Christiana Care Health System

Adults with sickle cell disease (SCD) are living longer due to advances in care but face a growing burden of chronic comorbid conditions that fall within the scope of primary care. However, primary care providers often lack structured guidance because literature on managing these conditions in the context of SCD is limited. This article outlines clinical approaches to hypertension, diabetes, obesity, chronic constipation, reproductive health, cognitive impairments, depression, and anxiety in people living with SCD. The authors highlight relevant epidemiology, screening recommendations, and treatment considerations that differ from those in the general population. Primary care providers play a crucial role in delivering comprehensive and preventive care to people living with SCD. Specific management of common chronic conditions in this population is necessary to reduce morbidity and improve quality of life.

Purpose/Objective(s) TTMV-HPV DNA is an established biomarker for HPV-positive OPSCC. We evaluated both its Positive Predictive value (PPV) and its negative predictive value (NPV) and clinical utility in a community program that uses the assay for pretreatment confirmation and post-treatment surveillance. Materials/Methods Between 2020–2023, 115 OPSCC pts treated with curative intent in a community hospital MDC underwent 659 prospectively collected TTMV-HPV DNA assays (NavDx®, Naveris, Inc.). Baseline HPV status was assessed by p16 immunohistochemistry and, in a subset, confirmed by TTMV-HPV DNA testing (HPV16/18/31/33/35). Post-treatment testing was integrated with imaging and physical examination and performed approximately every 3 months, consistent with NCCN guidelines. Eligible patients completed curative therapy and had ≥1 assay. Surveillance performance was evaluated at the interval level (a period of routine surveillance bounded by treatment or recurrence). Intervals without adequate post-test clinical follow-up (3 months for negative tests and 6 months for positive tests) were excluded. Results The median age of the cohort was 64 years (IQR: 57-68), with 92% of patients (106/115) presenting with nodal involvement at diagnosis. Most patients received CRT (93/115, 81%), either alone (49/115, 43%) or with additional therapy (44/115, 38%). Six patients received extreme de-escalated adjuvant therapy according to the DART protocol (Ma et al., Lancet 2025)(6/115, 5.2%). Median follow-up from end of treatment was 31 months (IQR: 24-37). Pretreatment testing was performed in 77% of patients (89/115), with a median TTMV score amongst positive tests of 337 (IQR: 87-1463). Per-patient pretreatment sensitivity in the p16-positive cohort was 87.5% (70/80, 95% CI: 78–94), consistent with pooled results from academic center studies (sensitivity 87.3%, 95% CI: 79–96). In patients with a positive pretreatment test, 94% achieved resolution of their TTMV-HPV DNA score to zero during or following completion of primary treatment, and only one demonstrated residual disease on imaging or exam. Patients with high nodal burden (N2–N3 disease) were less likely to achieve clearance than those with N0–N1 disease (84% vs. 93%, respectively). During surveillance, 77% of patients (88/115) received one or more follow-up tests (median: 5; range: 1–13). Among 84 evaluable intervals, 77 were all negative with 2 subsequent recurrences, yielding an NPV of 97.4% (95% CI: 91-99.3). 6 pts who initially cleared to zero subsequently tested positive with radiographic evidence of recurrence. One positive patient had an indeterminate PET and subsequently died of CLL, precluding determination of OPSCC recurrence. Conclusion As one of the earliest community-based programs to adopt both pre- and post-tx TTMV-HPV DNA testing for HPV-driven OPSCC, our findings align with larger academic centers and demonstrate a high NPV, supporting the clinical utility of TTMV-HPV DNA in routine community practice.

Background: In February 2024, Prisma Health, a 17-hospital healthcare system, changed the reflex urine culture criteria to ≥10 white blood cells (WBC) and rejecting cultures if ≥10 epithelial squamous cells in urinalysis (previously included leukocyte esterase and nitrites). In May 2025, we added verbiage to the Epic orderable emphasizing the criteria. Methods: Using the EMR, lists of urinalyses were generated before the reflex criteria change (August 2023, n=229), after (March 2024, n=102), and an additional data pull June/July 2025 to identify patients who had urinalyses done, and to further identify those who had rejected cultures based on the reflex criteria. A subset for pre/post were reviewed, and all patients with rejected cultures were reviewed. Their charts were reviewed and relevant data captured in RedCap databases. Results: Comparing pre-change (n=229) and after (n=102), there was no difference in the two groups for bacteriuria, leukocyte esterase, WBC, nitrites, and epithelial squamous cells (p=0.31). Antimicrobial prescribing was similar between the groups (p=0.17). Out of 24,978 urinalyses with microscopy in June/July 2025, 291 patients had urinalyses that were rejected for cultures (0.012%). Of the 291 patients, 5 were male, 3 nonbinary, and the rest female. Fifty-eight were pregnant persons. Mean body mass index was 32 mg/m2. The top five most common chief complaints were gastrointestinal (n=86), genitourinary (n=46), obstetric (n=41), gynecologic (n=17), musculoskeletal (n=17). For clinician reasoning from note review, most were ordered for suspected urinary tract infection or urinary symptoms (n=134), no rationale documented (n=52), obstetric workup (n=51), metabolic workup (n=16) or sepsis workup (n=16). Ten patients returned to the ED subsequently, but none required additional workup related to their rejected culture. Conclusions: There were no differences between the characteristics of patients between the reflex culture changes. Very few cultures ultimately were rejected due to skin contamination, emphasizing that rejecting samples for culture is a viable option to improve diagnostic stewardship. The predominance of female and obese patients with contaminated urinalyses emphasizes additional attention to urine collection techniques. Fifty eight obstetric patients were ordered routine urinalyses, not following the orderset obstetric patients excluded from reflex culturing; providers need to be educated to ensure they follow pathways in place. Improved documentation about symptoms and different uses for urinalysis is is key for interpretation of this test.

