Anthony Kerbage, MD, is an internal medicine resident at the Cleveland Clinic.

Non-English Primary Language Linked to Greater Repeat Screening Colonoscopy Risk

New research is shedding light on the impact of language barriers on bowel preparation for 

 and the subsequent need for repeat colonoscopies.

Findings from the retrospective cohort study of TriNetX Research Network data were presented at Digestive Disease Week (DDW) 2025 by Anthony Kerbage, MD, an internal medicine resident at the Cleveland Clinic, and highlight potential challenges in bowel preparation quality for patients with a primary language other than English.

“There's a lot to understand, and the instructions need to be clearly understood in order for the patient to take the bowel prep as instructed and then to optimize the bowel preparation for that colonoscopy,” Kerbage explained to 

. “Unfortunately, if patients have limited English proficiency or just general limited health literacy, they might not fully understand how to take their bowel preparation, and this might lead to inadequate bowel preparation.”

He goes on to explain how the US Preventive Services Task Force recommends a repeat screening colonoscopy within 1 year if the initial screening colonoscopy had inadequate bowel preparation due to the risk of missed lesions.

Kerbage and colleagues compared repeat screening colonoscopy rates within 1 year between patients with English as their primary language and those with a primary language other than English. Propensity score matching (1:1) was performed to adjust for age, gender, BMI, diabetes, opioid use, GLP-1 receptor agonist use, prior colorectal surgery, and neurological disorders.

A total of 308,186 patients who underwent screening colonoscopies were included in the study, with a mean age of 65 (± 10) years. The majority of patients were female (54.15%) and White (65.88%), with 10.36% identifying as Hispanic or Latino.

The primary language other than English cohort consisted of 18,022 patients, while the English primary language cohort included 290,164 patients. After propensity score matching, each cohort included 17,981 patients.

Upon analysis, the rate of repeat screening colonoscopy within 1 year was significantly greater in the primary language other than English cohort (1.1%) compared with the English primary language cohort (0.8%) (adjusted odds ratio, 1.42; 95% CI, 1.14–1.75; 

“Non-English speaking patients had higher rates of repeat colonoscopy within 1 year, but I have to mention that the rates were low in both cohorts,” Kerbage said, noting that although the rates were low, the difference between the cohorts did reach statistical significance.

He was careful to explain the limitations of this research, referring to it as a “foundation study” for future studies to build upon.

Editors’ note: Kerbage has no relevant disclosures.

Kerbage A, Haddad S, Deiri DA, et al. IMPACT OF NON-ENGLISH PRIMARY LANGUAGE ON REPEAT SCREENING COLONOSCOPY RATES. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

Anthony Kerbage, MD, explains the heightened risk of repeat screening colonoscopy among patients with a primary language other than English.

Anthony Kerbage, MD

Dr. Birgit Vogel is a cardiologist and cardiovascular disease researcher. She is the Director of Academic Affairs at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai, in the Fuster Heart Hospital.

Brigit Vogel, MD: Exploring Geographical Disparities in PAD Care Across US

A nationwide analysis of 2,376,300 Medicare beneficiaries with 

 revealed significant racial and geographic disparities in treatment, disproportionately affecting Black Americans.

Conducted between 2018 and 2022, this study, presented at the 

American Heart Association (AHA) Scientific Sessions 2024

, found that disparities in amputation rates varied widely across states, underscoring geographical differences in PAD treatment inequities.

“There was not any correlation between revascularization and the [Social Vulnerability Index (SVI)] index, but a modest correlation between major amputation rates and SVI. That suggests that the SVI reflects socioeconomic and demographic factors like poverty and minority status,” Birgit Vogel, MD, the director of academic affairs at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai, told HCPLive. “We think that community-level risk could impact these patterns of major amputation.”

In the analysis, Black patients experienced markedly higher rates of major amputations compared to White patients in every U.S. state (3.0% vs. 0.9%; 

<0.001). Despite undergoing revascularization more frequently than White patients (8.4% vs. 7.0%; 

<0.001), Black patients additionally consistently faced greater risks of limb loss.

Further analysis revealed that county-level Social Vulnerability Index (SVI) scores—a measure of community-level risk factors—were more strongly correlated with amputation rates (rho 0.46, p<0.001) than revascularization rates (rho 0.10, 

<0.001). These data suggest the contribution of structural and community factors to the disproportionate burden of limb loss in Black patients.

