Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Sacroiliac Dysfunction In A Middle-Aged Female Runner: A Case Study, Blair Bradshaw

Clinical Practice in Athletic Training

Introduction: Research has indicated an increased prevalence of low back pain (LBP) due to SIJ dysfunction, with some reports suggesting it is the main source of pain in 15- 30% of cases. Women are more prone to incidence of SIJ pain due to a wider, more uneven, less curved, and posteriorly rotated sacrum. Additionally, women have increased mobility at the SIJ which increases stress and shear loading. Repetitive loading such as running can further contribute to SIJ dysfunction. Research suggests that female runners with SIJ pain had common biomechanical patterns putting them at more risk for injury including decreased knee …

Breaking Barriers: Disparities Among Minority Collegiate Athletes In Concussion Reporting, Josette Villanueva, Melissa Long

Clinical Practice in Athletic Training

Introduction: Concussions are a serious concern in sports medicine because of their potential long-term effects on cognitive and neurological health. However, many athletes, especially those from minority groups, hesitate to report symptoms due to fears of being sidelined, pressure to keep playing, and challenges like limited access to education, language barriers, and distrust in healthcare systems. The objective of this study was to investigate the barriers to concussion reporting among Division I collegiate athletes, with a particular focus on demographic differences, particularly racial and ethnic disparities. The goal was to identify key factors that hinder self-reporting and to propose strategies …

Hyoid Bone Fracture In A Division 1 Football Player: A Conservative Management Case Study, Kynnedy Louis, Andrew Crane, Mark Knoblauch, Layci Harrison

Clinical Practice in Athletic Training

Introduction: The hyoid bone plays an important role in speaking, swallowing, and supporting the tongue. Hyoid bone fractures account for 0.002% of all fractures and are typically seen in cases dealing with strangulations or a blunt force trauma such as occurs from vehicle accidents or martial arts injuries. Signs and symptoms of hyoid fractures can include dyspnea, pharyngeal tear, or subcutaneous emphysema, and if not recognized early can significantly damage the airway. Patient Information: A 23-year-old male collegiate football player sustained blunt trauma to the anterior part of his neck due to a tackle forcing the helmet chin strap against …

Ulnar Collateral Ligament Reconstruction Compared To Common Flexor Tendon Repair With Ulnar Collateral Ligament Reconstruction: A Case Series, Amanda Dubois, Melissa Long

Clinical Practice in Athletic Training

Introduction: The ulnar collateral ligament (UCL) is found in the medial aspect of the elbow joint capsule and is commonly injured in baseball pitchers. The common flexor tendon (CFT) is also found in the medial elbow and is less commonly injured. Both structures are key in overhead throwing, repaired via surgery, and injured due to valgus stress placed on the elbow. There is research on UCL injuries but very little on CFT injuries. There is not substantial research on the return to play protocol or rehabilitation process for either of these two structures after surgery. Patient Information: The patients for …

Overcoming Thoracic Outlet Syndrome In A Young Athlete: A Case Study, Cormia Lewis, Christina Fry, Mark Knoblauch, Layci Harrison

Clinical Practice in Athletic Training

Introduction: Thoracic Outlet Syndrome (TOS) is a rare and complex condition caused by the compression of neurovascular structures in the thoracic outlet. TOS is estimated to affect 3 to 80 individuals per 1,000,000 annually, with neurogenic TOS accounting for approximately 95% of cases. Athletes who perform repetitive overhead motions are at higher risk due to increased stress on the brachial plexus. Diagnosis can be challenging as symptoms such as pain, numbness, and weakness, often mimic other conditions such as nerve entrapment or tendon pathologies. Treatment for TOS typically begins with a conservative approach, including postural correction and strengthening, activity modification, …

Impressions And Gastrointestinal Tolerance Of An Electrolyte Hydration Beverage Among Individuals Participating In Collegiate Baseball, S. Andrew Cage, Alexander Jacobsen, Brandon Warner, Jessie Gibson, Derek Lege, Robert French

