standing gap in dermatology and primary care education observed in a period in which PAs' role is expanding role in the skin cancer space.

Dermoscopy is now widely regarded as crucial for clinicians who assess the presence pigmented lesions and is being increasingly included in training within the dermatology field. The process is also gaining traction in primary care as melanoma and non-melanoma skin cancer rates continue to see increases around the country.

However, Young et al noted, despite the large number of PAs seeing patients across specialties, no agreed-upon dermoscopic learning objectives had been determined as guidelines for PA practices specifically. In this study, the investigative team sought to shift this paradigm.

There were 14 experienced dermoscopists gathered for this consensus panel, including 8 dermatologists and 6 PAs with backgrounds in consensus-building efforts for clinician dermoscopy benchmarks, standardized testing frameworks, and recommended PA competencies. Young and coauthors noted most participants had significant experience with the dermoscopy technique: 86% had implemented dermoscopy for over 12 years and there was a mean of 15.5 years of use.

A modified Delphi process was utilized for the group, combining 2 rounds of electronic surveys with a facilitated roundtable discussion following these surveys.

 Those included as panelists assessed dermoscopic expectations across 54 diagnoses. The experts were asked to determine which of various conditions represent foundational knowledge for PAs who are in the early-career period in primary care versus in dermatology.

By the second survey round, the experts were successful in attaining a consensus on 39 of the 54 diagnoses, or 72%, determining such diagnoses as appropriate for inclusion in PA educational materials.

 The remaining 28% of these were determined by the panel to be lower-priority items and not essential for beginners. Ultimately, the expert panel endorsed 14 key conditions for PAs practicing in primary care and 25 for those who work in dermatology, which Young and colleagues noted indicates a higher degree of diagnostic complexity expected in specialty settings.

The investigative team noted the strong interest in dermoscopy observed among those working as PAs. They highlighted prior national data indicating 77% of practicing PAs in all fields believe in the necessity of standard, formal dermoscopy instruction for their training. Dermatology-focused PA certification already involves dermoscopic content, but the team noted educators and supervising physicians lack guidance on which specific diagnoses constitute meaningful proficiency for those who are newer.

Overall, the expert consensus list generated through this study's process was designed to fill that void. As PAs continue to assume larger roles in dealing with patients showing suspicious lesions, the presence of shared dermoscopy training priorities may enhance diagnostic accuracy and even streamline collaboration among care teams.

Young and coauthors point to the potential of adopting these recommendations for professional organizations, training programs, and supervising dermatologists as leading to improved competence among PA trainees and early-career clinicians.

Young P, Middleton H, Seiverling E, et al. Expert consensus recommendations on dermoscopy proficiency standards for physician assistants: results of a modified Delphi survey. Presented at the Society of Dermatology Physician Associates (SDPA) Fall Conference, November 5-9, San Antonio, TX.

Lapides R, Saravi B, Roider E, et al. Possible Explanations for Rising Melanoma Rates Despite Increased Sunscreen Use over the Past Several Decades. Cancers (Basel). 2023 Dec 16;15(24):5868. doi: 10.3390/cancers15245868. PMID: 38136411; PMCID: PMC10741796.

A new expert consensus report has established the first formal dermoscopy proficiency standards for physician assistants (PAs), addressing a gap in dermatology and primary care education. The report, developed by a panel of experienced dermoscopists, utilized a modified Delphi process to identify key dermoscopic diagnoses for PA training. The consensus identified 14 essential conditions for PAs in primary care and 25 for those in dermatology, reflecting the complexity of specialty settings. This initiative aims to enhance diagnostic accuracy and collaboration among care teams, improving PA competence in skin cancer assessment.

This research, presented at the SDPA Fall Conference, highlights a consensus report proposing the first formal set of dermoscopy proficiency expectations for PAs.

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 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Expert Consensus Provides Recommendations on Dermoscopy Standards for PAs 

Marcus Shaker, MD, a professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine

Screenshot 2025-11-06 at 10.12.42 AM.png

Frequently asked questions (FAQ) about treating anaphylaxis:

When should I give my patients epinephrine for suspected anaphylaxis?

What’s the best observation period when treating anaphylaxis?

What test should I order for patients who experienced anaphylaxis?

Why should I instruct patients to call 911 after using an epinephrine auto-injector?

asked Marcus Shaker, MD, MSc, professor of pediatrics and medicine at the Geisel School of Medicine at Dartmouth, rapid-fire FAQ questions about the treatment of 

When should epinephrine be administered for suspected anaphylaxis?

 Right away. Epinephrine is the first-line treatment for suspected anaphylaxis.

What's the best observation period when treating anaphylaxis?

 The best observation period varies and depends on context and severity of anaphylaxis. For patients who have resolved non-severe anaphylaxis for at least an hour, the likelihood of recurrence of anaphylaxis is in the range of 5%.