Notably, Black patients were younger (75.8 years vs. 76.9 years; p<0.001), more likely to be female (54.7% vs. 47.8%; p<0.001), and had a higher prevalence of comorbidities compared to their White counterparts. These findings emphasize the urgent need for targeted interventions addressing racial and geographic disparities in PAD care, particularly focusing on preventive strategies and access to limb-preserving treatments in high-risk communities.

“By looking at regional differences and identifying areas that have the largest disparities, we could think about resource allocation and prioritize those areas to not only do research, but also when we are trialing public health initiatives, or even we could even think about health policy on a state level that might differ between certain areas,” Vogel told 

Disclosures: Vogel reports no relevant disclosures.

Vogel B, Dangas K, Di Muro FM, Sartori S, et al. Geographical variations of treatment disparities between Black and White patients with peripheral artery disease across the United States. Presented at the American Heart Association (AHA) Scientific Sessions 2024. Chicago, Illinois. November 16-18, 2024.

A comprehensive analysis of Medicare beneficiaries with peripheral artery disease (PAD) highlights significant racial and geographic disparities in treatment, particularly affecting Black Americans. Conducted from 2018 to 2022, the study reveals that Black patients face higher major amputation rates despite more frequent revascularization compared to White patients. The Social Vulnerability Index (SVI) correlates more with amputation rates than revascularization, indicating the influence of socioeconomic and demographic factors. The findings underscore the need for targeted interventions to address these disparities, focusing on preventive strategies and equitable access to limb-preserving treatments.

Birgit Vogel, MD discusses racial inequities and geographic variations in peripheral artery disease care in the United States.








Birgit Vogel, MD: Exploring Geographical Disparities in PAD Care Across US

Birgit Vogel, MD

In the pediatric population, it is no secret that needle phobia can have an impact on the administration of routine vaccines, injections to prevent allergic reactions, and intravenous uses for blood work.

According to the American Academy of Pediatrics, at least two-thirds of children have a fear of needles, which isn’t just a pediatric fear, as nearly a fourth of adults also have the phobia.

While there have been long-standing practices to help children get through the challenges of a needle, vaccine, or injection—such as acknowledging their very real concern while decreasing shame, or substituting words such as “shot,” with “pinch” or “poke” to help limit fear—needle-free options for children with this phobia can eliminate the needle while delivering the medical care the child needs.

In some cases of needle phobia, the fear is so great that it could prevent receipt of potentially life-saving care through vaccination or injection, according to the Centers for Disease Control and Prevention (CDC).

"We know that a lot of patients are reluctant to either inject themselves or inject their children with epinephrine because of needle phobia," said Thomas Casale, MD, professor of medicine and chief of Clinical and Translational Research, Allergy and Immunology at the University of South Florida, in a previous interview with our sister publication 

. "Having alternatives is very important.”

It has been a good year of progress for needle-free options among the pediatric population, specifically with the FDA approvals of epinephrine nasal spray (neffy; ARS Pharmaceuticals) to treat type 1 allergic reactions, including anaphylaxis, and Influenza Vaccine Live (FluMist; AstraZeneca) to prevent influenza disease for self- or caregiver-administration.

Neffy to treat type 1 allergic reactions, including anaphylaxis

On August 9, 2024, epinephrine nasal spray was approved by the FDA for adult and pediatric patients who weigh at least 66 lbs (30 kg). The approval followed a Complete Response Letter issued nearly a year prior on September 20, 2023, because of an FDA request to complete a pharmacokinetic/pharmacodynamic study to assess repeat doses of epinephrine nasal spray compared to repeat doses of an epinephrine injector.

Once approved, epinephrine nasal spray became the first nasal spray to treat anaphylaxis, an exciting statement for those who encounter life-threatening allergic reactions and are also afraid of injection treatments.

Epinephrine nasal spray is a single-dose nasal spray administered into 1 nostril. A second dose can be given if there is no improvement in symptoms or if symptoms worsen. The secondary dose is used with a new nasal spray to administer in the same nostril, stated the FDA when epinephrine nasal spray was approved.

Russell Libby, MD, founder and president of the Virginia Pediatric Group and an assistant clinical professor of Pediatrics at the George Washington University School of Medicine and Health Sciences, stated and reinforced the benefits and importance of this FDA approval.

