Medical Specialties Commons^™

Harmonizing Clinical, Research, And Teaching Aims: Team Care For Patients With Complex Needs, Alicia Williams, Millie Wykoff, Ryan Tewell, Jodi Polaha, Jim Holt

ETSU Faculty Works

At the conclusion of this session, the participants will be able to:
1. Describe a team-based approach to addressing complex patients’ needs.
2. Develop engaged and experiential methods for teaching interprofessional learners about team-care for complex patients.
3. Demonstrate familiarity with an evaluation strategy and preliminary outcomes data for a team approach for complex patients.

Heat Shock Factor 1-Mediated Transcription Activation Of Omi/Htra2 Induces Myocardial Mitochondrial Apoptosis In The Aging Heart., Dan Liu, Linguo Wu, Ye Wu, Xin Wei, Wen Wang, Suli Zhang, Ming Yi, Jing Li, Huirong Liu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

BACKGROUND: Increased cardiac apoptosis is a hallmark of the elderly, which in turn increases the risk for developing cardiac disease. The overexpression of Omi/HtrA2 mRNA and protein contributes to apoptosis in the aged heart. Heat shock factor 1 (HSF1) is a transcription factor that binds to the promoter of Omi/HtrA2 in the aging myocardium. However, whether HSF1 participates in cardiomyocyte apoptosis via transcriptional regulation of Omi/HtrA2 remains unclear. The present study was designed to investigate whether HSF1 plays a role in Omi/HtrA2 transcriptional regulation and myocardial apoptosis.

METHODS AND RESULTS: Assessment of the hearts of mice of different ages was …

Post-Overdose Interventions Triggered By Calling 911: Centering The Perspectives Of People Who Use Drugs (Pwuds), Karla D. Wagner, Robert W. Harding, Richard Kelley, Brian Labus, Silvia R. Verdugo, Elizabeth Copulsky, Jeanette M. Bowles, Maria Luisa Mittal, Peter J. Davidson

Environmental & Global Health Faculty Research

Background Opioid overdose deaths have increased exponentially in the United States. Bystander response to opioid overdose ideally involves administering naloxone, providing rescue breathing, and calling 911 to summon emergency medical assistance. Recently in the US, public health and public safety agencies have begun seeking to use 911 calls as a method to identify and deliver post-overdose interventions to opioid overdose patients. Little is known about the opinions of PWUDs about the barriers, benefits, or potential harms of post-overdose interventions linked to the 911 system. We sought to understand the perspectives of PWUDs about a method for using 911 data to …

Sclerosing Peritonitis Presenting As Complete Mechanical Bowel Obstruction: A Case Report, Sabah Saqib, K. M. Inam Pal

Section of General Surgery

Introduction: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction.
Case Presentation: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis …

Using Education To Increase Compliance With Heart Failure Medications, Kara Stout Do, Isaac Navarro Dmd

Internal Medicine

• Approximately 5.7 million adults in the United States have heart failure.
• 25% of individuals die within one year of diagnosis and more than 80% die within 8 years.
• Full adherence to medications may be as low as 30% in heart failure patients.
• Non-compliant patients are two times more likely to be readmitted to the hospital and have a three times higher mortality rate.

Comparison Of Long-Term Oral Anticoagulation Therapies Including Newly Approved Reversal Agent For Dabigatran, Mackenzie Devine, Natalie Lennartz, Michaela Wolford, Rebecca Worden, Joelle Farano, Erin Petersen

Pharmacy and Wellness Review

Anticoagulants are a well-known class of agents essential for the prevention of blood clots, which may further develop into deep vein thrombosis, pulmonary embolism or stroke. Individuals at a high risk of clotting, such as those with atrial fibrillation, multiple risk factors or recent hip/knee surgery, are in need of long-term anticoagulation therapy. The purpose of this review is to highlight the pros and cons for each available anticoagulant as well as discuss pivotal clinical trials that evaluated the safety and efficacy of these agents. Warfarin, the oldest anticoagulant, requires the patient to attend frequent appointments with a health care …

