Faculty Bibliography

INTRODUCTION/BACKGROUND:on the amount of FFP needed to normalize the R-time. METHODS:(ΔPV) and ΔR-time within 24 h of administration of FFP. Responders were divided in high and low based on a decrease in R-time > 5 min after the administration of FFP. Data presented as mean ± SD and median with interquartile range were analyzed with parametric and non-parametric tests as applicable. RESULTS:before transfusions but it was affected by the amount FFP and the resulting ΔPV (483 ± 173 vs. 296 ± 99 and 17.0% ± 6.6% vs. 8.6% ± 3.0%; p < 0.05). CONCLUSIONS:is the key element required to estimate the volume of FFP needed to correct a prolonged R-time.

IMPORTANCE/UNASSIGNED:One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening. OBJECTIVE/UNASSIGNED:To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites in the US including community and academic practices from November 20, 2023, to April 5, 2024. Data analysis was conducted from April to August 2024. INTERVENTION/UNASSIGNED:Eligible participants collected a sample with the SC method, followed by a clinician-collected (CC) sample. The SC sample was eluted into PreservCyt at the laboratory and both samples were tested on an FDA-approved high risk human papillomavirus (hrHPV) test approved for primary screening. Participants were followed up for safety and completed usability and screening preference surveys. MAIN OUTCOME AND MEASURES/UNASSIGNED:The primary outcome measures were positive percentage agreement (PPA) and negative percentage agreement for detection of hrHPV between the SC and CC samples. Other study measures included clinical sensitivity for high grade cervical dysplasia and usability. RESULTS/UNASSIGNED:Of 609 screening-eligible participants, 599 (262 aged 30-39 years [43.7%]; 583 identified as female [97.3%]) had paired SC-CC samples, of which 582 had valid paired samples included in the end point analysis. Among the 582 evaluable paired samples, the PPA between SC compared with paired CC samples for detection of hrHPV was 95.2% (95% CI, 92.1%-97.1%; 278 of 292 participants). The absolute clinical sensitivity for detection of high-grade cervical dysplasia was 95.8% (95% CI, 86.0%-98.8%; 46 of 48 participants), equivalent to the CC (relative sensitivity, 1.00). Nearly all participants (555 of 601 participants [92.3%]) reported that the device instructions were easy or very easy to understand and also that they would choose SC if they knew the results were comparable to CC results (560 of 602 participants [93.0%]). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this nonrandomized clinical trial, SC samples collected with the device showed equivalent clinical sensitivity and exceeded the PPA end point for cervical screening. This SC method was found to be easy to use and to be a preferred option with high clinical performance intended for use in an at-home setting. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT06120205.

OBJECTIVE:To evaluate the Maryland All-Payer Model's impact on the rate of elective major joint replacement surgery. STUDY DESIGN/METHODS:A retrospective cohort study of patients in Maryland undergoing elective major joint replacement between 2011 and 2018 was performed using a 20% fee-for-service Medicare sample in a difference-in-difference framework with patients undergoing hip fracture repair serving as controls. METHODS:Among Maryland residents, there were 7147 Medicare fee-for-service patients undergoing elective major joint replacement and 1008 Medicare fee-for-service beneficiaries undergoing hip fracture repair. We used patient-level generalized linear models with a negative binomial family function and a log link function to estimate the association of the All-Payer Model with the rate of elective major joint replacement surgery. RESULTS:Under the All-Payer Model, the rate of elective major joint replacement surgery increased more than that of hip fracture repair (adjusted relative risk, 1.31; 95% CI, 1.15-1.51). Compared with hospitals without affiliates in adjacent states (Maryland-only hospitals), those with affiliates (Maryland hospitals with affiliates) saw rates of elective major joint replacement grow more slowly (adjusted relative risk, 0.87; 95% CI, 0.80-0.95) after the All-Payer Model. Furthermore, major joint replacement rates for Maryland residents at affiliated hospitals in adjacent states increased from 4.26 per 10,000 in the preintervention period to 5.23 per 10,000 in the postintervention period. CONCLUSIONS:Under the All-Payer Model, population-based rates of elective major joint replacement surgery increased more rapidly than did rates of hip fracture repair. Although rates of major joint replacement at Maryland hospitals with affiliates grew more slowly than for Maryland-only hospitals, rates among Maryland residents increased at the affiliates in adjacent states.