What test should you order for patients who experienced anaphylaxis?

 The blood test is called the serum tryptase, and it can be very helpful in establishing a diagnosis.

Why do some patients need to call 911 even after using an epinephrine auto-injector?

 If symptoms are severe or don't immediately resolve or nearly resolve, patients may need additional epinephrine.

They may need additional support, including oxygen and IV fluid. Anaphylaxis can be severe and life-threatening, so if symptoms have not completely resolved or if they recur, patients should call 911 and seek care immediately.

2025 American College of Allergy, Asthma, & Immunology Annual Scientific Meeting

 in Orlando, Florida, from November 6 – 10, Shaker presented on misconceptions many people have surrounding epinephrine use in anaphylaxis management.

 According to Shaker, one of the most enduring myths both clinicians and patients have about epinephrine is that it is dangerous

“It's not,” Shaker told HCPLive during the meeting. “Epinephrine is the first-line treatment of anaphylaxis, and if you're having a severe allergic reaction, it is the recommended approach.”

Another misconception he listed was the necessity of calling 911 after administering epinephrine. Although patients may need to call 911 in certain situations, such as experiencing persistent or worsening symptoms, cardiovascular involvement, or a history of severe reactions, involving emergency services is not always necessary. Shaker said this misconception may result in patients not using their epinephrine to avoid a hospital visit. This myth can also feed the misbelief that epinephrine is dangerous.

At the conference, Shaker also discussed the nuanced approach clinicians must take when managing patients with a known trigger for anaphylaxis.

For instance, it may not be helpful to test a patient for peanut allergies if they are already 100% certain they have a peanut allergy. In this case, it would be more logical to shift the focus from diagnosis to treatment and preparedness.

Clinicians have many food allergy treatment options to select from, including oral and sublingual immunotherapy, biologics such as omalizumab, and a growing range of epinephrine delivery options. He said all of these options allow for richer discussions with patients and families about goals of care and management preferences.

Shaker M. Epinephrine Misconceptions Persist in Anaphylaxis Care, With Marcus Shaker, MD. HCPLive. November 7, 2025. 

https://www.hcplive.com/view/epinephrine-misconceptions-persist-anaphylaxis-care-marcus-shaker-md

Shaker M. When to Prescribe Epinephrine for Known Anaphylaxis Triggers, With Marcus Shaker, MD. HCPLive. November 7, 2025. 

https://www.hcplive.com/view/when-prescribe-epinephrine-known-anaphylaxis-triggers-marcus-shaker-md

Epinephrine is the primary treatment for suspected anaphylaxis and should be administered immediately. Observation periods vary based on the severity of the reaction, with a 5% recurrence rate for non-severe cases. Serum tryptase tests can aid in diagnosis. Patients should call 911 if symptoms persist or worsen after using an epinephrine auto-injector. Misconceptions about epinephrine's safety and the necessity of emergency services can hinder proper use. Clinicians should focus on treatment and preparedness, especially when triggers are known, and consider various allergy treatment options.

A quick guide for clinicians on epinephrine dosing, optimal observation periods, and the role of tryptase and other labs in anaphylaxis care.


Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

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The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

Anaphylaxis Treatment FAQ: When to Give Epinephrine, Order Tests, Call 911

Michelle O'Donoghue, MD, is the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women's Hospital and associate professor at Harvard Medical School

Olpasiran Lowers Lp(a) Irrespective of Apo(a) Isoform Size, With Michelle O’Donoghue, MD

atherosclerotic cardiovascular disease (ASCVD)

, irrespective of apolipoprotein(a) isoform size, according to results from the OCEAN(a)-DOSE trial.

Lp(a) concentration is predominantly driven by genetics, with a well-documented inverse correlation between it and the number of Kringle IV-2 (KIV-2) repeats on apolipoprotein(a) alleles. However, the relationship between the size of these apo(a) isoforms and the response to Lp(a) lowering via RNA interference via olpasiran has not been studied. To that end, this analysis of the OCEAN(a)-DOSE trial was undertaken.

 spoke with Michelle O’Donoghue, MD, the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women’s Hospital and associate professor at Harvard Medical School, to discuss the implications of this finding, not only for olpasiran, but for apo(a)-targeting ASCVD care at large.

“This is relevant because a lot of studies are looking at participants and individuals who have the highest levels of Lp(a),” O’Donoghue told 

. “We really need to better understand whether all people will have a similar type of response to these therapies, even if we end up pushing down to lower baseline Lp(a) concentrations.”

OCEAN(a)-DOSE was a phase 2, dose-finding randomized clinical trial evaluating 4 active doses of olpasiran – 10 mg every 12 weeks (Q12W), 75 mg Q12W, 225 mg Q12W, and 225 mg Q24W. For inclusion, patients were required to have ASCVD and Lp(a) levels >150 nmol/L. Investigators also measured the number of Kringle IV-2 (KIV-2) repeats, which are inversely correlated to the concentration of Lp(a), in each patient via a gel electrophoresis and immunoblotting system.