Purpose/Objective(s) To evaluate the rate of elective nodal failure in HNSCC patients treated with extreme dose de-escalation to either 40 Gy or 30 Gy, followed by a sequential boost to gross disease or resected primary site and N+ disease. Materials/Methods We identified 103 HNSCC pts in our HN-MDC, with SCC arising either in the oral cavity, oropharynx, larynx or hypopharynx, treated with either definitive chemo-radiotherapy or surgery + adjuvant radiotherapy ± chemotherapy between May 2017 and May 2025. All pts were treated with IMRT/VMAT uniformly to the GTVp +GTVn and elective nodal volume (ENV) to either 30 or 40 Gy, followed by a sequential boost to the GTV or high-risk surgical bed. A small cohort of 6 pts were treated adjuvantly to a total uniform dose of 24-36 Gy with the Mayo-DART regimen to the surgical bed + ENV. Pt demographics, tumor characteristics (including p16 status), and treatment details were collected. Pts were staged by AJCC 8th edition. The primary endpoint was the regional control rate within the de-escalated ENV (defined as the adjacent uninvolved nodal levels). Secondary endpoints included overall 2-year local regional control (LRC), and Local regional recurrence stratified by p16 positivity. Results The median age of this cohort was 64 years, and predominantly male (84.5%, n = 87). The oropharynx was the most common primary tumor site (87.4%, n = 90). 85.1% (n = 86) were p16+. Most pts, (80.6%, n = 83), received definitive chemoradiation, while 18.4% (n = 19) underwent surgery followed by adjuvant chemoradiation, and 1% (n = 1) received adjuvant radiation alone. Initial stages included Stage I (48.5%, n = 50), Stage II (29.1%, n = 30), Stage III (10.7%, n = 11), and Stage IV (11.7%, n = 12). ENV's were treated with 40 Gy in 83 pts and 30 Gy in 20 pts. Of the definitive chemoradiation pts, 84 received between 56-70 Gy to the GTVp, and GTVn. Of the adjuvant chemoradiation pts, 13 received 50-70 Gy to high risk nodal and surgical bed sites, and 6 received 24-36 Gy (DART-Mayo regimen). With a median follow-up of 26.4 months, there were no observed elective nodal failures in either the 40 Gy or 30 Gy dose levels. There were a total of 13 recurrences overall; 7 local/regional and 6 distant metastases. The overall 2-year LRC was 93.2% (95% CI: 86.3–96.7). Local regional recurrence occurred in 13.3% (2/13) of the p16-negative group and 5.8% (5/86) in p16 + group. Conclusion This is the largest report demonstrating the efficacy of extreme dose de-escalation to ENV's for HNSCC within a community hospital. We showed that reduced doses to the ENV ranging from 40 Gy to as low as 30 Gy, are associated with exceptionally low rates of failure for both surgical and non-surgical pts, and validate similar findings from larger academic centers, maintain oncologic efficacy.

STUDY OBJECTIVE:To evaluate publication patterns of Complex Benign Gynecology (CBG) scholarship in specialized and general Obstetrics and Gynecology (OB/GYN) journals and assess their association with indicators of subspecialty maturation within the OB/GYN publication ecosystem. DESIGN:Retrospective bibliometric analysis. SETTING:Five major peer-reviewed gynecologic journals: Journal of Minimally Invasive Gynecology (JMIG), Fertility and Sterility (F&S), American Journal of Obstetrics and Gynecology (AJOG), BJOG, and Obstetrics & Gynecology (O&G). PARTICIPANTS:A total of 2,798 articles published between January 1, 2015, and December 31, 2025, identified through systematic searches for endometriosis, uterine fibroids, and chronic pelvic pain. INTERVENTIONS:Articles were stratified by Primary CBG Focus (disease as central objective) vs Secondary CBG Focus (disease as contextual variable). Publication volume, focus distribution, citation impact, and functional specialization were compared using chi-square tests, Kruskal-Wallis H tests, and multivariable regression models. MEASUREMENTS AND MAIN RESULTS:The 5 journals demonstrated distinct publication patterns that were complementary in scope. Specialized journals (JMIG and Fertility and Sterility) had a higher proportion of primary CBG-focused (62-77%) articles, whereas general OB/GYN journals published a larger share of secondary CBG-focused content (62-83%). Across journals, primary CBG-focus was independently associated with approximately 28% higher citation counts after adjustment for journal and publication year. JMIG contributed the largest volume of CBG publications but had lower per-article citation rates compared with the general and reproductive journals, consistent with its narrower subspecialty scope and audience. CONCLUSION:OB/GYN journals together support a collaborative publication environment for CBG scholarship, with subspecialty journals emphasizing disease-focused content (reflected by a higher proportion of primary CBG-focus articles and greater overall CBG volume) and general journals disseminating CBG work to broader clinical audiences (reflected by higher field-weighted citation efficiency and annual citation rates). These patterns are consistent with an emerging, differentiated scholarly profile for CBG.