Healthcare Travel Contributes Substantially to U.S. Emissions; Telehealth May be a Solution

airplane-flying-gloomy-background-emissions

Health care is responsible for 4.6% of all global greenhouse gas emissions, according to research published in The Lancet. For the U.S., a study in Health Affairs (Millwood) put that figure at 8.5%. 

Alexander P. Cole, MD, a urologic oncologist in the Department of Urology at Mass General Brigham, and colleagues noted that patient-related travel was not included in the U.S. estimate. In a cross-sectional nationwide study published in JAMA Network Open, they conclude patient travel accounts for 6.4% of healthcare-related greenhouse gas emissions in the U.S.  Read More

Review: Optimizing Local Control in the Surgical Management of Bladder Cancer

visual concept of a bladder and cancer cells

The past decade has witnessed exciting progress in the surgical treatment of localized muscle-invasive bladder cancer (MIBC), including prehabilitation programs, increasingly effective systemic therapies, robotics-assisted surgery, and organ-sparing approaches.

Matthew Mossanen, MD, MPH, Department of Urology at Mass General Brigham, Chong-Xian Pan, MD, PhD, of the Department of Medicine, Vincent D. D’Andrea, MD, formerly a resident physician in the Department of Urology, and colleagues review these and other crucial advances in Nature Reviews Urology. This summary focuses on the latest innovations: the use of novel biomarkers, in vivo and in vitro tumor models, artificial intelligence, and bladder transplantation. Read More

Review: Urology on a Changing Planet

piece of glacier in sea

The United Nations and the World Health Organization recognize climate change as one of the largest threats facing human health, and patients receiving care for urological conditions are a vulnerable population. 

In Nature Reviews Urology, Alexander P. Cole, MD, of the Department of Urology at Mass General Brigham and assistant professor of surgery at Harvard Medical School, and colleagues review the epidemiological evidence about links between climate change and urological diseases.  Read More

Automated Frailty Screening Tool Aims to Improve Care of Vulnerable Older Adults

Doctor with a patient looking at an ipad

Frailty is associated with higher risk for adverse outcomes such as falls, hospitalizations, disability, and mortality as well as preventable healthcare system costs. It affects up to a quarter of community-dwelling adults aged 65 or older and is becoming more prevalent as the U.S. population ages.

In her research, geriatrician Ariela Orkaby, MD, MPH, of the Brigham and Women’s Hospital Division of Aging, focuses on healthy aging through the lens of preventing frailty and cardiovascular disease. She led the development of the Mass General Brigham Frailty Index (MGB-FI), a new tool that automates frailty screening based on patients’ existing data while also guiding clinicians on managing care for at-risk individuals. The MGB-FI will be available in Epic nationwide sometime in 2026. Read More

New Criteria Proposed for Diagnosis of Early Pregnancy Loss After IVF

Doctor looking at an ultrasound image

Early pregnancy loss (EPL), a pregnancy that fails before 14 weeks of gestational age, has substantial physical, emotional, and financial consequences for patients and their partners. These concerns may be amplified in patients who have undergone in vitro fertilization (IVF), and a prolonged time to diagnosis of EPL adds to the burden.

In all patients, accurate diagnosis of EPL is paramount. Therefore, guidelines are conservative and focus on changes in ultrasound findings over time, without considering pregnancy dating based on the last menstrual period, which is relatively inaccurate.

However, in an IVF population, the precise embryo transfer date is known. Andrea Lanes, PhD, an epidemiologist in the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital, Roisin Mortimer, MBBCH, BAO, MSc, a clinical fellow in the Department of Obstetrics and Gynecology, and colleagues propose taking that date into account in the diagnosis of EPL in IVF clinics. Read More

Large Language Models May Be Useful Adjuncts to Human Expert Consensus Panels

AI collage artistic photo

The Delphi method is commonly used for developing consensus documents such as clinical guidelines, diagnostic criteria, and healthcare policies when empirical evidence alone is insufficient. Delphi studies facilitate structured communication among experts through iterative rounds of anonymous feedback, minimizing the interpersonal influences that might bias individual judgment in face-to-face meetings. 

The conventional Delphi method requires extensive administrative coordination, substantial time commitment from busy specialists, and participation of a Delphi expert to create the statements to be evaluated. 

Abdelrahman Nimeri, MD, FACS, director of bariatric surgery in the Center for Weight Management and Wellness at Brigham and Women’s Hospital, Ahram Han, MD, of Seoul National University Hospital in Korea, and Young Suk Park, MD, PhD, and colleagues found in an exploratory study that a Delphi process involving large language models (LLMs) achieved high levels of consensus on medical statements, with substantial concordance to human expert decisions.  Read More

Augmented Reality for Advanced Neuronavigation for Arterial Control in Brain AVM Surgery

radiology image of AVM blood vessels in the brain

Arteriovenous malformations (AVMs) are rare and among the most complex cerebrovascular conditions treated in neurosurgery. Although surgical resection can be curative, it carries substantial risk, including hemorrhage and injury to surrounding brain tissue that may result in paralysis, visual loss, or other neurological deficits.

Nirav Patel, MD, a neurosurgeon at the Mass General Brigham Neuroscience Institute and director of Mass General Brigham’s Brain AVM Program, has led the development and refinement of innovative surgical strategies that leverage augmented reality, advanced neuronavigation, and multimodal neuromonitoring to improve the safety and precision of AVM microsurgery. These techniques focus on identifying and controlling arterial feeders before nidus dissection—a paradigm shift in AVM surgery. Read More

Composite Ultrasonic Findings Show Promise for Diagnosis of Adenomyosis

doctor working on an ultrasound machine

The gold standard for the diagnosis of adenomyosis is histopathology, which typically requires hysterectomy. Ultrasound has been proposed as a much less invasive, fertility-sparing alternative. In 2022, a consensus statement published in Ultrasound in Obstetrics & Gynecology listed direct and indirect sonographic findings suggestive of adenomyosis.

Researchers in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital, including Parmida Maghsoudlou, BA, and Yvette S. Groszmann, MD, MPH, aimed to validate the markers by evaluating them in patients with and without histopathologically confirmed adenomyosis. In The Journal of Minimally Invasive Gynecology, they say the composite of direct findings was 100% sensitive for adenomyosis. Read More

The First Large Cohort Analysis to Frame Spinal Cord Injury as a Chronic Disease

glowing-spinal-cord-inside-body

Traumatic spinal cord injury isn’t just a one-time event but also a chronic condition. Furthermore, people with a history of spinal cord injury are more likely to develop cardiovascular, neurological, psychiatric, and endocrine diseases—regardless of age, location of injury, or prior health status.

These are two key takeaways from research led by Mass General Brigham investigators published in JAMA Network Open. Read More

Improving Surgical Decision-making for Persons Living With Dementia

doctor sitting and talking with a patient

Limited longitudinal data on outcomes. An inability of the patient to fully participate in the discussion. Vague advance directives with multiple care partners (surrogates). These are among the many factors that complicate surgical decision-making with persons living with dementia (PLWD).

Complex challenges like these are exacerbated by the lack of evidence-based guidelines to inform clinicians who must recommend whether to proceed with surgery, a nonsurgical treatment, or no treatment at all. The goal of the Decisions Around Dementia and Surgery (DecADES) project is to fill this gap, thus improving surgical decision-making with PLWD as well as recovery when surgery is chosen. Read More