Background Asthma is among the most common chronic diseases affecting pregnant women. In adults with uncontrolled asthma, the addition of a long-acting β-agonist (LABA) to inhaled corticosteroids (ICS) is more effective than increasing the dose of ICS for asthma control. However, data on the gestational safety of LABAs are limited. Objective To evaluate the risk for major birth defects, small for gestational age (SGA), spontaneous abortion (SAB), and preterm delivery (PTD) in women using LABA during pregnancy. Methods Participants in the United States or Canada were recruited between 2009 and 2014 by MotherToBaby Pregnancy Studies at UC San Diego. Pregnant women treated with LABAs, with or without ICS, were compared with those using short-acting β-agonists (SABAs), with or without ICS, and with those without asthma. Data on exposures and outcomes were collected through maternal interviews and medical records. Results A total of 439 participants were enrolled: 100 exposed to LABAs, 103 exposed to SABAs, and 236 nonasthmatic women. Liveborn infants of women exposed to LABAs were not significantly more likely to have major congenital malformations compared with either reference group (adjusted relative risk [aRR], 1.05; 95% confidence interval [CI], 0.32, 3.40; and aRR, 0.63; 95% CI, 0.23, 1.67, respectively). LABA exposure was no more likely to result in SAB, PTD, or SGA infants than in either comparison group. Conclusion There was no significant increase in risk for the selected adverse outcomes in women exposed to LABAs during pregnancy.
BACKGROUND: Imaging is a critical aspect of vestibular schwannoma (VS) management, influencing essentially every aspect of care including diagnosis, surveillance, treatment decision making, and follow-up after either resection or stereotactic radiosurgery. Despite this, treatment protocols are heterogeneous, and frequently based on historical practices, or low-quality evidence. OBJECTIVE: To update evidence-based guidelines for the use of imaging in the clinical management of patients with VS published by the Congress of Neurological Surgeons in 2018. METHODS: Systematic review of the literature published from 1/1/2015 to 5/20/2022 regarding imaging protocols for VS management. Salient questions were identified by a writing group of diverse individuals with topic-specific expertise. Questions were validated by the Congress of Neurological Surgeons Guidelines Committee. Following systematic review, literature tables and summary statements pertinent to the study questions were generated by the writing group, which underwent subsequent evaluation and revision by the task force before formalization. RESULTS: Seven questions were formulated; adequate literature was identified to formulate updated recommendations for 6 of these. Search strategy identified 1143 unique records, of which 109 underwent full-text review, and 57 were included in this study. Most studies provided level III evidence, with rare level II studies noted, yielding level III recommendations. CONCLUSION: The current evidence base for imaging protocols in VS clinical management is broad, diverse, low certainty, and low quality. This in part reflects a heterogeneous disease, although variability in treatment philosophies may also influence local decision making. Key areas for future study include the clinical utility of advanced imaging techniques and head-to-head comparisons of imaging protocols for patients in common initial VS management pathways (eg, observation, resection, or stereotactic radiosurgery). The full guideline can be seen online at https://www.cns.org/guidelines/treatment-adults-vestibular-schwannoma/5-role-of-imaging-in-management-of-patients-with-v
Objectives: Nearly 70% of people who use tobacco want to quit. Combination nicotine replacement therapy (cNRT), a long-acting controller plus short-acting reliever, is the most effective way to prescribe nicotine but is infrequently prescribed by primary care physicians (PCPs). We tested the feasibility and effectiveness of a brief, educational intervention to increase cNRT prescribing by PCPs in a large integrated health system. Methods: We conducted a pre-post study from 2022-2023 at a large integrated health system in California where specific NRT products are covered with a prescription. PCPs were offered a 30-minute virtual training about cNRT during a required monthly meeting (n = 267; 202 attended). The training was interactive, included simple "asks" and a 6-week follow-up communication. Chi-square analysis was used to test for changes in cNRT prescribing behaviors in the 6 months before and after training. Results: Among physicians who completed a posttraining questionnaire (180/202), 93% reported increased confidence, 91% reported favorable attitudes, and 88% reported intention to prescribe cNRT. According to data obtained from the integrated pharmacy database, the total number of patients who received a cNRT prescription increased from the 6-month pre- to 6-month postintervention from 135 (9%) to 380 (23%), P < 0.001. The total number of physicians who prescribed cNRT increased pre- to posttraining from 78 (23%) to 124 (37%), P < 0.001. Conclusion: cNRT is an underutilized form of tobacco cessation therapy by PCPs. This may reflect a gap in prescriber knowledge. A brief, virtual training delivered to PCPs was associated with increased cNRT prescribing.
