University Of Rochester Medical Center Research Articles

Adjuvant immune checkpoint inhibitor therapy may benefit pediatric patients with stage III melanoma and sentinel lymph node positivity: a case series.

Melanoma is the most common skin cancer in children. While the current literature establishes treatment protocols for adult-type melanoma, very few pediatric-specific studies exist, and children are often excluded from melanoma clinical trials2. We report a case series of 23 pediatric patients aged 2-20 years old diagnosed with melanoma at the University of Rochester Medical Center between 1/1/2011 and 1/1/2022. 9/23 patients were Stage III; all patients underwent wide local excision and 9 received adjuvant therapies. 2/23 (8.7%) patients had recurrence of their malignancy after therapy while 21/23 (91.3%) remained without disease progression; 1 patient died from unknown cause, but the rest are alive and currently without disease. All patients whose initial therapy included nivolumab in addition to wide local excision did not have recurrence or progression of their disease. This case series highlights trends in the presentation, treatment, and outcomes of pediatric melanoma; however, additional multi-center studies are needed to establish the clinical utility of such features in pediatric melanoma.

Gender Disparities in Quality of Life Outcomes Among Kidney Stone Formers.

This study investigates gender-based disparities in health-related quality of life (HRQOL) outcomes among kidney stone patients and explores potential contributing factors. A retrospective review of medical records at the University of Rochester Medical Center was conducted on 2199 new urolithiasis patients who completed the Wisconsin Stone Quality of Life Questionnaire (WISQOL) standardized on a 0-100 scale. Demographic and clinical data were collected. Statistical analyses included univariate tests, chi-squared tests, and multivariate linear regression. Of the 2199 kidney stone patients, 1085 (49.3%) were female. Females reported significantly lower QoL scores compared to males (71.6 vs 80.7; p<0.001), and this persisted across all domains, including social impact (80.2 vs 86.9; p<0.001), emotional impact (67.3 vs 77.1; p<0.001), disease impact (67.3 vs 77.1; p<0.001), and impact vitality (62.6 vs 72.9; p<0.001). Female gender was identified as an independent predictor of diminished QoL scores, along with younger age, symptomatic status, number of surgeries and presence of a psychosocial comorbidity. Our findings suggest that women with kidney stones experience lower HRQOL compared to men, even accounting for clinical and demographic factors. While this study provides preliminary insights, additional research is needed to validate these findings in broader and more varied populations.

Retrospective Analysis of the Outcomes of Genetic Testing in Patients Suspected to Have Hereditary Hearing Loss or Deafness.

Uncorrected hearing loss can result in detrimental sequelae. Research addressing clinical presentation and genetic testing would inform clinical decision making. A retrospective chart review of 96 patients aged 1 month to 46 years (median age = 6 years) diagnosed with hearing loss or deafness and who underwent genetic testing at University of Rochester Medical Center from 2011 to 2021. Chi-square and Fisher's exact tests examined the relationship between a diagnostic positive genetic test result and various characteristics of hearing loss, including congenital (n = 52), noncongenital (n = 34), prelingual (n = 53), postlingual (n = 33), progressive (n = 13), not progressive (n = 47), bilateral (n = 67), unilateral (n = 26), sensorineural (n = 68), conductive (n = 14), mixed (n = 5), syndromic (n = 10), and nonsyndromic (n = 87) hearing loss. We also examined the number of patients with presence of developmental disabilities (n = 35), having a first-degree relative with hearing loss (n = 19), having hearing aids or cochlear implants (n = 45), and having a multisystem presentation prior to diagnosis (n = 45). Patients with sensorineural hearing loss (44.1%) had significantly more diagnostic positive results than those with mixed (0%) or conductive hearing loss (21.4%), p = .004. However, significantly fewer patients with disabilities (19.4%) had diagnostic positive tests than those without disabilities (43.3%), p < .05. More patients with a multisystem presentation were also found to have syndromic causes of hearing loss (23.3%) than patients who did not have a multisystem presentation, p < .05. Our study suggests a significant association between sensorineural type of hearing loss and a diagnostic positive genetic test result, while the presence of disabilities was significantly associated with a nondiagnostic genetic test result. Knowledge of these findings is critical for understanding the cause of the hearing loss, identifying other associated symptoms, and determining risk to family members.