This document serves to update the 2018 ACR Appropriateness Criteria® colorectal screening guidance document. In light of new recommendations from the US Preventative Services Task Force (USPSTF), an updated literature review of the imaging procedures for the screening of colorectal cancer was performed. Average-risk, elevated-risk, and high-risk individuals as well as those individuals who had an incomplete colonoscopy or were unable to tolerate colonoscopy were included. CT colonography without contrast was found to be usually appropriate for individuals at average and elevated risk between 45 to 75 years of age at initial screening. Additionally, CT colonography without contrast was found to be usually appropriate in individuals at average risk, elevated risk, and at high risk after incomplete colonoscopy or unable to tolerate colonoscopy. Other imaging procedures such as barium fluoroscopy and CT of the abdomen and pelvis were usually not appropriate. CT colonography without contrast, barium fluoroscopy, and CT of the abdomen and pelvis were usually not appropriate in high-risk individuals who can undergo a complete colonoscopy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

PURPOSE/UNASSIGNED:Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL). METHODS AND MATERIALS/UNASSIGNED:We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT. RESULTS/UNASSIGNED:Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT. CONCLUSIONS/UNASSIGNED:GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.

PURPOSE/OBJECTIVE:The dermatological management of cancer patients with cutaneous adverse events occurring during and after oncologic treatment is known as supportive oncodermatology. This includes prevention, early identification, and mitigation of dermatologic toxicities. The aim of the international RESCUE (Residents' survey on training of dermatology residents in supportive oncodermatology) study was to ascertain the current level of expertise in supportive oncodermatology among dermatology residents. METHODS:The European Task Force "Dermatology for cancer patients" and the US Oncodermatology Society developed an online questionnaire with 30 multiple-choice items. Responses were collected using qualitative ordinal data (yes/no, 1-5 ratings) and multiple-choice options. Ordinal range results were analyzed by aggregating responses 1 + 2 + 3 versus 4 + 5, with 5 representing the highest grade ("extremely confident" or "full training"). RESULTS:A total of 442 dermatology residents from 20 countries replied. These participants reported receiving less comprehensive training in supportive oncodermatology (only 41% receiving complete training) compared to immunodermatology (75%), cutaneous oncology (75%), dermoscopy (64%), and dermatologic surgery (50%). Only 17% of the residents reported feeling confident in managing the dermatological toxicities associated with anticancer treatments. Residents also indicated receiving less education regarding toxicities related to endocrine therapies (28%). In particular, lower levels of competence were reported in managing nail, hair, and oral toxicities. A significant majority of residents (98%) deemed it essential to enhance training in dermatological toxicities associated with anticancer therapies during their oncology residency. CONCLUSION/CONCLUSIONS:The RESCUE study represents the first project assessing residents' education in supportive oncodermatology. To enable future generations of dermatologists to provide enhanced care for cancer patients, supportive oncodermatology training should be integrated in residency programs worldwide, corresponding to training in other subspecialties. A more practical approach should also be incorporated, including extended training in hair, nail, and oral toxicities, enhancing the competencies of dermatology residents in all countries.

BACKGROUND/OBJECTIVES/OBJECTIVE:Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is rapidly becoming the most prevalent form of chronic liver disease in both pediatric and adult populations. It encompasses a wide spectrum of liver abnormalities, ranging from simple fat accumulation to severe conditions such as inflammation, fibrosis, cirrhosis, and liver cancer. Major risk factors for MASLD include obesity, insulin resistance, type 2 diabetes, and hypertriglyceridemia. METHODS:This narrative review employed a comprehensive search of recent literature to identify the latest studies on the relationship between MAFLD and obesity, the health consequences and the latest treatment options to prevent long-term damage to the liver and other organs. Additionally, the article presents perspectives on diagnostic biomarkers. RESULTS:Childhood obesity is linked to a multitude of comorbid conditions and remains a primary risk factor for adult obesity. This abnormal fat accumulation is known to have long-term detrimental effects into adulthood. Scientific evidence unequivocally demonstrates the role of obesity-related conditions, such as insulin resistance, dyslipidemia, and hyperglycemia, in the development and progression of MASLD. Oxidative stress, stemming from mitochondrial dysfunction, is a leading factor in MASLD. This review discusses the interconnections between oxidative stress, obesity, dyslipidemia, and MASLD. CONCLUSIONS:Atherogenic dyslipidemia, oxidative stress, inflammation, insulin resistance, endothelial dysfunction, and cytokines collectively contribute to the development of MASLD. Potential treatment targets for MASLD are focused on prevention and the use of drugs to address obesity and elevated blood lipid levels.