Clinical Practice in Athletic Training

Context: Performing physical activity in numerous environmental conditions often results in mild to moderate dehydration. Dehydration can be problematic for the physically active population, as it can lead to decreases in physical and cognitive performance. This places emphasis on making sure individuals are properly hydrated during exercise. One of the barriers to appropriate hydration behaviors that has been identified in physically active individuals is a dislike of available hydration options. This highlights the need for sports medicine professionals to provide physically active individuals with appealing hydration options. Currently there is a lack of research exploring the flavor appeal of hydration …

Athletic Trainers’ Motivations For And Satisfaction With Transition To The Physician Practice Setting, Abigail G. Overstreet, Nicolette A. Harris, Cailee E. Welch Bacon

Clinical Practice in Athletic Training

An increasing number of athletic trainers are transitioning from traditional settings, such as secondary schools, colleges, universities, and professional sports, to physician practice. Although research suggests athletic trainers may be changing settings in search of better working conditions, little is known about their motivations for and satisfaction with the setting transition. The objective of this research was to explore athletic trainers’ motivations for and satisfaction with transition to the physician practice setting. A qualitative design was used to collect and interpret data. Eleven certified athletic trainers (6 women, 5 men; age 1⁄4 38.5 6 10.0 years) who transitioned from a …

Trust, Culture, And Conversation: How Athletic Training Leaders Navigate High-Stakes Interactions, Nicole A. Wilkins, Ashley B. Thrasher, Ericka P. Zimmerman

Clinical Practice in Athletic Training

Introduction: Engaging in difficult conversations is central to leadership growth and requires sustained effort to refine and strengthen these skills. Leaders not only need to navigate the complexities of their role within an organization, but also the intersectionality of interpersonal dynamics, emotional intelligence, structural hierarchies, and the nuanced environments that influence how communication occurs. Furthermore, leaders must adapt to role expectations that shift across clinical, academic, and administrative contexts, adjusting their approach to engaging in conversations based on these complexities. As part of a larger research project examining difficult conversations, this portion of the study explored how leaders in athletic …

Integrating Wearable Technologies Into Athletic Training: Bridging Innovation And Clinical Practice, Michael Douglas

Clinical Practice in Athletic Training

Athletic training is entering a transformative period driven by the convergence of wearable technologies, artificial intelligence (AI), and advanced biomechanical modeling. Historically, wearable technology in sport was primarily used for performance tracking, including workload monitoring, heart rate assessment, and movement quantification. However, advances in sensor accuracy and data analytics have expanded the clinical relevance of wearable systems, allowing athletic trainers to monitor fatigue markers, movement asymmetry, and neuromuscular control patterns that inform injury risk and rehabilitation progression. Wearable sensor technologies provide objective data that can support clinical decision-making when integrated with traditional evaluation methods.¹Despite these advancements, wearable technologies present persistent …

Recurrent Lateral Patellar Dislocation After Mpfl Repair With Subsequent Tibial Tubercle Anteromedialization And Concomiant Mpfl Reconstruction, Jacob Hardy, Anthony Thomas Drazick, Joshua Pratt, Jeremy M. Burnham

Clinical Practice in Athletic Training

Introduction: Patellar instability is a common knee pathology, particularly among adolescents and young adults, with reported incidence rates ranging from 7 to 77 per 100,000 person-years. Following an initial patellar dislocation, recurrence rates have been reported as high as 86%, particularly in patients with underlying anatomic risk factors. Identification of the multifactorial contributors to patellar instability is critical to guide appropriate management and prevent recurrent episodes. Common pathoanatomic factors associated with recurrent instability include trochlear dysplasia, patella alta, lateralized tibial tubercle, coronal or torsional malalignment, and abnormal patellar shift. This case report describes a patient who presented with a chronic …

Improving Entry-Level Athletic Training Student Confidence In Emergency Care: A Pilot Study, Michele Pye, Cade Watts, John Hunt, Kimberly Pritchard