Use Of Botulinum Toxin In Central Nervous System Disorders, Julie Puvogel, Paige Torbet, Jourdan Ujlaki, Rebecca Worden, Lindsey Peters

Pharmacy and Wellness Review

Botulinum toxin is a neurotoxin that is produced by Clostridium botulinum. At one time, this toxin was only seen as a lethal substance, but now scientists have found many medical uses for it. There are eight distinctive toxins (A-H), but only A and B currently have clinical uses. Botulinum toxin A has three different versions that are U.S. Food and Drug Administration (FDA) approved: onabotulinumtoxinA (Botox®), abobotulinumtoxinA (Dysport®), incobotulinumtoxinA (Xeomin®). Botulinum toxin B is also FDA approved as rimabotulinumtoxinB (Myobloc®). The toxins work by inducing reversible, local, dose-dependent chemodenervation by inhibiting acetylcholine release from presynaptic terminals. These drugs are approved …

Hormonal Therapy And Preventive Care Of Transgender Patients, Angela Chu, Jana Randolph, Austin Hopkins, Victoria Cho, Sophocles Chrissobolis

Pharmacy and Wellness Review

Transgenderism occurs when an individual's gender identity conflicts with the individual's biological sex. A variety of methods may be used in order to reconcile this disparity in transgender individuals including psychological counseling, cross-sex hormone therapy and sex reassignment surgery. The most important role for pharmacists in the treatment of transgender patients is in dispensing hormonal medications for cross-sex treatment. Hormone therapy may be used to suppress characteristics of the patient's biological sex as well as to induce development of characteristics that correlate with the patient's gender identity. In male-to-female (MtF) transgender patients, the most commonly used medications include agents which …

Pharmacologic And Nonpharmacologic Approaches To Palliative Care In Oncology, Daniel Powell, Sunitha Johns, Samia Alam, Isabel E. Cwikla, Brendan Rasor, David W. Koh

Pharmacy and Wellness Review

In recent decades, few fields have changed as drastically as oncology. A wide variety of approaches must be taken in order to best care for cancer patients. With the globalization of health care and modern society, nontraditional management of cancer symptoms is once again increasing in popularity. The National Comprehensive Cancer Network (NCCN) has also recently updated their palliative care guidelines. These guidelines provide a detailed approach for the care of a wide range of cancer patients but largely focus on traditional pharmacotherapy. An increasing number of studies are being conducted on nonpharmacologic approaches to care for patients with cancer. …

Antibiotic Stewardship And Overcoming Antibiotic Resistance In Upper Respiratory Tract Infections, Katherine Elsass, Austin Hilverding, Steve Blake, Brendan Rasor, Steven N. Leonard

Pharmacy and Wellness Review

Antibiotic resistance has rapidly become one of the most significant challenges facing modern health care. Despite widespread public education efforts by the national government and health organizations worldwide, there remains a significant lack of public understanding of antibiotic resistance, how to prevent it and the implications if the science and health care communities fail to find a solution. The Centers for Disease Control and Prevention (CDC) and the American College of Physicians (ACP) recently published updated guidelines for appropriate antibiotic use in upper respiratory tract infections. These guidelines include several key recommendations for acute bronchitis, pharyngitis and acute rhinosinusitis (including …

Legionnaires' Disease, A Rising Occurrence In The United States, Jennifer Harklerode, Olivia Henton, Myranda Smith, Rebecca Worden, Andrew Roecker

Pharmacy and Wellness Review

Legionella pneumophila, a microscopic bacterium usually responsible for a number of illnesses and fatalities, can eliminate a local population, a region or even a nation. In 1976, L. pneumophila was first discovered due to a number of cases presenting with pneumonia-like symptoms. These cases occurred in an isolated population attending an American Legion convention in Philadelphia, Pennsylvania, therefore lending to the name Legionella. Usually found in aquatic environments such as lakes, streams, cooling towers, air conditioning systems and hot tubs, its ability to thrive in artificial and natural environments makes it an ideal bacterium. L. pneumophila can be transmitted via …