RocHealthData.org: Development and usage of a publicly available, geographic source of social determinants of health data.

Access to local, population specific, and timely data is vital in understanding factors that impact population health. The impact of place (neighborhood, census tract, and city) is particularly important in understanding the Social Determinants of Health. The University of Rochester Medical Center's Clinical and Translational Science Institute created the web-based tool RocHealthData.org to provide access to thousands of geographically displayed publicly available health-related datasets. The site has also hosted a variety of locally curated datasets (eg., COVID-19 vaccination rates and community-derived health indicators), helping set community priorities and impacting outcomes. Usage statistics (available through Google Analytics) show returning visitors with a lower bounce rate (leaving a site after a single page access) and spent longer at the site than new visitors. Of the currently registered 1033 users, 51.7% were from within our host university, 20.1% were from another educational institution, and 28.2% identified as community members. Our assessments indicate that these data are useful and valued across a variety of domains. Continuing site improvement depends on new sources of locally relevant data, as well as increased usage of data beyond our local region.

Perception of Determinants of Psychotic Patients and Impact of Psychotic Patients on the Family of Kathmandu District in Nepal

Perception of determinants of psychotic patients and their impacts on the family of Kathmandu district in Nepal aims at finding out the determinants in terms of biological, psychological, and sociological aspects and their impacts in terms of social, financial, emotional, and health. The theoretical method is incorporated for roughly 30 caregivers (the sample size is estimated with the Population Proportion Formula) of psychotic patients in Nepal. Nonclinical data was used for the analysis, with a survey method for quantitative data and an interview method for qualitative data. The questionnaire and interview schedule are used as study instruments. Those instruments are tested through conceptual definitions, operational definitions, design, development, statistical analysis, and thematic content analysis. The analysis of the data for objective number 1 revealed that social determinants had the highest number of occurrences, but these were actually psychosocial and biological determinants. These determinants were directly or indirectly related to psychological or emotional factors and are synchronized with the bio-psychosocial model. (B.P.S.) developed by George Libman Engel of the University of Rochester Medical Center, New York. The results of objective number 2 concluded that the emotional impacts of psychotic patients were the most prominent, followed by social, financial, and health impacts. It is clear that emotional impact comes first, followed by other impacts such as financial, social, and health. These findings will support the fresh data for the urgent need for further in-depth study of the determinants of psychotic patients and their impacts on the family.

Risk of Sudden Cardiac Death in Patients Undergoing Cancer Treatment

The risk of sudden cardiac death (SCD) in patients with cancer receiving cancer therapies is not well defined. In this study we aimed to (1) evaluate the risk of SCD during the first 6months of cancer treatment and (2) identify risk factors (RFs) for SCD in patients who underwent active cancer treatment. The study population comprised 8,356 patients who received any cancer treatment at the University of Rochester Medical Center from 2011 to 2020. The primary end point was the occurrence of SCD within 6months of cancer treatment. SCD was defined by using the modified Hinkle-Thaler classification. The mean age at the time of cancer treatment was 64 ± 14years and 49% were women. All-cause mortality occurred in 834 patients (10%), of whom 51 (6%) were identified as SCD. The cumulative probability of SCD at 6months was 0.6%. Age <74 years (0.042) and history of congestive heart failure (0.058) and lung cancer (0.004) were identified as independent RFs for SCD in the multivariate Cox regression models. The cumulative probability of SCD at 6months from cancer treatment initiation was significantly higher in patients with ≥2 RFs (1.6%) than in patients with 0 or 1 RF (0.5%) (log-rank p <0.001). In conclusion, our findings suggest that active cancer treatment is associated with SCD risk that is more pronounced in younger patients, patients with cancer with a history of heart failure, and those who underwent treatment for lung cancer. Future studies should address appropriate modalities for prevention and protection in this high-risk population.