Clinical Practice in Athletic Training

Introduction: Immediate and emergency care is essential to athletic training education and clinical practice. Athletic training students (ATS) may have limited exposure to emergencies during their clinical experiences, which can undermine their confidence. AT educators can improve ATS confidence and clinical reasoning using a simulation-based, learner-centered SNAPPS approach. SNAPPS consists of Summarizing the history and findings, Narrowing and Analyzing the differential diagnoses, Probing peers about uncertainties or confusion, Planning management, and Selecting case-related knowledge gaps for self-directed learning. This empowers students to control the learning environment while adding realism to encounters. The purpose of this pilot study was to determine …

Performance On The Timed Single-Leg Step-Down Test Is Correlated With Hip And Knee Biomechanics As Measured By 3d Markerless Motion Capture, Ghislain Aminake, Anthony Drazick, Christ Focht, Chloe Roy, Emily Clark, Savannah Knighton, Edward Austin, Jeremy Burnham

Clinical Practice in Athletic Training

Introduction: The timed single-leg step-down (SLSD) test is widely used in clinical and sports settings to assess lower extremity function and injury risk, yet the specific biomechanical determinants of performance on this test remain poorly understood. The purpose of this study is to investigate the relationship between performance on the timed SLSD test and hip and knee biomechanics captured by a markerless 3-D motion-analysis system. Methods: Twenty (20) healthy high school athletes with no recent history of lower extremity injury completed a 60-second timed single leg step down test. The number of quality SLSD repetitions (REPS) constituted their SLSD score. …

An Ai Approach To Differentiating Lung Squamous Cell Carcinoma From Metastases Of Other Origins, Mark G Evans, Jennifer Ribeiro, Todd Maney, Anthony Helmstetter, Jennifer Johnson, Anthony Karnezis, Casey Bales, George Sledge, David Spetzler, Ari Vanderwalde, Matthew Oberley, Balazs Halmos, Hossein Borghaei, Farah Abdulla, David Bryant, Fred Hirsch, Hassan Ghani

Department of Medical Oncology Faculty Papers

IMPORTANCE: Distinguishing primary lung squamous cell carcinoma (SCC) from squamous metastases to the lung is a clinical challenge due to histopathologic similarities. Accurate diagnosis is essential to guide treatment decisions.

OBJECTIVE: To assess the utility of an artificial intelligence (AI) approach that includes evaluation of key orthogonal evidence in distinguishing primary lung SCCs from metastatic tumors of other tissue origins.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used GPSai, a tissue-of-origin AI model run automatically on each sample submitted for molecular profiling, to flag potential misdiagnoses among research-eligible cases submitted as lung SCC. Molecularly profiled cases within the Caris Life …

Editorial: Clinical Imaging, Neurophysiological, Neuropathology And Neuroethics Studies On Disorders Of Consciousness, Coma Mechanisms, And Theories Of Consciousness: A Unifying Attempt, Diego Iacono, Manuel Trachsel, Thanh Phan, Charlène Aubinet

Department of Neurology Faculty Papers

No abstract provided.

Mass Cytometry Workflow To Achieve High-Dimensional Immunophenotyping In Resource-Limited Or Decentralized Environments, Natalie Smith, Michael Cohen, Lauren Tracey, Julie Alipaz, Christina Loh, David King, Neha Pulyani, Rebecca Auzins, Elin Gray, Sandra Taylor, Rajat Rai, Steven Kao, Barbara Fazekas De St Groth, Helen Mcguire

Research outputs 2022 to 2026

Globally, regional and remote communities are burdened by both an increased prevalence and worse prognosis of many infectious and chronic diseases. However, largely owing to logistical challenges, these communities are under-represented in clinical trials and research studies. As individuals from rural communities experience unique environmental exposures and risk factors for disease, immune phenotyping data collected from metropolitan populations may not be broadly generalizable. To address this, we present a workflow that enables the inclusion of resource-limited sites in high-parameter mass cytometry studies. In this approach, whole blood (WB) or peripheral blood mononuclear cells (PBMCs) are collected, stained fresh for surface …