“I think this [treatment] will just float way to the top as soon as it becomes an option and people are aware of it, and there are a number of reasons why,” noted Libby, who also serves as a board member for the Physicians Foundation and an editorial advisory board member of 

. “The first one, to me, is that it is needle-free and it is a stable solution. When you look at EpiPens, you have a real narrow window of temperatures where it stays stable. Sometimes it can become impotent, but more often, the potency just diminishes.”

Libby added this increased flexibility for use life and storage benefits are notable positives that can make treating with epinephrine nasal spray effective, offering peace of mind for parents. According to ARS Pharmaceuticals, epinephrine nasal spray should be stored at room temperature between 68°F to 77°F (20°C to 25°C), but storage at high temperatures up to 122°F (50°C), is “allowed for a few days,” per the nasal spray’s prescribing information.

“That’s an amazing scope of stability,” said Libby. “On top of that, it lasts 30 months on the shelf without decreased potency, and when we think about shelf life and expiration dates, we think about potency, not necessarily its inability to do the intended treatment. So, it is quite an alternative; needle-free, stable in extreme temperatures, and a longer shelf life. It is amazing.”

Approval was based on comparable epinephrine blood concentration data following administration of epinephrine nasal spray or approved epinephrine injection products demonstrated in 4 studies comprising 175 healthy adults without anaphylaxis. Similar increases in blood pressure and heart rate, a pair of critical epinephrine effects when treating anaphylaxis, were demonstrated relative to injection products.

Click here to view additional data points that led to the FDA approval of neffy including highlights of the nasal spray’s pharmacokinetic profile compared to injection, as well as additional video commentary from Thomas Casale, MD.

FluMist for self- or caregiver-administration

This updated indication of Influenza Vaccine Live, which was originally approved in 2003 for individuals aged 5 to 49 years, saw the age expand down to 2 years, as well as the ability for self- or caregiver-administration.

The updated indication was approved by the FDA on September 20, 2024, and still requires a prescription. Influenza Vaccine Live contains a weakened form of live influenza virus strains sprayed in the nose. With the updated indication, the vaccine may be administered by a health care provider in a health care setting (including a pharmacy) or by the vaccine recipient or a caregiver who is 18 years of age or older, according to previous coverage by 

The CDC recommends everyone aged 6 months and older should receive a flu vaccine every year with rare exceptions. In seasons when flu vaccine viruses are similar to circulating flu viruses, influenza vaccination has demonstrated a risk reduction of having to visit a doctor by 40% to 60%.

For infants and young children, who are among individuals with the greatest risk of flu complications, vaccination is critical. Per the CDC, flu vaccination prevents “millions of illnesses and flu-related visits to the doctor each year.”9 More specifically, in the 2019-2020 influenza season, the CDC stated that vaccination prevented approximately 7 million influenza illnesses, 3 million associated medical visits, 100,000 hospitalizations, and 7,000 associated deaths in the United States.

With numbers such as these, a strong track record of effectiveness, and with your recommendations for seasonal and routine vaccines, it is clear influenza vaccination is critical in protecting the entire population, including children. For those children with needle phobia, who are likely already afraid of a doctor’s office, the at-home administration option among those aged 2 years and up is a welcomed addition and should help increase vaccination rates overall.

"This intranasal live attenuated vaccine has been around for years as an option for influenza vaccination, but utilization of the vaccine has been less than expected,” said 

Editor-in-Chief Tina Tan, MD, professor of pediatrics at the Northwestern University Feinberg School of Medicine and the pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago.

"It can only be given to healthy individuals 2 to 49 years of age with no underlying conditions, including asthma. Making it available for in home use should increase the use of this vaccine and influenza vaccine, however, it will be important that the selling of this vaccine be monitored as you do not want the wrong individuals receiving the vaccine," said Tan.

Tan noted that attention to detail should be taken for those administering the intranasal vaccine, but this option should help those afraid of poking and prodding.

"There will need to be clear instructions as to what should be done if the person does not receive the entire dose given that this is a nasal spray, but there is some volume to it, so parts of the dose could drip out of the nose," Tan added.

 "In-home vaccine is not available this influenza season but is expected to be available next influenza season. It's definitely an option for needle phobic individuals."

A potential new needle-free treatment for severe allergic reactions

In an October 24, 2024, announcement from Aquestive Therapeutics, positive topline results were demonstrated in the Oral Allergy Syndrome (OAS) challenge study for epinephrine sublingual film (Anaphylm), a polymer matrix-based epinephrine prodrug product candidate.