Characterizing Granuloma Annulare in 73 Pediatric Patients.

Granuloma annulare (GA) is a common, benign, idiopathic inflammatory dermatosis. Aside from case reports and small studies, there are limited data about the characteristics of GA in children. This study aimed to better characterize the epidemiologic and clinical features, triggering factors, disease associations, and outcomes of GA in the pediatric population. We conducted a retrospective study of 73 pediatric patients diagnosed with GA at the University of Rochester Medical Center over a 7-year period. The most common subtype was localized GA (71.2%, n = 52), followed by subcutaneous (also known as "deep GA"; 16.4%, n = 12) and generalized (12.3%, n = 9) subtypes. Over 90% of patients had idiopathic GA, with the remaining patients reporting viral infection or trauma as triggers. Half of the patients studied had comorbid conditions, most frequently atopic dermatitis (17.8%, n = 13), obesity (9.59%, n = 7), asthma (6.85%, n = 5), and allergic rhinitis (6.85%, n = 5). The median duration of the disease was 11.00 months (interquartile range (IQR) 15.75 months); generalized GA had the shortest duration (median 10.00 months, IQR 15.50 months), while subcutaneous GA had the longest duration (median 12.00 months and IQR 29.00 months). Although recurrence rates for subcutaneous and generalized GA were high at 45.5% and 33.3%, respectively, most patients achieved clearance or improvement with treatment. Most cases of GA in our study were idiopathic, with no clear differences between GA subtypes and associated comorbidities. Topical steroids were the most prescribed treatment with mixed efficacy.

Oncofertility Counseling Practices in Pediatric Hematology/Oncology: Addressing Barriers and Time Pressures

The National Comprehensive Cancer Network, American Society of Reproductive Medicine, and American Society of Clinical Oncology emphasize the importance of counseling patients receiving chemotherapy about its long-term effects on fertility. However, survivors often report inadequate attention to this crucial aspect of care. Balancing timely treatment initiation with comprehensive oncofertility counseling presents several challenges, including cost, patient age at diagnosis, information overload at diagnosis, and time constraints. To address the insufficient study of time pressures on oncofertility counseling, we conducted a retrospective review at the University of Rochester Medical Center. The study involved 210 pediatric patients diagnosed with a malignancy requiring chemotherapy between January 1st, 2015, and May 31st, 2022, excluding those treated elsewhere or with relapsed disease. We performed individual electronic medical record (EMR) chart abstractions, collecting data on diagnosis, pathologic diagnosis date, systemic chemotherapy initiation, oncofertility documentation, and Tanner staging. Hematologic malignancies comprised 37.65% of the cohort, with acute lymphoblastic leukemia (15.43%) and acute myeloid leukemia (7.72%) being the most prevalent. The median age was 7, with a male predominance (59%) and predominantly Caucasian patients (845) Only 11.9% of the patient population saw reproductive endocrinology or urology for an oncofertility visit and 59% had documented oncofertility discussions with their oncology team. Sexual health was discussed in only 2.3% of cases, and only 10.9% of patients had documented Tanner staging before treatment initiation. Hematologic malignancy patients had an average of 14.38 days between pathologic diagnosis and treatment initiation, significantly lower than extracranial solid tumors (14.78 days) and CNS tumors (97.18 days). Peripubertal or post-pubertal patients (≥10 years) had an average of 19.7 days from diagnosis to treatment, compared to 12.4 days for pre-pubertal patients (&amp;lt;10 years). Considering the short interval between diagnosis and treatment initiation for pediatric hematologic malignancies, achieving in-depth oncofertility discussions before therapy initiation seems unrealistic, particularly given fertility interventions will normally take days to weeks to coordinate. While most of these patients will likely have retained fertility on current treatment protocols, any chemotherapy exposure can potentially affect fertility. Additionally, high risk patients that relapse will receive definitive salvage therapy with a bone marrow transplant which is much more likely to threaten fertility. The results of this study illustrate that in depth oncofertility counseling may be better suited after initial diagnosis but before relapse in high-risk patients. This will balance the opportunity for patients and families to discuss an important topic close to diagnosis but at a time when they can effectively process the information and plan for their future.