Automated Abdominal Aortic Calcification Scores And Atherosclerotic Cardiovascular Disease In The Uk Biobank Imaging Study, Marc Sim, James Webster, Cassandra Smith, Afsah Saleem, Syed Zulqarnain Gilani, Carlos J. Toro-Huamanchumo, David Suter, Gemma Figtree, Anne Karine Lagendijk, Emma L. Duncan, Carl Schultz, Pawel Szulc, Joseph Hung, Wai H. Lim, Parminder Raina, Nicola P. Bondonno, Richard Woodman, Jonathan M. Hodgson, Douglas P. Kiel, Richard L. Prince, William D. Leslie, John P. Kemp, Nicholas C. Harvey, John T. Schousboe, Joshua R. Lewis

Research outputs 2022 to 2026

Background: Abdominal aortic calcification (AAC) is a subclinical measure of atherosclerotic cardiovascular disease (ASCVD). AAC can be captured on lateral spine images obtained from bone density machines during routine osteoporosis screening. Identifying individuals with AAC provides a new opportunity to prevent disease progression. Objectives: The aim of the study was to externally validate a machine learning-derived AAC 24-point algorithm (ML-AAC24) with incident ASCVD. Methods: Middle-aged individuals from the UK Biobank Imaging Study with lateral spine images, obtained via dual-energy x-ray absorptiometry, were included. ML-AAC24 scores were grouped as low (<2), moderate (2 to <6), and high (≥6). Linked health records were used to identify ASCVD-associated events, including hospitalizations and death. Results: Among 53,611 participants (52% female; mean age 65 years), 78.2% had low, 16.4% had moderate, and 5.4% had high ML-AAC24. After excluding people with prevalent ASCVD or missing data, 1,163 (2.3%) of 50,923 people had an incident ASCVD event over a median follow-up of 4.1 [3.0-5.5] years. In age- and sex-adjusted analysis, compared to those with low ML-AAC24, those with moderate (HR: 1.80 [95% CI: 1.57-2.08]) and high ML-AAC24 (HR: 2.87 [95% CI: 2.39-3.44]) had a higher HR for incident ASCVD. Results remained comparable after adjustment for established ASCVD risk factors. Consistent patterns were observed when considering incident coronary artery disease, myocardial infarction, and stroke. Conclusions: Assessing ML-AAC24 on lateral spine images offers a new and promising screening method to identify people with higher risk of incident ASVD events.

Elixhauser Comorbidity Index To Predict Perioperative Bleeding And Adverse Spine Surgery Outcomes, Mitchell K. Ng, Michael A. Mont, Mosadoluwa Afolabi, Prathiksha N V, Amitha Kumar, Stephen S. Johnston

Rothman Institute Papers

Introduction: As spine surgery volume continues to grow, ensuring patient safety and minimizing complications are increasingly critical. Disruptive bleeding—defined as hemorrhagic events requiring clinical intervention—is a significant perioperative challenge. This study aimed to: (1) quantify disruptive bleeding incidence; (2) evaluate associations between patient demographics, Elixhauser Comorbidity Index (ECI), and bleeding risk; and (3) assess the impact of disruptive bleeding on mortality, ventilator use, length of inpatient stay, 90-day readmissions, and inpatient costs. Methods: A nationwide healthcare database was used to identify patients who underwent spine surgery in 2019. Patients were subdivided by the Elixhauser Comorbidity Index (ECI) from 0 to …

Attentional Blindness Of The Clinical Gaze, Lily Anderson-Chavarria

Clinical Research in Practice: The Journal of Team Hippocrates

This article presents the case of Mr. C, a patient who received over 65 imaging tests without any pathology ever being found. The case is well-explained by a social science concept known as the clinical gaze, a socio-cognitive process of assigning pathological explanations to diseased bodies. This article provides some historical context for the concept and applies it to the case of Mr. C. When viewed through a social science lens, the excess imaging underwent by Mr. C transforms from something seemingly irrational to an almost inevitable outcome of the modern medical diagnostic process.