According to the announcement, the data presented from OAS marked the completion of the final supportive adult study in the development program before Aquestive meets with the FDA.

In addition to seeking approval for the adult population, the company is on track to commence a pediatric study among individuals who weigh 30 kg or more in the fourth quarter of 2024. Further, Aquestive plans to submit a New Drug Application to the FDA in the first quarter of 2025.

Taking fear and pain out of needles–for your child and you. HealthyChildren.org. Updated August 3, 2022. Accessed December 6, 2024. https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/managing-your-childs-pain-while-getting-a-shot.aspx

Healthcare providers: Understanding needle fears and phobia. Centers for Disease Control and Prevention. Updated March 17, 2022. Accessed December 6, 2024. https://www.cdc.gov/ncbddd/humandevelopment/covid-19/needle-phobia/healthcare-providers.html

Fitch, J. FDA approves neffy as first nasal spray to treat anaphylaxis. 

. August 9, 2024. Accessed December 9, 2024. https://www.contemporarypediatrics.com/view/fda-approves-neffy-as-first-nasal-spray-to-treat-anaphylaxis

Fitch, J. FDA issues CRL for neffy nasal spray to treat allergic reactions, requests more research. 

. September 20, 2023. Accessed December 6, 2024. https://www.contemporarypediatrics.com/view/fda-rejects-approval-of-neffy-nasal-spray-for-allergic-reactions-requests-more-research

FDA approves first nasal spray for treatment of anaphylaxis. FDA. Press release. August 9, 2024. December 6, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-nasal-spray-treatment-anaphylaxis

Highlights of prescribing information. ARS Pharmaceuticals. Pdf. Accessed December 6, 2024. https://www.ars-pharma.com/wp-content/uploads/pdf/Prescribing_Information.pdf

Fitch, J. FDA approves FluMist for self- or caregiver-administration. 

. September 20, 2024. Accessed December 6, 2024. https://www.contemporarypediatrics.com/view/fda-approves-flumist-for-sefl--or-caregiver-administration

Seasonal flu vaccine basics. Centers for Disease Control and Prevention. September 17, 2024. Accessed December 6, 2024. https://www.cdc.gov/flu/vaccines/index.html

Aquestive Therapeutics announces positive topline results from Oral Allergy Syndrome (OAS) Challenge study for Anaphylm (epinephrine) sublingual film. Aquestive Therapeutics. Press release. October 24, 2024. Accessed December 6, 2024. https://investors.aquestive.com/news-releases/news-release-details/aquestive-therapeutics-announces-positive-topline-results-oral

Needle-free treatments, such as Neffy and FluMist, offer promising alternatives for children and adults with needle phobia, ensuring access to critical care.

2024’s Needle-Free Approvals Transform Management of Anaphylaxis, Influenza in Children

Joshua Fitch

 As we come to a close on this discussion, I sincerely appreciate all 3 of you taking your time to talk about atopic dermatitis; you’re all seasoned, work in well-known clinics, and are definitely leaders among your peers. Do you have any pearls, hints, words of encouragement, or topics that you’d say make sure you discuss with your patients and teach colleagues without your wealth of experience? Whether you’re talking about triggers, hints for adherence, or talking about all the features and facts associated with the disease. Everybody pick something and tell me the one thing that you must say, to make sure that these youngsters who don’t know everything, I know that I could pass along to them. Matthew, what would be your thing that you would tell new PAs [physician assistants] or colleagues who haven’t seen as much atopic dermatitis as you have?

 I go back to the thing we learned when we were in our training: listen to your patient, they will tell you what’s wrong with them. Part of that is taking a good history, talk to them about their family, their personal history, things like asthma, hay fever, and sinus allergies. I always ask patients if pollen bothers them when the pollen season is bad. We have a terrible pollen season here in Georgia. I think those things help you. “Have other family members had rashes like you?” Talk to them about their experience. Sometimes the elderly patients have forgotten their history of childhood, but they’ll say, “I had a brother who had asthma.” Talking through those things and getting that history up front, that’s been the most valuable thing for me in terms of differentiating between a patient with atopic dermatitis and a patient who may just be having a single episode of eczema.