Implementation of a postgraduate dermatology fellowship program for nurse practitioners.

Transition to practice programs (also referred to as fellowship, residency, or postgraduate training programs) for nurse practitioners (NPs) are becoming more popular, especially in specialties such as dermatology. A nationwide shortage of dermatology clinicians, which had led to long appointment wait times and inadequate patient access to care, has led to more NPs practicing dermatology to help meet the demand for care. New graduate NPs may struggle in their transition to practice, and fellowship programs have been shown to support NPs as they transition from novice to expert. In this article, the University of Rochester Medical Center shares its experience in developing, implementing, and managing a postgraduate dermatology fellowship program for NPs.

Impact of COVID-19 pandemic on social isolation and loneliness among minority populations

BackgroundThe impact of social isolation and loneliness (SIL) was heightened during the COVID-19 pandemic. Although the pandemic disproportionately affected racial/ ethnic minorities, no studies have investigated the ramifications of the pandemic on SIL among these populations. This study aimed to determine the prevalence and pervasiveness of SIL during the COVID-19 pandemic on minority communities. Materials and methodsThis was a single center, cross sectional study conducted by scientists from the University of Rochester Medical Center (URMC) working in collaboration with members of the Rochester community. Adult patients presenting to the emergency department at URMC who identified themselves as belonging to minority communities were asked to complete a survey that comprised questions from the Lubben Social Network Scale-6 and questions from the Campaign to End Loneliness Measurement Tool. We analyzed the percentage of SIL and conducted linear regression models to study the association between these outcomes and race/ ethnicity, age, gender, chronic disease status and the frequency of hospitalizations. ResultsA total of 1,029 subjects completed the survey. Social isolation was reported by 375 (37%) persons. Those of Latinx ethnicity had higher prevalence of social isolation (41%) compared to those of Black/African American race (36%) and also had higher degrees of isolation (14.8%) (15.42; p = 0.07). Loneliness was documented by 215 (21%) for the cohort with no differences based on race or ethnicity. ConclusionsSocial isolation was common among minority communities during the pandemic but loneliness was less pervasive. The study highlights the need to address the specific needs of these populations.

Frequency of lipoprotein(a) measurements in patients with or at risk of cardiovascular disease

Knowledge of lipoprotein(a) measurement in community practice is limited. The objective of this study is to evaluate the frequency of Lp(a) screening across the University of Rochester Medical Center (URMC). Descriptive data were collected for all URMC patients >= 18 years old who have had at least one Lp(a) measurement from January 2011 to August 2022 from the URMC electronic health record (EHR). Cardiovascular diagnoses were queried to define yearly frequency and demographic information. We identified 2,698 patients with at least one Lp(a) result. An increasing number of patients were tested per year. There were more women than men, and about 11% having more than one Lp(a) measured with the majority having a level <30mg/dL (the normal-range in the UMRC lab). The majority do not have a listed diagnosis of cerebral infarction, peripheral vascular disease, myocardial infarction, coronary artery disease, or aortic stenosis. Across URMC, there has been a steady increase of Lp(a) measurements in the past several years.

Trends and Non-Clinical Predictors of Respiratory Syncytial Virus (RSV) and Influenza Diagnosis in an Urban Pediatric Population.