Musculoskeletal Infection Reporting And Data System (Mski-Rads): Reviewed And Explained, Angela He, Flavio Duarte Silva, Mina Guirguis, Erin F. Alaia, William B Morrison, Avneesh Chhabra

Department of Radiology Faculty Papers

A standardized guideline and scoring system are recommended for the imaging evaluation of musculoskeletal infections on MR imaging. The Musculoskeletal Infection Reporting and Data System (MSKI-RADS) is a recently developed and validated classification system using MR imaging that can be used to classify the severity and extent of musculoskeletal infections, improve radiology-pathology concordance, and outline the corresponding management recommendations. This review article explains MSKI-RADS and discusses the different elements of this system in detail with a review of pertinent literature so that the readers can apply it in their practices. The work outlines the technical considerations for optimal MR imaging …

Green Vessel Signal On Multicolor Imaging As An Early Sign Of Ischemic Vasculitis In Irvan Syndrome: A Case Report, Daniel M. Markowitz, Jirat Nimworaphan, Carl Regillo, James P. Dunn, Robert C. Sergott

Wills Eye Hospital Papers

PURPOSE: Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is typically diagnosed after characteristic intravenous fluorescein angiography (IVFA) findings develop. This case demonstrates that identifying a green intravascular and perivascular signal on multicolor fundus imaging may be a potential noninvasive imaging sign for ischemic retinal vasculitis in IRVAN.

OBSERVATIONS: A 55-year-old female presented with bilateral optic disc edema and subtle peripapillary retinal vascular changes. Multicolor imaging showed a distinct green intravascular and perivascular signal before undergoing IVFA evaluation. Subsequent IVFA ultimately showed peripheral capillary nonperfusion, microaneurysms, and leakage consistent with IRVAN.

CONCLUSIONS AND IMPORTANCE: This case demonstrates the potential utility …

Etiologies, Management, And Outcomes Of Pediatric Stroke In A Tertiary Care Center, Supinya Naruphanthawart, Tanitnun Paprad, Tanai Trongmonthum, Tunchanok Paprad, Krisanachai Chomtho

Chulalongkorn Medical Journal

Background

Recent developments in neuroimaging and treatments, such as thrombolysis and endovascular thrombectomy, have improved across pediatric stroke diagnosis and management. However, no contemporary data exist on stroke characteristics related to clinical outcomes among Thai children.

Objectives

To study clinical characteristics, investigations, and treatments associated with outcomes in Thai pediatric stroke patients.

Methods

Methods: We enrolled children aged 28 days to 18 years with "cerebrovascular disease" recorded as ICD 10 and inpatient records from January 2011 to September 2022. Outcomes included disability at discharge (mRS grade 4-5), in-hospital mortality, and two-year recurrent stroke rate.

Results

Of 206 patients, 53.4% had …

Diagnostic Accuracy Of Cerebral Amyloid Angiopathy Criteria In The First Pathologically Confirmed Thai Cohort: A Pilot Study, Thanapoom Taweephol, Thachamai Smitasiri, Thanakit Pongpitakmetha, Sekh Thanprasertsuk, Anand Viswanathan

Chulalongkorn Medical Journal

Background: The gold standard for diagnosing cerebral amyloid angiopathy (CAA), full brain post-mortem examination, is rarely performed. Current diagnostic criteria, primarily based on clinico-radiological features, were developed from Western populations and may have limited applicability to Asian populations.

Objective: We aimed to evaluate the accuracy of current diagnostic criteria and examine the clinico-radiological characteristics of Thai CAA patients.

Methods: Brain histopathological specimens from patients with clinical symptoms of CAA who underwent neurosurgical procedures, including intracerebral hemorrhage (ICH) evacuation, between 2011 and 2021 at King Chulalongkorn Memorial Hospital, Thailand, were reviewed. Patient characteristics and clinical events for each individual were retrospectively …

How Does Pattern Of Bone Healing Affect The Strain Of Plate Implant Via Frequency Detection? A Biomechanical Cadaveric Study, Chavarin Amarase, Chanyaphan Virulsri, Pairat Tangpornprasert, Pisitpong Chancharoen, Saran Tantavisut