 My big thing is, we just talked about the future of 2023 and all these exciting things, to not be afraid to have a low threshold for topical therapy. Because we just spent an hour talking about how eczema is a systemic disease, so you wouldn’t treat diabetes with a topical, you would treat diabetes with an oral therapy. That’s how we look at psoriasis, and that’s how we’re going to start looking at eczema. If somebody is not responding well with topical therapy, we need to discuss and educate our patients and their parents on what else is out there because we don’t want these patients to suffer, and they truly do suffer. Itch and infection are horrible, and constant antibiotics, oral steroids, and topical steroids are not good for our patients, and long term we know that’s not good as well. We have many safe options in the biologic space and potentially in the oral space such that we are OK to have a low threshold on when it’s time to get to that next level.

 My pearl, first, for NP [nurse practitioner] or PA colleagues who are novices, is to get excited about treating atopic dermatitis. It may not be the new sexy disease on the page right now, but it is a very rewarding career to treat these patients and become the expert in your clinic for managing atopic dermatitis. Your ability to transform patients’ lives, treat these patients, and see them grow and thrive is extraordinary. Feel comfortable with this disease, become involved in your national societies, go to meetings where there are atopic dermatitis experts lecturing, and become comfortable in your algorithm and in your treatment plan. There are many resources available for you with up-to-date information so that you can become comfortable and an expert in managing atopic dermatitis.

My pearl for [working with] patients is to teach them that you are excited about treating them. When I walk in the room with a new patient with eczema or even psoriasis, I tell them how excited I am that they’re here and that I’m going to be their partner through this entire disease. Then I ask them this pivotal question, “What is it about this disease that is keeping you from finding joy in your life or living your best life? If you give me time and your trust, I’m going to help you find that joy. I’m in this with you and partnering with you to help you live the best life that you can.” I think those are 2 important things that patients want to hear from us as dermatology providers and for us to recognize within our patients, that this disease can be consequential for them and their happiness, and their ability to thrive in their lives.

 One thing I always think about that’s really important is to help them understand that it’s not their fault. There are triggers, we know it can be pollens, it can be animal dander. There are certain things that can trigger patients with atopic dermatitis that you might have some control over, but this is a disease. It’s a disease that involves a lot of components, a poorly functioning barrier, and an inappropriate cytokine response to triggers, but it is a disease. It’s not their fault, so they must understand that they’re not doing anything wrong.

For my colleagues, I would say practice evidence-based medicine, don’t get caught up in people saying, “But if I don’t eat this, or I use this CBD [cannabidiol] oil, or I use whatever, I’m a little better, or this helps.” They’re searching, and you have to say, “Look, here’s the deal, I know a little about that, but I can tell you what the science and the evidence say.” We’ve got excellent data now that explain what this disease is, what’s going wrong, and how these medicines are specific to try to treat it. So know your medicine. If you’re going to prescribe it, and diagnose and treat these patients, medicine is a wonderful thing, so make sure you really understand that.

Thank you for this insightful discussion and thank you to the audience for watching this 

 presentation with Alexa, Matthew, and Lakshi. I hope that you have learned something and that you will take this information to heart the next time you see a patient and you start thinking this child could have atopic dermatitis. As Alexa says, have a low threshold for moving along and getting them pediatric-approved therapies and get them going. You’re going to change some lives and be heroes to these patients, and really make a big difference. Thank you.

Alexa Hetzel, MA, PA-C; Lakshi Aldredge, MSN, ANP-BC, DCNP, and Matthew Brunner, PA, share practice pearls and clinical management tips for the care of pediatric patients with atopic dermatitis.

Practice Pearls for the Management of Atopic Dermatitis 

Lakshi Aldredge, MSN, ANP-BC, DCNP 

I'm sorry, but it seems there is no article text provided for me to summarize and extract key takeaways from. Could you please provide the text of the article

Panelists discuss how lifestyle interventions, including diet, physical activity, and smoking cessation, complement pharmacotherapy in the management of dyslipidemia, and explore unmet needs in cardiovascular risk reduction, highlighting the role of emerging therapies such as bempedoic acid, inclisiran, and gene editing technologies.

Navigating Lifestyle and Pharmacotherapy Interventions in Dyslipidemia Management  

Pam R. Taub, MD, FACC, FASPC  

panel discussion on a head-to-head sequence study of rizankizumab vs ustekinumab in the treatment of CD, as well as approaches to choosing first-line treatment.

Sequence Study of Risankizumab vs Ustekinumab in CD

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The transcript discusses the findings of the sequence study, focusing on the comparison between two drugs, P41 (referred to as risankizumab) and P19 (referred to as IL (interleukin)-23 therapy). The study aimed to evaluate the efficacy of risankizumab in patients with Crohn's disease who had been exposed to TNF.