To evaluate the demographic, maternal, and community-level predictors of pediatric respiratory syncytial virus (RSV) and influenza diagnosis among an urban population of children residing in Rochester, NY. A test-negative case-control design was used to investigate various non-clinical determinants of RSV and influenza diagnosis among 1,808 children aged 0-14 years who presented to the University of Rochester Medical Center (URMC) or an affiliated health clinic in Rochester, NY between 2012-2019. These children were all tested for RSV and influenza via polymerase-chain-reaction (PCR) method, including RSV and influenza diagnosis of all severity types. Test results were linked to medical records, birth certificates, questionnaires administered through the Statewide Perinatal Data System, and the US census by census tracts to obtain information on child, maternal, demographic, and socio-economic characteristics. Overall the strongest predictor of RSV and influenza diagnosis was child's age, with every year increase in child's age, risk for RSV decreased (OR: 0.75; 95% CI: 0.71, 0.79) and risk for influenza increased (OR: 1.20; 95%: 1.16, 1.24). In addition to age, non-private insurance type was positively associated with influenza diagnosis. When considering the proportion of positive cases for RSV and influenza over all PCR tests by respiratory season, a spike in influenza cases was observed in 2018-2019. Age was a strong predictor of RSV and influenza diagnosis among this urban sample of children.

Association of early completion of portable medical orders with inpatient costs at end-of-life for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS).

6645 Background: Patients with hematologic malignancies receive more aggressive care at end-of-life (EOL) compared to patients with solid tumors. Costs of care in patients with hematologic malignancies at EOL are high, particularly in the inpatient setting. We previously found that early completion of portable medical orders [termed medical orders for life sustaining treatment (MOLST) in New York state] is associated with less intense care at EOL for patients with AML and MDS. Thus, we hypothesized that early MOLST completion would also be associated with lower inpatient costs at EOL among patients with AML and MDS. Methods: We previously conducted a retrospective study of 358 adults patients with AML or MDS treated at Wilmot Cancer Institute and its affiliated sites who died between January 1, 2014, and December 31, 2019. Of these, 271 patients were eligible for cost analysis. Cost of inpatient care received at the University of Rochester Medical Center (URMC) within the last 30 days of life was obtained from our Finance Decision Support Department. Patients were excluded if inpatient costs at EOL were unavailable. Results: Mean age of patients was 69 years (N=271, range 20-95); 84% (n=227) of patients were hospitalized within 30 days of death. One-third (34%, n=93) of patients completed a MOLST early (&gt;30 days prior to death) whereas 66% (n=178) either did not complete a MOLST or completed a MOLST late (less than or equal to 30 days prior to death). Mean and median inpatient cost of care for all patients at EOL was $39,284 and $19,703, respectively. The rate of hospitalization was lower for patients who completed a MOLST early vs late/never (73.1% vs 90.5%, respectively; p=0.0003), although there was no difference in the number of inpatient visits between the two groups (median=1 visit in both groups; p=0.23). In addition, median cost of inpatient care was lower for patients who completed a MOLST early vs late/never ($10,673 vs $23,177, respectively; p&lt;0.0001). After adjusting for age, sex, and diagnosis, there was a trend toward lower EOL costs in patients completing a MOLST early (p=0.07). Conclusions: In patients with AML or MDS, early MOLST completion may be associated with lower inpatient costs at EOL. Viewing MOLST completion as a surrogate for a goals-of-care discussion, it follows that interventions aimed to increase the frequency of early goals-of-care discussions, advanced care planning, and MOLST completion are likely to improve quality of care and decrease costs at EOL in these patient populations.

CORR Insights®: Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study.

1Assistant Professor of Surgery, Pediatrics, and Biomedical Engineering, Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA N. A. Wilson, University of Rochester Medical Center, Golisano Children’s Hospital, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study” by Yoon and colleagues available at: DOI: 10.1097/CORR.0000000000002612. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Web Exclusive. Annals On Call - The Complete Blood Count: Cleaning Up the Clutter.