Chulalongkorn Medical Journal

Background: Detecting bone union is a crucial process in treating bone fractures to prevent complications, including implant failure and bone nonunion. Nowadays, there are many methods and new innovative devices for detecting bone union through strain measurements, such as strain gauges, fluid level displacement, contrast media, and frequency changes. There is also a trend toward increasing these methods in the future. However, the patterns of bone healing studied with these methods still do not provide a standard for determining the true bone healing process. The aim of this study is to identify the most appropriate bone healing pattern for …

Pediatric Pqct-Derived Tibial Bone Mineral Density Estimates: A Systematic Review And Meta-Regression, Anna Maria Markarian, Dennis R. Taaffe, Daniel A. Galvão, Jodie Cochrane Wilkie, Carolyn J. Peddle-Mcintyre, Mark Markarian, Daniel J. Schiferl, Robert U. Newton

Research outputs 2022 to 2026

Background: Assessing bone mineral density (BMD) in children and adolescents is essential for detecting skeletal deficits and fracture risk. Peripheral quantitative computed tomography (pQCT) has gained increasing attention as a valuable imaging tool due to its ability to assess bone quality. Unlike dual-energy x-ray absorptiometry, pQCT provides volumetric BMD measurements and distinguishes between cortical and trabecular compartments. Despite these advantages, its clinical adoption remains limited due to the lack of reference data and standardized protocols. Methods: A systematic search was conducted in CINAHL, Embase, PubMed, SPORTDiscus, and Web of Science from inception to November 2024. Studies reporting pQCT-derived tibial BMD …

Factors Associated With Upstaging In Patients With Resectable Non-Small Cell Lung Cancer: A Modern Institutional Sample, Sneha Alaparthi, Hamza Rshaidat, Luke Meredith, Scott H. Koeneman, Christina Grindley, Jacob Heilizer, Purab Kothari, Prarthna Chandar, Tyler Grenda, Nathaniel R. Evans Iii, Olugbenga T. Okusanya

Department of Surgery Faculty Papers

BACKGROUND: There is significant value in predicting and better assessing patients who are at risk of post-surgery upstaging in lung cancer. The objective of this study is to review patients who were upstaged following resection and evaluate their clinical and demographic data to elucidate which factors portend an increased risk of pathologic upstaging at our institution (the Thomas Jefferson University Hospital).

METHODS: A retrospective review of institutional data was performed between 2011 and 2023. Patients with stage I-II non-small cell lung cancer (NSCLC) were included. Patients were excluded if they received neoadjuvant systemic therapy, including chemotherapy and/or immunotherapy, and were …

Spatially Distinct Cellular And Molecular Landscapes Define Prognosis In Triple-Negative Breast Cancer, Kavitha Mukund, Darya Veraksa, David Frankhouser, Lixin Yang, Jerneja Tomsic, Raju Pillai, Srijan Atti, Zahra Mesrizadeh, Daniel Schmolze, Jovanny Zabaleta, Xiao-Cheng Wu, Mary-Anne Leblanc, Lucio Miele, Augusto Ochoa, Victoria Seewaldt, Shankar Subramaniam

School of Medicine Faculty Publications

Triple-negative breast cancer (TNBC) is a prevalent breast cancer subtype with the lowest 5-year survival. Several factors influence outcomes, but their inherent molecular and cellular heterogeneity are increasingly acknowledged as crucial determinants. Here, we report on the spatio-molecular heterogeneity underlying TNBC tumors in a retrospective, treatment-naive cohort with differential prognoses (17 good prognoses [GPx] >15-year survival and 15 poor prognoses [PPx] < 3-year survival]) profiled using GeoMx Digital Spatial Profiler. Analyses reveal that epithelial and microenvironment (TME) states are transcriptionally distinct between groups. Invasive GPx epithelia show an increase in immune transcripts, with a more immune-rich TME (via IF). PPx epithelia, in contrast, are more metabolically and translationally active, with a mesenchymal/fibrotic TME. Pre-cancerous epithelia in PPx exhibit a presence of aggressiveness, marked by increased EMT signaling and complement activity. We identify distinct epithelial gene signatures for PPx and GPx that can accurately classify diagnostic samples and likely inform therapy.

