Robinson, Shane S.

Prostate cancer is the second most common cancer in U.S. men, with higher incidence and mortality among African Americans and those with genetic or familial risk. Despite guidelines promoting early detection, prostate-specific antigen (PSA) screening in primary care remains inconsistent. We assessed PSA screening patterns and the association between risk factors and testing. A retrospective analysis was conducted on men aged ≥40 seen at primary care clinics from 2020 to 2022. Risk scores were created based on the number of prostate cancer risk factors. Univariate and multivariate analyses assessed associations between the risk scores, PSA screening, and cancer diagnosis. Of 176,326 patients, 31.4% underwent PSA testing, rising to 78.1% with a risk score of 4. The predictive model was significant (χ 2 = 19,527.021, df = 11, p < .001). PSA testing odds were higher with Medicaid or commercial insurance (vs. Medicare) and lower for self-pay patients. Former and never smokers were more likely to be tested than current smokers. Age, African American race, and family history increased the odds of receiving PSA testing. Prostate cancer diagnosis reached 25% at a risk score of 5, with significant predictors including older age, African American race, family history, and mention of “prostate” in clinical notes. PSA screening remains underused in primary care, even among high-risk patients. More risk factors were linked to higher testing rates, but African American and low-income groups were under-tested. Provider education and decision-support tools may improve guideline adherence and equity.

Introduction: Heparin induced-thrombocytopenia (HIT) is a severe autoimmune reaction to heparin that increases patients' risk of developing venous thrombosis, leading to fatal conditions such as pulmonary embolism. The clinical 4T scoring system guides need for further testing, based on noting fall in platelet counts, the timing of platelet counts falling in conjunction with heparin exposure, the presence of new thromboses, and ruling out other causes of thrombocytopenia. In patients in whom 4T scoring indicates a higher protest probability for HIT, screening is then performed. The Enzyme-Linked Immunosorbent Assay (ELISA) detects antibodies against platelet factor 4 (PF4)-heparin complexes. In order to confirm the diagnosis of HIT, the serotonin release assay testing is required, which refers to measuring the serotonin levels produced during platelet activation using radio-labeling techniques. Since the start of the COVID-19 Pandemic in 2020, there has been ongoing discussion regarding whether incidence of HIT diagnosis has increased. Herein we report on a retrospective observational study of a cohort of patients seen at a community hospital in Georgia between March 2017 to December 2022 to determine the changes in frequency of HIT and SRA testing, and to assess its association with the COVID-19 pandemic. Methods: We included patients aged &gt;18 years, hospitalized at a community hospital in Georgia during the study duration and de-identified data was collected from electronic medical records. Text-based data analysis was performed to identify those patients who received HIT testing, SRA testing, and ultimately a final diagnosis of HIT (HIT positive and SRA positive). The overall rates of 4T scoring documentation and assessment in the hospital were also assessed. Several multivariable logistic regression models were constructed to examine factors associated with HIT testing and SRA testing, and their association since the start of the the COVID-19 pandemic (March 2020). Results: A total of 244,457 patients were included in the study population. Of them, 2,375 (0.97% of total) patients were tested with the HIT-ELISA, and only 468 (0.19% of total) patients were tested with SRA. In further subgroup analysis, evaluating the temporal associations of HIT and SRA testing, it was observed that the rate of HIT-ELISA testing increased since the onset of the COVID-19 pandemic, as did the rate of SRA testing (p &lt; 0.000). Notably, of the 2,375 patients who received the HIT-ELISA testing, only 193 (8% of HIT-tested patients) had documentation of clinical suspicion of HIT with the 4T score. Discussion: An increase in HIT and SRA testing has been observed since the start of COVID-19 pandemic, with a notable lack of 4T score data in the study population preceding this testing. This study emphasizes the importance of clinician education regarding the process of accurate HIT diagnosis, which would start with clinical 4T scoring, followed by ELISA testing for screening, and finally confirmed by SRA testing. Further research is warranted to understand the barriers that may exist in providing guideline-directed evaluation of HIT so that targeted interventions can be implemented to ensure high-quality care is delivered to patients.

Abstract Purpose In 2019, the National Comprehensive Cancer Network (NCCN) recommended genetic testing for all patients with pancreatic ductal adenocarcinoma (PDAC). To evaluate the status of implementation of these guidelines in a loco-regional setting, we performed a retrospective, observational study among patients with newly diagnosed PDAC who received oncologic care at Northeast Georgia Medical Center in Georgia. Methods Chart abstraction of patients with newly diagnosed PDAC from January 1, 2020 to December 31, 2021, was performed to include information on genetic testing recommendation and completion, and time from diagnosis to testing. The deidentified dataset was then analyzed using appropriate descriptive and associative statistical testing. Results Of the cohort of 109 patients, 32 (29.4%) completed genetic screening; 16 (14.7%) were screened within 10 days of diagnosis. Among the 77 (70.6%) patients who did not receive genetic screening, 45 (41.3%) were not recommended genetic screening despite treatment intent with standard of care therapy. However, 32 (29.4%) were not recommended genetic screening in conjunction with a desire to pursue palliative care/hospice/or due to terminal illness. Conclusions The study highlighted the gap in implementation of NCCN guideline-directed genetic testing in PDAC patients as only a third underwent testing suggesting the need for systematic processes to facilitate testing. The test was more likely to be completed if done early in the course, especially soon after the diagnosis. Research is needed to explore discussing genetic testing for the large proportion of patients who are terminally ill at diagnosis where genetic screening would potentially benefit the family members.