Faculty Bibliography

BACKGROUND:Prostate cancer (PCA) germline testing (GT) is now standard-of-care for men with advanced PCA. Thousands of men may consider GT due to clinical and family history (FH) features. Identifying and consenting men for GT can be complex. Here we identified barriers and facilitators of GT across a spectrum of providers which informed the development of Helix - an educational and clinical/FH collection tool to facilitate GT in practice. MATERIALS AND METHODS/METHODS:A 12-question survey assessing knowledge of genetics PCA risk and FH was administered December 2017 to March 2018 in the Philadelphia area and at the Mid-Atlantic AUA meeting (March 2018). Responses were analyzed using descriptive statistics. Semi-structured interviews were conducted with medical oncologists, radiation oncologists, and urologists across practice settings from March-October 2020 as part of a larger study based on the Tailored Implementation in Chronic Diseases framework. Helix was then developed followed by user testing. RESULTS:Fifty-six providers (50% urologists) responded to the survey. Multiple FH and genetic knowledge gaps were identified: only 66% collected maternal FH and 43% correctly identified BRCA2 and association to aggressive PCA. Genetic counseling gaps included low rates of discussing genetic discrimination laws (45%). Provider interviews (n = 14) identified barriers to FH intake including access to details and time needed. In user testing (n = 10), providers found Helix helpful for FH collection. All providers found Helix easy to use, suggesting expanded clinical use. CONCLUSION/CONCLUSIONS:Helix addressed multiple GT knowledge and practice gaps across a spectrum of providers. This tool will become publicly available soon to facilitate PCA GT in clinical practice.

While SARS-CoV-2 is a novel virus, contagious respiratory illnesses are not a new problem. Limited research has examined the extent to which place- and race-based disparities in severe illness are similar across waves of the COVID-19 pandemic and historic influenza seasons. In this study, we focused on these disparities within a low-income population, those enrolled in Medicaid in New York City. We used 2015-2020 New York State Medicaid claims to compare the characteristics of patients hospitalized with COVID-19 during three separate waves of 2020 (first wave: January 1-April 30, 2020; second wave: May 1-August 31, 2020; third wave: September 1-December 31, 2020) and with influenza during the 2016 (July 1, 2016-June 30, 2017) and 2017 influenza seasons (July 1, 2017-June 30, 2018). We found that patterns of hospitalization by race/ethnicity and ZIP code across the two influenza seasons and the first wave of COVID-19 were similar (increased risk among non-Hispanic Black (aOR = 1.17, 95% CI: 1.10-1.25) compared with non-Hispanic white Medicaid recipients). Black/white disparities in hospitalization dissipated in the second COVID wave and reversed in the third wave. The commonality of disparities across influenza seasons and the first wave of COVID-19 suggests there are community factors that increase hospitalization risk across novel respiratory illness incidents that emerge in the period before aggressive public health intervention. By contrast, convergence in hospitalization patterns in later pandemic waves may reflect, in part, the distinctive public health response to COVID-19.

Introduction: Prostate cancer diagnosis and treatment have a significant impact on sexual function and quality of life. Although prostate cancer is often called a "couples disease," there is limited research on the needs of partners who are affected by the patient's sexual dysfunction.
Objective(s): The objective of our study was to compare the sexual health concerns and unmet needs of patients with prostate cancer and partners using real-world data from an online prostate cancer community.
Method(s): We performed a mixed-methods analysis of data from the Inspire UsTOO Prostate Cancer Online Support & Discussion Community. This online health community about prostate cancer has more than 30,000 members, including both patients and partners. Through a data use agreement, we obtained anonymized text from public postings to the Sexual Health & Intimacy Forum on this community. Quantitative and qualitative data were examined from a random sample of 10% of the posts by women about sexual health (n=66), and were compared to an equal number of randomly selected posts by men.
Result(s): Among 6193 posts about sexual health and intimacy in prostate cancer, 661 (11%) were by female contributors. Of posts with cancer treatment details, surgery was the most common treatment discussed followed by hormonal therapy. Erectile dysfunction was the most common sexual complaint for both men and women. Posts by women were most likely to discuss problems with communication, relationship conflict, their partner's loss of libido, and the importance of intimacy. Common themes of the posts included coping with a "new normal" in their relationship, lack of access to and expense of erectile aids, and insufficient information and support from clinicians surrounding sexual recovery. A greater proportion of female posts conveyed emotion compared to male posts. The most common positive emotions were satisfaction and hope; while the most common negative emotions were frustration and loss of familiar sexual interaction. Although many posts discussed a variety of medical and surgical therapies for sexual recovery, very few discussed counseling or other psychosocial treatments.
Conclusion(s): Patients with prostate cancer and their partners experience a wide range of sexual health issues related to prostate cancer diagnosis and treatment. Online communities are widely used to give and receive peer-to-peer advice and support during sexual recovery. These findings highlight an unmet need for more extensive education and support surrounding sexual health for couples during the prostate cancer journey. Disclosure: No
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BACKGROUND:Studies report higher diagnostic accuracy using the collective intelligence (CI) of multiple clinicians compared with individual clinicians. However, the diagnostic process is iterative, and unexplored is the value of CI in improving clinical recommendations leading to a final diagnosis. METHODS:To compare the appropriateness of diagnostic recommendations advised by individual physicians versus the CI of physicians, we entered actual consultation requests sent by primary care physicians to specialists onto a web-based CI platform capable of collecting diagnostic recommendations (next steps for care) from multiple physicians. We solicited responses to 35 cases (12 endocrinology, 13 gynecology, 10 neurology) from ≥3 physicians of any specialty through the CI platform, which aggregated responses into a CI output. The primary outcome was the appropriateness of individual physician recommendations versus the CI output recommendations, using recommendations agreed upon by 2 specialists in the same specialty as a gold standard. The secondary outcome was the recommendations' potential for harm. RESULTS:= 0.11). LIMITATIONS:Cases were from a single institution. CI was solicited using a single algorithm/platform. CONCLUSIONS:When seeking specialist guidance, diagnostic recommendations from the CI of multiple physicians are more appropriate than recommendations from most individual physicians, measured against specialist recommendations. Although CI provides useful recommendations, some have potential for harm. Future research should explore how to use CI to improve diagnosis while limiting harm from inappropriate tests/therapies.