Evaluating The Role Of Fecal Microbiota Transplant In The Treatment Of Clostridium Difficile Infection, Anh Dao Le, Olivia Henton, Shane Bogusz, Brian Heilbronner, Jessica Hinson

Pharmacy and Wellness Review

Fecal microbiota transplant (FMT) therapy is an increasingly prevalent treatment option for Clostridium difficile infection (CDI). Clostridium difficile infection is an aggressive and potentially fatal disease state, and antibiotic therapy often fails to resolve the disease state effectively. Clostridium difficile infection occurs most commonly subsequent to the use of antimicrobial agents that disrupt the natural bacterial flora of the gastrointestinal (GI) tract. Since disease state pathophysiology operates in this way, researchers have experimented with ways to restore GI flora to a natural state in which nonpathogenic bacteria can proliferate. Probiotic agents do not impose an acute enough response to recreate …

Prevention And Treatment Of Glucocorticoid-Induced Osteoporosis, Mackenzie Devine, Anh Dao Le, Julie Puvogel, Victoria Cho, Michelle Musser

Pharmacy and Wellness Review

Osteoporosis is a disease state resulting in decreased bone mineral density (BMD) and increased risk of fracture, specifically of the vertebrae, spine and hip. Risk factors and high risk populations for developing osteoporosis include low BMD, long-term glucocorticoid therapy, genetics, diet, postmenopausal women and patients with inflammatory or chronic disease states. A variety of signaling pathways involving hormones, cytokines and other signaling molecules are involved in bone formation and are affected by long-term glucocorticoid therapy, leading to the development of glucocorticoid-induced osteoporosis (GIO).

There are a variety of drugs that work efficaciously to prevent and treat GIO. Alendronate is a …

Treatment Of Basal Cell Carcinoma With Vismodegib, Sunitha Johns, Katlyn Brown, Emily Loudermilk, Crystal Zheng, Anh Dao Le, Sophocles Chrissobolis

Pharmacy and Wellness Review

The most prevalent nonmelanoma skin cancers are basal cell carcinoma (BCC) and locally advanced basal cell carcinoma (aBCC). Current, effective first-line treatments for BCC aim to remove and destroy cancerous skin cells through excision surgery, Mohs surgery, radiation therapy and cryotherapy, while treatment of aBCC remains limited. An emerging treatment option for aBCC that promotes tumor size reduction is vismodegib, a pharmaceutical product approved in 2012 by the U.S. Food and Drug Administration (FDA). Vismodegib was approved for the treatment of aBCC, metastasized HCC (mBCC) or recurrent BCC after surgery as well as for use in adults who are not …

Improving Healthcare Costs And Patient Outcomes Across Healthcare Professions, Hannah Lamb, Jourdan Ujlaki, Paige Torbet, Isabel Cwikla, Rebecca Worden, Michael Rush

Pharmacy and Wellness Review

Healthcare professionals must be aware of the importance of preventive medicine and the responsibility they have in contributing to it. There are three levels of preventive medicine that a healthcare professional can provide based on the patient population that is receiving care and the goals of the particular service. Preventive medicine has the ability to improve both overall healthcare costs and have a positive impact on a patient's quality of life. All healthcare professionals have the potential to fulfill a role in each level of preventive medicine, and should understand the role of each member of the healthcare team, to …

Triple Therapy Or Triple Threat: An Analysis Of Triple Antiplatelet Therapy Compared To Dual Antiplatelet Therapy, Isabel E. Cwikla, Kara C. Horvath, Elaina Gollmar, Austin Hilverding, Erin Petersen