The results indicate that risankizumab-exposed patients were more likely to achieve clinical response, clinical remission, and endoscopic improvement compared to those on P40 (risankizumab with IL-12 and IL-23). The transcript emphasizes that the head-to-head comparison provides valuable insights, guiding clinicians in choosing the most effective therapy.

It highlights that risankizumab, along with its biosimilar, is an approved and effective option for Crohn's disease. The discussion touches upon the significance of the sequence study's second primary endpoint, endoscopic remission, and how it could be a pivotal moment in the field.

The conversation also touches on the evolution of clinical trials in Crohn's disease, emphasizing the importance of endoscopic outcomes and the progression from subjective measures to objective proof of efficacy. The participants express optimism about the potential impact of risankizumab, especially when used as a first-line therapy.

Furthermore, the transcript discusses the importance of early intervention in Crohn's disease, suggesting that initiating treatment early is more likely to result in a positive response and prevent further damage. The participants encourage setting higher expectations for patients and discuss the advantages of using risankizumab in biologic treatment-naive patients.

In conclusion, the discussion underscores the positive findings from the sequence study, positioning risankizumab as a promising option for Crohn's disease, particularly in terms of achieving endoscopic remission and improving patient outcomes. The participants stress the need for effective communication with patients about treatment options and the potential long-term benefits of early intervention.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

David Rubin, MD, leads the panel discussion on a head-to-head sequence study of rizankizumab vs ustekinumab in the treatment of CD, as well as approaches to choosing first-line treatment.

Remo Panaccione, MD, FRCPC

Do each of you have some parting advice or a word of wisdom for any physicians out there taking care of patients with prurigo nodularis [PN]? Shawn, I'll start with you.

I would tell the physicians, ‘You have an opportunity to make a humongous impact on someone's quality of life.’ When we looked at the overall quality of life and how it's affected in PN patients, it's as severe as having a stroke, chronic heart failure, or being on hemodialysis. I think that's underestimated, the opportunity that any type of doctor has when you encounter a PN patient, to make a difference. At that moment, you can give folks the proper diagnosis. You can do a lab workup. You can make sure that they don't have many of these different disease comorbidities. You can also start them on therapies that are going to reduce, in my view, their likelihood of developing many different comorbidities. Sleep problems, anxiety, depression, and even worsening type 2 diabetes. I think it's a great opportunity that doctors have to intervene and make a tremendous difference. I think it's one of those conditions that has such a significant effect on quality of life. It's arguably one of the highest we see among any patients in our specialty.

How about you Sarina? Any parting thoughts?

Yes. I couldn't say it better than that. I usually say at the end of these that I advise physicians to care about their patients. I will say also to think broadly and stay up-to-date on the treatments we can offer. This is a landscape that is changing; as we mentioned, there are multiple drugs. I think there are probably going to be more that are coming online as the landscape of AD, atopic dermatitis, evolves, and the landscape of other disorders evolves. We will also learn more about prurigo nodularis. It's not just the limited few that we spoke about. I encourage everybody to really stay up-to-date and keep an eye out for things on the horizon.

I really can't put it better than both of you did. The one thing I tell my residents when it comes to any patients, but particularly these patients, is just listen. Just take a second and listen. You'll be surprised how much you figure out. How quickly you're going to change what your point of view might have been when you came into the room. Your viewpoint when you read the chief complaint or looked through the chart and saw what other notes said before the same findings you eventually get to. You'll find that perhaps you will understand why this is such an interesting and fascinating disease state and one which deserves to be treated as such. Just alongside all the other diseases that we think about potentially that are more prevalent or better understood.

With that, thank you, Shawn and Sarina, for this rich and informative discussion. This was amazing to talk to 2 world experts and get to the cutting edge of where we are and where we should be going. Thank you all for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox. Thank you very much.

Shawn Kwatra, MD, and Sarina B. Elmariah, MD, PhD, share final pearls of wisdom for other physicians taking care of patients with prurigo nodularis (PN).

Advice for Managing Patients With PN

Sarina B Elmariah, MD, PhD

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease

Nehad Soloman, MD, FACR; Andrew Sharobeem, DO, FACR, and Sunil Patel, MD, explore the nephrologist's vital role in gout diagnosis, treatment options for gout patients with chronic kidney disease, and strategies for managing refractory gout and its associated challenges.