A total of 277 patients were enrolled in the trial, with a mean age of 62 years (interquartile range [IQR], 56-69). At baseline, the median Lp(a) concentration was 260.2 (IQR, 197.9-358.5) nmol/L. Lp(a) concentration was generally higher among patients with a lower number of KIV-2 repeats (

 = 0.02). Patients were then randomly assigned to 1 of 4 of the active subcutaneous doses of olpasiran or placebo; the final dose was administered at week 36 for the Q12W arms and at week 24 for the Q24W arm.

By week 36, the placebo-adjusted LSM percent change from baseline in Lp(a) with olpasiran was consistent irrespective of baseline KIV-2 repeat number (

 = .66). Additionally, no significant change was observed over time in the percent expression of the dominant apo(a) isoform with olpasiran versus placebo (mean change from baseline [+/- standard deviation] +1.1 [+/-9.8] % with olpasiran and + 2.1 [+/- 12.8] % with placebo; 

“Most people carry 2 different copies of an apo(a) allele, so they have a variable number of KIV-2 repeats in their blood, reflecting each of those 2 alleles – the dominant isoform is really just determined by what percent expression you have of one or the other,” O’Donoghue said. “We found that olpasiran really seems to target both isoforms equally; it doesn’t seem to matter how many KIV-2 repeats you have. It’s being taken out.”

Editor's Note: O'Donoghue reports disclosures with Amgen, Novartis, AstraZeneca, Janssen, Novo Nordisk, Verve, and others.

Monguillon V, Lopez A, Rosenson R, et al. Efficacy of Olpasiran by Apolipoprotein(a) Isoform Size: Insights from the OCEAN(a)-DOSE Trial. Presented at the American Heart Association’s Scientific Sessions 2025. New Orleans, Louisiana. November 8-10, 2025.

Rosenson RS, López JAG, Gaudet D, et al. Olpasiran, Oxidized Phospholipids, and Systemic Inflammatory Biomarkers: Results From the OCEAN(a)-DOSE Trial. JAMA Cardiol. 2025;10(5):482-486. 

O’Donoghue discusses the results of the recent OCEAN(a)-DOSE trial and addresses the implications for Lp(a)-lowering therapies moving forward.

Atherosclerotic Cardiovascular Disease

Dyslipidemia

Yasmine Kirkorian, MD, is a dermatologist and chief of Dermatology at Children's National Hospital.

Kirkorian speaks in this interview about her sessions at SDPA Fall on genetic disorders in pediatric dermatology patients.

Guidelines on Genetic Disorders of the Skin and Pediatric Patients, With Yasmine Kirkorian, MD

Halpin reviews the state of triple therapy inhaler prescribing strategies in the era of new biologic options.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

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COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

COPD Inhaler Use in the Biologic Era, with David Halpin, MBBS, DPhil

Associate Professor, University of Alabama and Chief Medical Officer for AllerVie Clinical Research

Soong discussed the role of allergist's in atopic dermatitis care at a recent HCPLive clinical forum.

Shared Decisions, Better Outcomes in Atopic Dermatitis, With Weily Soong, MD

Explore the long-term safety and efficacy of JAK inhibitors in atopic dermatitis, enhancing patient care and clinician confidence.

Special Report: Safety, Future Directions, & the Art of Therapy Selection in Atopic Dermatitis

Healthcare providers discuss the importance of effective communication when switching patients from biologics to JAK inhibitors.

Special Report: Overcoming Therapeutic Inertia and Communicating Safety of  JAK Inhibitors

Special Report: Inadequate Response and When to Switch Systemic Therapy in Atopic Dermatitis

Explore the evolving landscape of atopic dermatitis treatment, focusing on advanced therapies and long-term patient management strategies.

Special Report: Treat-to-Target in Atopic Dermatitis—Applying the AHEAD Recommendations

Healthcare professionals explore effective questioning techniques to uncover deeper emotional and physical impacts of skin pain in patients.

Special Report: Practical Communication Strategies for Skin Pain in Atopic Dermatitis 

This video explores skin pain as a key symptom of atopic dermatitis and reviews clinical trial data with JAK inhibitors.

Special Report: Reframing Skin Pain in Atopic Dermatitis

Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

Latest News

How to Recognize and Treat Atopic Dermatitis in Patients with Skin of Color

Addressing Post-Pandemic Cardiovascular Mortality Rate Increases, With Brandon Yan, MD

Expert Consensus Provides Recommendations on Dermoscopy Standards for PAs

Anaphylaxis Treatment FAQ: When to Give Epinephrine, Order Tests, Call 911

Olpasiran Lowers Lp(a) Irrespective of Apo(a) Isoform Size, With Michelle O’Donoghue, MD