Pharmacy and Wellness Review

Triple antiplatelet therapy (TAPT, or triple therapy), is an oral medication regimen designed to reduce the risk of major cardiovascular events. It consists of aspirin, clopidogrel or an alternative, and an oral anticoagulant (OAC). It differs from dual antiplatelet therapy (DAPT) due to inclusion of an OAC. Multiple clinical studies have indicated that triple therapy is more effective at clot prevention, when compared to aspirin monotherapy and DAPT, but is associated with a higher risk of major bleeding. Pharmacists have a key role in determining candidates for DAPT and TAPT regimens. Other opportunities for pharmacists include patient monitoring, counseling and …

Programmed Death Pathway Inhibition: Emerging Therapeutic Options For Treatment Of Advanced Or Refractory Cancers, Katherine Elsass, Morgan Homan, Jana Randolph, Brendan Rasor, David Kinder

Pharmacy and Wellness Review

The programmed death-1 (PD-1) pathway has a significant role in the promotion of immune tolerance. The PD-1 receptor ligands are normally expressed on various inactive immune cells. When cancer cells express these ligands, they are able to interact with active T and B lymphocytes to induce this tolerance. Nivolumab and pembrolizumab are two recently approved agents that act to disrupt this binding and facilitate an immune response against cancer cells. Numerous trials, including KEYNOTE-002 and CheckMate 063, have demonstrated the superior safety and efficacy of these drugs in patients with advanced or refractory cancers. Initially approved for the treatment of …

Zika Virus Induced Neurological Disorders And Impacts On Public Health, Alexandra Herman, Martha Zimmerman, Olivia Vanscoy, Olivia Henton, Lindsey Peters

Pharmacy and Wellness Review

Zika virus is a public health emergency of international concern. Zika virus (ZIKV) is a mosquito-borne pathogen that is carried by the Aedes genus. Zika is spread through direct bite and nonvector transmission. Most individuals infected with Zika will be asymptomatic, but some may present nonspecific viral symptoms. A rising number of neurological disorders in newborns whose mothers were infected with ZIKV during pregnancy have been reported due to recent outbreaks. Neurological disorders affect both the central and peripheral nervous systems and can result from bacterial, viral, fungal or parasitic infections of the nervous system or from the immune response …

Pcsk9 Inhibitors: A Novel Class Of Pharmacotherapy For Hypercholesterolemia, Angela Chu, Austin Hilverding, Elizabeth Kramer, Brendan Rasor, Boyd Rorabaugh

Pharmacy and Wellness Review

The recent U.S. Food and Drug Administration (FDA) approval of two new drugs, alirocumab (Praluent®) and evolocumab (Repatha®) is a breakthrough in the treatment of familial hypercholesterolemia. These drugs are a part of a new class called the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that act by increasing the number of low density lipoprotein receptors (LDL-R) recycled to hepatocyte membranes. The increased density of LDL-R facilitates greater clearance of low density lipoproteins from the blood. Numerous clinical trials have demonstrated the efficacy of these agents, particularly for patients in whom standard cholesterol-lowering therapy is insufficient. However, data on long-term …

Zika Virus: Infectious Process And Public Health Response, Morgan Homan, Julia Dickman, Jenna Deininger, Austin Hopkins, Olivia Henton, Steven N. Leonard

Pharmacy and Wellness Review

The Zika virus has become a growing concern as a global pandemic. Since being identified in Uganda in 1947, the virus has spread around the world, recently emerging in South America with a great impact on Brazil. As of 2016, Zika has made its appearance in the United States and is now actively being transmitted in Florida. The virus is a mosquito-vectored flavivirus primarily transmitted by the Aedes mosquito which infects a human through biting. Transmission through sexual intercourse is also possible as well as transmission from a pregnant woman to her fetus. This latter form of transmission presents the …

Belsomra®: A Novel Dual Orexin Receptor Antagonist For The Treatment Of Insomnia, Shane Bogusz, Steven Blake, Michaela Wolford, Victoria Cho, Manoranjan D'Souza