Web Exclusives4 April 2023Annals On Call - The Complete Blood Count: Cleaning Up the ClutterFREERobert M. Centor, MD, W. Richard Burack, MD, PhD, and Marshall A. Lichtman, MDRobert M. Centor, MDHuntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Search for more papers by this author, W. Richard Burack, MD, PhDDepartment of Pathology and Laboratory Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (W.R.B.)Search for more papers by this author, and Marshall A. Lichtman, MDDepartment of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (M.A.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/A22-0007 CME/MOC SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this episode of Annals On Call, Dr. Centor discusses the complete blood count and how it could be improved with Drs. W. Richard Burack and Marshall A. Lichtman.Annals articles discussed include...The Complete Blood Count: Increasing Its Precision and Impact: https://www.acpjournals.org/doi/10.7326/M22-3071About Annals On CallAnnals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.For more information on Annals On Call and for more episodes, visit go.annals.org/OnCall. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Department of Pathology and Laboratory Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (W.R.B.)Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (M.A.L.)Disclosures: All relevant financial relationships have been mitigated. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=A22-0007.Editors' Disclosures: The editors have no relevant financial relationships to disclose. Individual forms may be viewed at www.annals.org/editorsdisclosures.This article was published at Annals.org on 4 April 2023. Nextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Complete Blood Count: Increasing Its Precision and Impact W. Richard Burack and Marshall A. Lichtman Metrics Latest ePublished: 4 April 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.Loading ...

21 Epidemiology of Infectious Keratitis at University of Rochester Medical Center

OBJECTIVES/GOALS: Infectious keratitis is a potentially sight-threatening disease. Its epidemiology has been considered on various national and regional levels, which demonstrates unique patterns in patient risk factors, causative organisms, antimicrobial resistance and clinical outcomes. This study will examine the patterns specific to the Rochester, NY area. METHODS/STUDY POPULATION: This project will be a ten-year retrospective study, examining all patients who were diagnosed with infectious keratitis at the University of Rochester Medical Center between 2011 and 2021. The study population is selected from a compiled list of those patients with an ICD diagnosis code including ’keratitis’ in the eRecord that falls within our chosen date range. Participants were excluded if the patient’s physician documented that the keratitis is most likely not infectious in etiology. If eligible for the study, there is documentation of patient demographics, clinical risk factors, clinical course, culture data from corneal scraping and antimicrobial resistance patterns, if available. Once data is collected, it will be analyzed and compared to pre-existing regional and national data. RESULTS/ANTICIPATED RESULTS: Between 2011 and 2021, there were 1652 patients with ICD diagnoses of keratitis at the University of Rochester Medical Center. Of these patients, we anticipate approximately 1,200 to meet our inclusion criteria. Some of the major risk factors for developing infectious keratitis in this population include contact lens use, immunocompromised state (elderly, diseased or iatrogenic) and corneal trauma. Clinical complications include progression to endophthalmitis, need for interventional surgery, or failure to improve on clinical exam after 2 weeks of antimicrobials. Causative organisms are most often bacterial. Certain organisms are associated with specific risk factors while other organisms predict greater risk of complications. We also anticipate patterns of antimicrobial resistance to emerge. DISCUSSION/SIGNIFICANCE: This study will provide insights into the risk factors and clinical course of infectious keratitis according to causative organisms in the Rochester, NY area. This can help us mitigate risk factors and help prognosticate for patients, once diagnosed. Also, patterns of antimicrobial resistance can inform empiric antimicrobial recommendations.