Moving Beyond the Joint: The Interplay Between Gout and Kidney Disease 

Sunil Patel, MD  

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 editorial team sat down with Tejesh Patel, MD/MBBS, about his portion of the session at RAD titled ‘Dose Flexibility in Adult Atopic Dermatitis.’

Patel, a professor and department chair at the University of Tennessee Health Science Center Department of Dermatology, was asked about examples of dose flexibility in the context of 

 treatment. He spoke about the current landscape in terms of dose adjustments in various treatments for the skin condition.

Discussing Dose Flexibility in Adult Atopic Dermatitis, with Tejesh Patel, MD

“It's a really exciting time for atopic dermatitis,” Patel explained. “There are lots of different medications coming out and different ways we can deliver them. We have oral medications, we have injections, and we have new topical medications coming out also. In real clinical practice, we're seeing patients’ clinical responses to these medicines vary from the standard regimes that are out there. We're seeing that we can, in fact, actually have some flexibility in the way we manage these patients and maybe even extend times for maintenance. In that respect, [we can] decrease exposure to medicine, and therefore some of the side effects and so forth.”

Patel noted that there are biologics and Janus Kinase (JAK)-inhibitors, highlighting systemic drugs as an example of a drug that can have some flexibility in its use.

“In terms of the biologics, these are subcutaneous injections,” Patel said. “For maintenance, once we've got a clinical response, this data out there shows that you can actually increase the length of injections and maintenance of these injections. For dupilumab, you can go from around 2 weeks to maybe Q4W to, in some instances, Q8W. That's really exciting for both the patient and the clinician, because there's less frequency of administering this medicine. [This leads to] increased compliance, and they're less exposed to the medicine so some of the side effects may be decreased. Overall, there may be a decrease in cost to the healthcare system as well, because you're not administering these medicines as frequently.”

Patel highlighted that he believes it is an exciting time to talk to patients about dose flexibility in their atopic dermatitis drugs.

“I think in terms of compliance, if we're administering a medication less frequently or at a lower dose, I think that's appealing to the patients in terms of compliance,” Patel explained. “...I think one major takeaway from the talk is that you can really involve your patient with the decisions you're making. Give them the data, and see what appeals to them if they want to do an oral medicine or an injection. Involve them in every step, and also let them know that there's new data that come that's coming out that may mean that you're not needing to take the medicines as frequently, or you can lower the dose in the future.”

To find out more about dose flexibility in atopic dermatitis, as well as other related facts, view the full interview posted above. For more on these topics and others, view the 

The quotes contained in this interview summary were edited for clarity.

This interview at RAD 2025 highlights a session on dose flexibility in adult patients with atopic dermatitis, presented by Tejesh Patel, MD.

Tejesh Patel, MD/MBBS

Louis discussed the ASKmeGOC study and an electronic tool to help facilitate patient preference documentation.

Centering Patient Autonomy in Hospital Care for Older Adults, with Valerie Louis

Hospitalized older adults are often not asked about their goals of care until a health crisis occurs—if at all. In the absence of documented preferences, the default is to initiate full resuscitative measures, which may not align with patient values or best interests.

Valerie Louis, a medical student at Northern Ontario School of Medicine University in Canada, is working on addressing this unmet need and empowering elderly patients in their care with the AKmeGOC (goals of care) study. She presented an overview of the study and the electronic tool she and her colleagues developed that documented elderly patients’ preferences and goals for their care before a health crisis at the American College of Physicians (ACP) Internal Medicine (IM) Meeting 2025, held April 3-5, in New Orleans, Louisiana.

caught up with Louis during the meeting to learn more.

Louis and colleagues found that after using the tool and having conversations with elderly patients about their care, the proportion of patients who had no preferences documented in their charts dropped from 25% to 4% in the intervention group. Furthermore, the number of ICU days dropped by 30% for patients who got the conversation, and the number of ventilator days dropped by 60%.

“The 2 big things we’re working on are… letting patients have their own autonomy in decision making, it's their care, they should be the ones making the decisions; and reducing low value care, so reducing care that isn't actually beneficial for them. By scaling up this tool and expanding also to primary care offices or long-term care homes as well… are all things that we're working on expanding,” Louis told 

Louis V. Assessment of Shared Decision-making Tool for Eliciting Informed Goals of Care in the Hospitalized Elderly: A Randomized Trial (ASKmeGOC Study). Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.

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