Pharmacy and Wellness Review

Insomnia is a disease state characterized by a persistent difficulty in falling asleep, and results in enormous health-related and economic costs to both the individual and society. Several medications are currently available for the treatment of insomnia; however, these medications are associated with several limitations including anterograde amnesia, dependence, withdrawal symptoms upon stopping the medication and rebound insomnia. The U.S. Food and Drug Administration recently approved suvorexant (Belsomra®) as a treatment for insomnia. Suvorexant is a first-in-class dual orexin receptor antagonist for the treatment of insomnia. This review will first describe the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) …

Faculty Perceptions Of Readiness To Implement Interprofessional Education In Athletic Training, Meredith M. Parry, Jennifer Jordan Utley, Sue Shapiro, Stefanie Podlog

Athletic Training Collection

PURPOSE As the athletic training profession advances, master’s degree accreditation standards aim to position athletic trainers as key players on interprofessional healthcare teams. Interprofessional education standards were recently introduced to academic leaders as key elements in the professional healthcare education of athletic trainers.

While the current standards reflect essential skills for entry-level clinicians, faculty instructing these elements may require additional development.

METHODS The objective of this study was to explore athletic training educators’ perceptions of interprofessional education and to examine perceived barriers related to the implementation of IPE in athletic training curricula. An electronic survey was administered to a stratified, …

Enhancing Timeliness Of Drug Overdose Mortality Surveillance: A Machine Learning Approach, Patrick J. Ward, Peter J. Rock, Svetla Slavova, April M. Young, Terry L. Bunn, Ramakanth Kavuluru

Kentucky Injury Prevention and Research Center Faculty Publications

BACKGROUND: Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance.

METHODS: Using 2017–2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created …

Prevalence Of And Factors Associated With Female Sexual Dysfunction Among Women Using Hormonal And Non-Hormonal Contraception At The Aga Khan University Hospital Nairobi, Momin Butt, Valentino Lema, Abraham Mukaindo, Gulnaz Mohamoud, Jacob Shabani

Family Medicine, East Africa

Background: Female sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido.

Aim: To determine the prevalence of and the factors affecting FSD among women using contraception in our setting.

Setting: The study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites.

Methods: A cross-sectional study was …

Heterogeneity And Plasticity Of Human Breast Cancer Cells In Response To Molecularly-Targeted Drugs, Emira Bousoik, Ramina Nabiee, Farideh Amirrad, Ashley Nichols, Rebecca Witt, Parvin Mahdipoor, Hamidreza Montazeri Aliabadi

Pharmacy Faculty Articles and Research

Non-responsive subpopulation of tumor cells, and acquired resistance in initially responsive cells are major challenges for cancer therapy with molecularly-targeted drugs. While point mutations are considered the major contributing factor to acquired resistance, in this study we explored the role of heterogeneity and plasticity of selected human breast cancer cell lines (MDA-MB-231, MDA-MB-468, and AU565) in their initial and adjusted response, respectively, to ruxolitinib, everolimus, and erlotinib. After determination of lethal concentration for 50% cell death (LC50), cells were exposed to selected drugs using three different approaches: single exposure to 4 × LC50 and collection of surviving cells, multiple exposures …

Development Of A Non-Invasive Device For Swallow Screening In Patients At Risk Of Oropharyngeal Dysphagia: Results From A Prospective Exploratory Study, Catriona M. Steele, Rajat Mukherjee, Juha M. Kortelainen, Harri Pölönen, Michael Jedwab, Susan L. Brady, Kayla Brinkman Theimer, Susan Langmore, Luis F. Riquelme, Nancy B. Swigert, Philip M. Bath, Larry B. Goldstein, Richard L. Hughes, Dana Leifer, Kennedy R. Lees, Atte Meretoja, Natalia Muehlemann