MP49-12 ADVANCING COMPREHENSIVE URO-ONCOLOGIC CARE FOR THE URBAN UNDERSERVED

You have accessJournal of UrologyCME1 Apr 2023MP49-12 ADVANCING COMPREHENSIVE URO-ONCOLOGIC CARE FOR THE URBAN UNDERSERVED Kit Yuen, Alexis Steinmetz, Mark Ninomiya, and Divya Ajay Kit YuenKit Yuen More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Mark NinomiyaMark Ninomiya More articles by this author , and Divya AjayDivya Ajay More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial and socioeconomic disparities in the incidence, treatment, and outcomes of urologic cancers are well documented; solutions to these inequities are not. The purpose of this study was to assess the feasibility and effectiveness of integrating a urologic specialty care clinic into an existing primary care infrastructure. We also aimed to increase trainees’ awareness of health inequities in urologic cancer care. METHODS: St. Joseph’s Neighborhood Center (SJNC) is a Catholic charity organization that provides health care and social services to individuals without health insurance. University of Rochester Medical Center (URMC) has a long-standing partnership with SJNC through a student-led primary care clinic. In February 2021, URMC residents organized bi-monthly urology clinics at SJNC staffed by attending, resident, and student volunteers. A preliminary analysis of clinic records was conducted. Qualitative data was obtained through direct observation of program processes and informal feedback with volunteers. RESULTS: Twelve clinics have been held. Four to 6 patients referred by SJNC’s primary care team were seen in each 2-hour evening clinic. Patients were evaluated by student/resident teams, followed by discussion with an attending urologist. Approximately 40% of patients were referred for suspected genitourinary malignancy. Multiple barriers to oncologic diagnostics were identified (Table 1). Hematuria evaluations were the most difficult to coordinate due to cost and logistics of imaging and procedures. Trainees reported an increased awareness of cancer care disparities and the practical challenges of overcoming access to specialty care in a medically underserved community. CONCLUSIONS: Comprehensive cancer care is routinely fragmented or unavailable to medically underserved populations. Despite a nationally recognized cancer center in Rochester, NY, many individuals living within the urban area struggle to obtain routine cancer screening and evaluations for potentially treatable or curable cancers. We outlined a feasible model of integrating access to uro-oncologic care into a primary care system with sustainable buy-in from local partners. Future directions are to increase the frequency of clinics, access to clinical trials, and decreasing the financial burdens of care. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e683 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kit Yuen More articles by this author Alexis Steinmetz More articles by this author Mark Ninomiya More articles by this author Divya Ajay More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of splenectomy in management of splenic B-cell lymphomas

IntroductionSplenic B-cell lymphomas are rare and understudied entities. Splenectomy is frequently required for specific pathological diagnosis in patients with splenic B-cell lymphomas other than classical hairy cell leukemia (cHCL), and can be effective and durable therapy. Our study investigated the diagnostic and therapeutic role of splenectomy for non-cHCL indolent splenic B-cell lymphomas. MethodsObservational study of patients with non-cHCL splenic B-cell lymphoma undergoing splenectomy between 1 August 2011 and 1 August 2021 at the University of Rochester Medical Center. The comparison cohort was patients categorized as having non-cHCL splenic B-cell lymphoma who did not undergo splenectomy. ResultsForty-nine patients (median age 68 years) had splenectomy (SMZL n = 33, HCLv n = 9, SDRPL n = 7) with median follow up of 3.9 years post splenectomy. One patient had fatal post-operative complications. Post-operative hospitalization was ≤ 4 days for 61% and ≤ 10 days for 94% of patients. Splenectomy was initial therapy for 30 patients. Of the 19 patients who had previous medical therapy, splenectomy changed their lymphoma diagnosis in 5 (26%). Twenty-one patients without splenectomy were clinically categorized as having non-cHCL splenic B-cell lymphoma. Nine required medical treatment for progressive lymphoma and of these 3 (33%) required re-treatment for lymphoma progression compared to 16% of patients following first line splenectomy. ConclusionSplenectomy is useful for the diagnosis of non-cHCL splenic B-cell lymphomas with comparable risk/benefit profile and remission duration to medical therapy. Patients with suspected non-cHCL splenic lymphomas should be considered for referral to a high-volume center with experience in performing splenectomies for definitive diagnosis and treatment.