Intralabyrinthine Mri Flair As A Predictive Marker For Hearing Loss In Vestibular Schwannomas In Neurofibromatosis Type 2, Robert L. Walker, Maxwell T. Laws, H. Jeffrey Kim, Christopher Zalewski, Ashok Asthagiri, Sruthi Ranganathan, Christina Hayes, John D. Heiss, John A. Butman, Prashant Chittiboina

Department of Radiation Oncology Faculty Papers

BACKGROUND AND OBJECTIVES: The onset of hearing loss due to vestibular schwannomas (VS) is inevitable but does not correlate with the size of the tumor. In patients with Neurofibromatosis Type 2 (NF2) and VS, we previously found an association between pre-contrast fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR MRI) signal in the labyrinth and hearing loss. Here, we asked whether FLAIR hyper-intensity could serve as a predictive biomarker for hearing loss in NF2 patients with VS.

METHODS: A prospective longitudinal study (NCT00598351) of NF2 enrolled 168 subjects between 2008 and 2013. This study included 34 patients with small VS (total …

Accuracy Of Frozen Section For Hpv-Associated Squamous Cell Carcinoma Of Unknown Primary, Sindhura Sridhar, Annie Moroco, Shravan Gowrishankar, Mitra Mehrad, Kim Ely, James Lewis, Madalina Tuluc, Stacey Gargano, Melanie Hicks, Kyle Mannion, Arielle Thal, Adam Luginbuhl, Joseph Curry, David Cognetti, Michael Topf

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

INTRODUCTION: Current guidelines for the management of metastatic squamous cell carcinoma of unknown primary (SCCUP) recommend submission of suspicious primary sites for frozen section analysis (FSA). This study aims to investigate the diagnostic accuracy of FSA for identification of HPV-associated SCCUP.

METHODS: A retrospective cohort study of patients with biopsy-proven p16-positive SCCUP who underwent diagnostic operation at two tertiary care institutions was performed. Sensitivity, specificity, PPV, and NPV of diagnostic FSA were assessed.

RESULTS: 77 patients were included in analysis. 66 patients underwent definitive TORS (diagnostic TORS operation with subsequent neck dissection after identification of the occult primary tumor), 7 …

Development Of The Self-Administered Health Complexity Screening Instrument, Sheila Specker, Rachel Andrew, Emily Drexler, Emily Koithan, Steven Thurber, Steven Frankel

School of Medicine Faculty Publications

PURPOSE: The purpose of the study was to develop a self-administered screening tool to assist case managers, primary care physicians, and other clinicians in quickly and accurately identifying patients with complex health needs who require a definitive and detailed case management evaluation. In addition to medical and psychiatric items, this tool incorporates multiple social determinants of health (SDOH), known to add to clinical complexity. PRIMARY PRACTICE SETTING: This instrument is most appropriate for identifying patients with high complexity in the primary care sector. Due to the abundance of such patients with high biopsychosocial complexity and costs of treating these patients, …

686. Antibiotic Prescribing For Urinary Tract Infections In Outpatient Settings: A Multicenter Assessment Based On The Five Ds Of Stewardship, Amy Y. Kang, Oliver Tan, Sunwoo Oh, Nikki Derleth, Megan Shieh, Helen Vu, Inna Tagarino, Audrey Harrington, Deborah Kupferwasser, Loren G. Miller

Pharmacy Faculty Articles and Research

Background   Urinary tract infections (UTIs) are a leading cause of outpatient antibiotic use. Prior studies have documented inappropriate prescribing during outpatient UTI visits, but few have assessed intervention opportunities using a structured stewardship framework. We evaluated UTI prescribing practices in a healthcare system using the Five Ds framework: Diagnosis, Drug, Dose, Duration, and De-escalation.   Methods

We conducted a retrospective study across 4 medical centers and > 20 outpatient clinics within the Los Angeles County Department of Health Services, the second largest U.S. safety net healthcare system. To ensure adequate representation across sites while maintaining feasibility for manual chart review, we reviewed …