Neurology Faculty Publications

Oropharyngeal dysphagia is prevalent in several at-risk populations, including post-stroke patients, patients in intensive care and the elderly. Dysphagia contributes to longer hospital stays and poor outcomes, including pneumonia. Early identification of dysphagia is recommended as part of the evaluation of at-risk patients, but available bedside screening tools perform inconsistently. In this study, we developed algorithms to detect swallowing impairment using a novel accelerometer-based dysphagia detection system (DDS). A sample of 344 individuals was enrolled across seven sites in the United States. Dual-axis accelerometry signals were collected prospectively with simultaneous videofluoroscopy (VFSS) during swallows of liquid barium stimuli in thin, …

Current Practice Patterns In The Diagnosis And Management Of Sleep-Disordered Breathing In Infants., Rachana Kombathula, David G. Ingram Md, Zarmina Ehsan Md

Manuscripts, Articles, Book Chapters and Other Papers

STUDY OBJECTIVES: Currently, there are no universally accepted guidelines for diagnosis and management of sleep-disordered breathing (SDB) in infants. The purpose of this study was to survey pediatric sleep medicine providers regarding their current practice patterns for diagnosis and management of SDB in infants.

METHODS: An anonymous, web-based survey with 71 questions was distributed via the PEDSLEEP and Ped-Lung listserv, which serve as a hub of communication for pediatric sleep and pulmonary medicine providers worldwide.

RESULTS: Fifty-four providers from eight countries completed the survey. Ninety-six percent of providers reported performing sleep studies in infants with 53% performing more than 30 …

I Spy With My Little Eye … A Knee About To Go 'Pop'? Can Coaches And Sports Medicine Professionals Predict Who Is At Greater Risk Of Acl Rupture?, Anne Inger Mørtvedt, Tron Krosshaug, Roald Bahr, Erich Petushek

Michigan Tech Publications, Part 1

BACKGROUND: The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk, but it is not clear whether such assessments are valid.

AIM: To examine if sports medicine professionals and coaches are able to identify players at risk of sustaining an ACL injury by visually assessing player performance during a VDJ test.

METHODS: 102 video clips of elite female handball and football players performing a baseline VDJ test were randomly extracted from a 738-person prospective cohort study that tracked ACL injuries. Of the sample, 20 of 102 went on to suffer an ACL injury. These …

Comparison Of Mri- And Trus-Informed Prostate Biopsy For Prostate Cancer Diagnosis In Biopsy-Naive Men: A Systematic Review And Meta-Analysis., Hanan Goldberg, Ardalan E. Ahmad, Thenappan Chandrasekar, Laurence Klotz, Mark Emberton, Masoom A. Haider, Samir S. Taneja, Karan Arora, Neil Fleshner, Antonio Finelli, Nathan Perlis, Mark D. Tyson, Zachary Klaassen, Christopher J.D. Wallis

Department of Urology Faculty Papers

PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men.

METHODS: Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus …

Incorporating Mpmri Biopsy Data Into Established Pre-Rp Nomograms: Potential Impact Of An Increasingly Common Clinical Scenario, Joon Yau Leong, Jaime O. Herrera-Caceres, Hanan Goldberg, Elwin Tham, Seth Teplitsky, Leonard G. Gomella, Neil E. Fleshner, Costas D. Lallas, Edouard J. Trabulsi, Thenappan Chandrasekar

Department of Urology Faculty Papers

Background: We examine the practical application of multiparametric MRI (mpMRI) prostate biopsy data using established pre-RP nomograms and its potential implications on RP intraoperative decision-making. We hypothesize that current nomograms are suboptimal in predicting outcomes with mpMRI targeted biopsy (TBx) data.

Materials and methods: Patients who underwent mpMRI-based TBx prior to RP were assessed using the MSKCC and Briganti nomograms with the following iterations: (1) Targeted (T) (targeted only), (2) Targeted and Systematic (TS) and (3) Targeted Augmented (TA) (targeted core data; assumed negative systematic cores for 12 total cores). Nomogram outcomes, lymph node involvement (LNI), extracapsular extension (ECE), organ-confined …