OBJECTIVE:To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes. DATA SOURCES/METHODS:Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database. STUDY DESIGN/METHODS:Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires. DATA COLLECTION/EXTRACTION METHODS/METHODS:Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching. PRINCIPAL FINDINGS/RESULTS:Of 1993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry. CONCLUSIONS:Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients' social needs.

Peritonitis, as a major consequence of hollow visceral perforation, anastomotic disruption, ischemic necrosis, or other injuries of the gastrointestinal tract, often drives acute care in the emergency department, operating room, and the ICU. Chronic critical illness (CCI) represents a devastating challenge in modern surgical critical care where successful interventions have fostered a growing cohort of patients with prolonged dependence on mechanical ventilation and other organ supportive therapies who would previously have succumbed much earlier in the acute phase of critical illness. An important subset of CCI patients are those who have survived an emergency abdominal operation, but who subsequently require prolonged open abdomen management complicated by persistent peritoneal space infection or colonization, fistula formation, and gastrointestinal (GI) tract dysfunction; these patients are described as having tertiary peritonitis (TP).The organ dysfunction cascade in TP terminates in death in between 30 and 64% of patients. This narrative review describes key-but not all-elements in a framework for the coordinate multiprofessional team-based management of a patient with tertiary peritonitis to mitigate this risk of death and promote recovery. Given the prolonged critical illness course of this unique patient population, early and recurrent Palliative Care Medicine consultation helps establish goals of care, support adjustment to changes in life circumstance, and enable patient and family centered care.

BACKGROUND:In utero exposure to bisphenols, widely used in consumer products, may alter lung development and increase the risk of respiratory morbidity in the offspring. However, evidence is scarce and mostly focused on bisphenol A (BPA) only. OBJECTIVE:To examine the associations of in utero exposure to BPA, bisphenol F (BPF), and bisphenol S (BPS) with asthma, wheeze, and lung function in school-age children, and whether these associations differ by sex. METHODS:We included 3,007 mother-child pairs from eight European birth cohorts. Bisphenol concentrations were determined in maternal urine samples collected during pregnancy (1999-2010). Between 7 and 11 years of age, current asthma and wheeze were assessed from questionnaires and lung function by spirometry. Wheezing patterns were constructed from questionnaires from early to mid-childhood. We performed adjusted random-effects meta-analysis on individual participant data. RESULTS:Exposure to BPA was prevalent with 90% of maternal samples containing concentrations above detection limits. BPF and BPS were found in 27% and 49% of samples. In utero exposure to BPA was associated with higher odds of current asthma (OR = 1.13, 95% CI = 1.01, 1.27) and wheeze (OR = 1.14, 95% CI = 1.01, 1.30) (p-interaction sex = 0.01) among girls, but not with wheezing patterns nor lung function neither in overall nor among boys. We observed inconsistent associations of BPF and BPS with the respiratory outcomes assessed in overall and sex-stratified analyses. CONCLUSION:This study suggests that in utero BPA exposure may be associated with higher odds of asthma and wheeze among school-age girls.

BACKGROUND:Fetal exposure to endocrine-disrupting chemicals such as phthalates and bisphenols might lead to fetal cardiovascular developmental adaptations and predispose individuals to cardiovascular disease in later life. OBJECTIVES/OBJECTIVE:We examined the associations of maternal urinary bisphenol and phthalate concentrations in pregnancy with offspring carotid intima-media thickness and distensibility at the age of 10 y. METHODS:In a population-based, prospective cohort study of 935 mother-child pairs, we measured maternal urinary phthalate and bisphenol concentrations at each trimester. Later, we measured child carotid intima-media thickness and distensibility in the children at age 10 y using ultrasound. RESULTS: DISCUSSION/CONCLUSIONS:In this large prospective cohort, higher maternal urinary bisphenols concentrations were associated with smaller childhood carotid intima-media thickness. Further studies are needed to replicate this association and to identify potential underlying mechanisms. https://doi.org/10.1289/EHP10293.