Abstract P1-05-35: Identification of Circulating Tumor Cells captured by the FDA Cleared Parsortix® PC1 System from the Peripheral Blood of Metastatic Breast Cancer Patients using Immunofluorescence and Cytopathological Evaluations

Abstract Background: Circulating tumor cells (CTCs) captured from the blood of cancer patients may serve as a non-invasive surrogate source of tumor material to investigate tumor characteristics in real-time. The Parsortix® PC1 System, the first FDA-cleared medical device for the capture and harvest of CTCs from peripheral blood of metastatic breast cancer (MBC) patients for use in subsequent user-validated downstream analyses, enables the epitope independent capture of CTCs with diverse phenotypes based on cell size and deformability. In this study, CTCs isolated from the blood of MBC patients by the Parsortix® PC1 System were identified using an immunofluorescence (IF) based assay for detection of epithelial CTCs followed by Wright-Giemsa staining and cytomorphological review. The aim of this study was to determine the proportion of MBC patients and self-declared female healthy volunteers (HVs) that had one or more CTCs identified in the population of cells harvested from their peripheral blood by the Parsortix® PC1 System. Methods: Peripheral blood from 75 HVs and 77 patients with MBC was prospectively collected into K2EDTA tubes at the University of Rochester Medical Center. The blood collected from each subject (8.6±1.2mL) was processed on a Parsortix® PC1 System within 8 hours of collection. The cells harvested by the system were cytospun onto a charged slide and IF stained using an optimised antibody panel. The IF panel consisted of a nuclear dye (DAPI), positive selection markers targeting epithelial CTCs (Cytokeratins (CK) and EpCAM), and negative selection markers targeting white blood cells, such as lymphocytes, macrophages, granulocytes, monocytes, fibroblasts, and cells of megakaryoblastic potential. The stained slides were imaged using fluorescence microscopy and CTCs were defined as nucleated cells (DAPI+) that were positive for CK and/or EpCAM and negative for the blood lineage markers. The IF slides were subsequently stained with Wright-Giemsa and analysed by a qualified pathologist using light microscopy. Morphological features of malignant cells were used to define and identify CTCs. All laboratory testing and analysis was performed by operators blinded to the clinical status of each subject. Results: On the evaluable IF-stained slides, cells classified as CTCs based on their IF staining pattern were identified in 45.3% (34/75) of the MBC patients (range = 0 – 125 CTCs, mean = 7) and in 5.6% (4/71) of the HVs (range = 0 – 8 CTCs, mean = 0). No EpCAM+, CK- CTCs were identified in either MBC patients or HVs. In the 34 MBC patients with one or more CTCs observed, 70.6% had only CK+, EpCAM- cells, while the remaining 29.4% had at least one CK+, EpCAM+ cell. In the HVs, one out of the four CTC-positive donors had only CK+, EpCAM+ cells while the other three had only CK+, EPCAM- cells. On the evaluable Wright-Giemsa stained slides, cells classified as CTCs by the pathologist were identified in 57.1% (40/70) of the MBC patients (range = 0 – 41 CTCs, mean = 4) and in 4.4% (3/68) of the HVs (range = 0 – 14, mean = 0). Conclusions: This study demonstrated the ability of ANGLE’s Parsortix® PC1 System to capture and harvest CTCs from a significantly larger proportion of MBC patients compared to HV subjects. The presence of epithelial cells in subjects without diagnosed disease has been previously described in the literature, with their significance being unclear. This study also demonstrated that the cells harvested by the Parsortix® PC1 System can be successfully evaluated using both IF staining and Wright-Giemsa cytomorphological assessment for the identification of CTCs. Interestingly, a high proportion of the identified CTCs did not express EpCAM, further highlighting the limitations of using EpCAM-based approaches to capture CTCs. Citation Format: Mariacristina Ciccioli, Richard Moore, Kyu Kwang Kim, Negar Khazan, Michael C. Miller, Anne-Sophie Pailhes-Jimenez. Identification of Circulating Tumor Cells captured by the FDA Cleared Parsortix® PC1 System from the Peripheral Blood of Metastatic Breast Cancer Patients using Immunofluorescence and Cytopathological Evaluations [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-35.

The Ethics of Implementing Emergency Resource Allocation Protocols.

AbstractWe explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.