• Validation of PI-RADS v2 Scores at Various Non-University Radiology Practices

      Austin, Evan; The University of Arizona College of Medicine - Phoenix; Chang, John (The University of Arizona., 2021)
      Purpose: Validate the second version of the Prostate Imaging Reporting and Data System (PIRADSv2) scores in predicting positive in-bore MRI guided targeted prostate biopsy results across different non-university related institutions. Materials and Methods: This was a retrospective review of 147 patients who underwent multiparametric magnetic resonance imaging followed by in-bore MRI guided targeted prostate biopsy from 2014-2018. Lesions were rated according to PI-RADS v2 criteria. Scores were compared to MR-guided biopsy results and pre-biopsy PSA values. Results: Prostate Cancer (PCa) was detected in 54% (80/147) of patients, with more prostate cancer being detected with each increase in PI-RADS scores. Biopsy results with PI-RADS 3, 4, and 5 lesions resulted in PCa in 25.6% (10/39), 58.1% (33/55), and 86.0% (37/43) respectively. Clinically significant PCa (Gleason score ≥7) was detected in 17.9% (7/39), 52.7% (29/55), and 72% (31/43) of cases for PI-RADS 3, 4, and 5 lesions respectively. When PI-RADS scoring/biopsy results were compared across different institutions, there was no difference in the PI-RADS scoring or in positive biopsy rates.. The sensitivity, specificity, PPV, and NPV for PIRADS 3-4 were not statistically different across the institutions for detecting Gleason 7 or greater lesions. Conclusion: Our results agree with prior studies that higher PI-RADS scores are associated with clinically significant PCa and suggest lesions with PI-RADS 3-5 have sufficient evidence to warrant biopsy. Comparison of PI-RADS across different types of non-university practices revealed no difference in scoring/biopsy outcome, suggesting that PI-RADS v2 can be easily applied outside of the university medical center setting.
    • What do individuals experiencing homelessness want for their care?: A needs assessment survey

      Zeien, Justin; The University of Arizona College of Medicine - Phoenix; Hartmark-Hill, Jennifer (The University of Arizona., 2021)
      The homeless population is growing across the United States, particularly in urban areas. Homelessness has a detrimental impact on health and quality of life, especially among the unsheltered homeless population. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. The purpose of this study was to identify prioritized needs in an urban unsheltered homeless population and measure associations with self-reported health. We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, Chi-squared analysis, and multivariable logistic regression. Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized emergency departments (EDs) as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) or medical care (OR 2.47, 95% CI: 0.99-6.14) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an ED (OR 2.05, 95% CI: 0.81-5.25). The data demonstrate that food security was the top priority need of this urban unsheltered population. Interventions improving accessibility to transportation, high-quality medical care, and health education should be implemented to improve the health of this population. Such interventions may also decrease care sought in ED settings. These conclusions are likely generalizable to other unsheltered homeless populations in large urban cities; however, regional and cultural differences exist. Our needs assessment may serve as a template for future needs assessments of other urban unsheltered homeless populations.