To review the safety, efficacy, and clinical considerations of vaginal estrogen therapy for the treatment of genitourinary syndrome of menopause (GSM) in patients with a history of breast or gynecologic cancer. This is a narrative review of the current literature and clinical guidelines which evaluate vaginal estrogen use in cancer survivors, with a focus on the key outcomes of cancer recurrence and mortality as well as dosing considerations. Vaginal estrogen therapy is consistently associated with significant improvement in GSM symptoms and quality of life. There is minimal systemic absorption with low-dose formulations, with serum estradiol levels remaining within postmenopausal ranges. Large observational studies and meta-analyses show no increased risk of breast cancer recurrence or mortality among users, including those with estrogen receptor-positive disease and those on tamoxifen. Data on patients receiving aromatase inhibitors (AIs) are more limited. Current evidence supports the safety and efficacy of low-dose vaginal estrogen for GSM in most cancer survivors, with no clear increase in recurrence or mortality. Although nonhormonal therapies should be considered first-line, low-dose vaginal estrogen is an appropriate and effective option for patients with refractory symptoms along with shared decision making and multidisciplinary care. Further prospective studies are needed, especially in patients receiving AIs.

The rapid diffusion of generative AI is transforming health care delivery, education, administration, and research. In response, health care organizations have invested heavily in AI literacy initiatives and workforce development programs. Existing frameworks primarily focus on whether health care professionals understand AI and whether they can engage with AI effectively. However, health care practice increasingly reveals that individuals with similar levels of AI literacy and AI engagement often contribute very differently to AI-enabled work and organizational adoption. Some professionals primarily use AI to improve their own work, whereas others facilitate AI adoption, coordinate stakeholders, and integrate AI into routine practice. This observation suggests that current perspectives may overlook an important dimension of workforce AI enablement. In this Viewpoint, we argue that AI literacy and AI engagement alone provide an incomplete explanation of how health care organizations realize the benefits of AI. Drawing upon literature from AI literacy, fluency theory, human-AI interaction, innovation diffusion, implementation science, and health care workforce development, we propose the health care workforce AI enablement matrix (HWAEM). HWAEM conceptualizes workforce AI enablement through 2 complementary capabilities: AI fluency and AI harnessing. AI fluency refers to the capability to engage with AI effectively, appropriately, and responsibly across professional contexts, whereas AI harnessing refers to the capability to identify opportunities for AI-enabled improvement, mobilize stakeholders, facilitate adoption, and integrate AI into collective work practices. The interaction of these capabilities generates 4 workforce profiles: AI novices, AI practitioners, AI facilitators, and AI leaders. Through HWAEM, this Viewpoint argues that health care workforce AI enablement is better understood through the complementary capabilities of AI fluency and AI harnessing than through AI literacy and AI engagement alone. We illustrate how these profiles manifest in health care practice and discuss implications for workforce development and AI implementation. HWAEM offers a new perspective for understanding health care workforce preparedness in the generative AI era and provides a foundation for future empirical research.

➢ Meniscal root tears compromise load distribution within the knee, accelerating cartilage degeneration and leading to knee osteoarthritis.➢ Diagnosis relies on clinical suspicion supported by magnetic resonance imaging (MRI), with arthroscopy serving as the gold standard for confirmation.➢ Management decisions should be tailored to patient-specific factors, including age, activity level, tear characteristics, and the severity of degenerative chondral wear evident on preoperative imaging, including weight-bearing radiographs and MRI.➢ Root repair is associated with better long-term outcomes compared with partial meniscectomy and nonoperative management in appropriately selected patients.➢ There is currently no universally accepted postoperative rehabilitation protocol following meniscal root repair; however, most strategies limit weight-bearing in the early postoperative period and restrict loaded flexion, such as deep squatting, for up to 4 to 5 months. Further research is needed to guide standardized recovery pathways.

➢ Biologic and synthetic augmentation grafts have been developed to enhance both the mechanical integrity of rotator cuff repairs and the biologic healing at the tendon-bone interface, particularly in the setting of compromised tissue quality.➢ Xenograft augmentation is no longer favored because of inconsistent clinical outcomes, inflammatory responses, and a lack of supportive high-quality evidence.➢ Allograft and synthetic graft augmentation may provide benefit in selected cases; however, optimal indications, implant selection, and long-term outcomes remain incompletely defined.➢ Bioinductive collagen implants currently demonstrate the highest level of clinical evidence, with Level-I studies supporting improved structural healing and reduced retear rates in appropriately selected patients.➢ The long head of the biceps tendon autograft represents a viable, cost-effective biologic augmentation option when available, providing favorable biologic compatibility and surgical versatility.

In 2011, Brown University Health's Division of Geriatrics started its inaugural geriatric co-management service to improve older adult (OA) care for patients with hip fractures. Its success in care and cost reduction prompted the health system to expand geriatric co-management. Meanwhile, oncology surgeons treat increasingly older and frailer patients due to improved therapies and survival. The literature established what we saw here: increased mortality and complications in frail OA and failure of strategies like Enhanced Recovery After Surgery and Prehabilitation. In 2021, the division launched an oncologic surgery co-management program. Explicit to its launch, hospital sponsors required a 2-year study for benchmarks and quality metrics with a primary outcome of reducing mortality and delirium. QI metrics were developed through PowerBI dashboards using hospital and EMR data, analyzing 4,359 cases, which measured length of stay (LOS), readmissions, mortality, and disposition, from July 2018 to August 2024. We compared outcomes between the pilot (Geri) and those with no geriatric involvement (UC) using 1:1 propensity score matching. Bivariate analyses used chi-square and Student's t-tests for descriptive comparisons and multivariate linear or logistic regression analyses for outcome rates and adjusted when appropriate. The matched sample consisted of 309 cases in each group. 14% were underrepresented minorities. The Geri group had a lower odds ratio (OR) for hospice or in-hospital mortality (OR 0.27, 95% CI 0.12-0.61, p = 0.0016), as well as significantly lower odds of delirium, measured by a positive CAM (OR 0.29, 95% CI 0.11-0.73, p = 0.0086). ICU admission was lower in the geri group, although not statistically significant (18 vs 25, p = 0.0690). Overall hospital length of stay was longer in the geri group (8.2 ± 15.4 vs. 6.2 ± 5.6 days, p = 0.0350). Geri patients were less likely to be discharged home (OR 0.51, 95% CI 0.33-0.77) but were more likely to be discharged to a skilled nursing facility (OR 2.25, 95% CI 1.43-3.53) or inpatient rehabilitation facility (OR 8.52, 95% CI 1.04-69.6). Conclusion: Geriatric co-management in surgical oncology significantly reduced mortality and delirium as measured by CAM among OA, demonstrating meaningful improvements in patient outcomes. Although LOS increased and home discharges decreased, these results may indicate more appropriate discharge planning for this patient population. Geriatric co-management represents a critical, evidence-based component of surgical oncology care for OA. This study adds to the growing evidence supporting the role of Geriatric Medicine in improving the quality of care for OA.