Publications by authors named "Isabelle T Smith"

Maxillofacial trauma is a significant concern in emergency departments (EDs) due to its high prevalence and the complexity of its management. However, many ED physicians lack specialized training and confidence in handling these cases, leading to a high rate of facial trauma referrals and increased stress on consult services. Recent advancements in artificial intelligence, particularly in large language models such as ChatGPT, have shown potential in aiding clinical decision-making.

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Article Synopsis
  • - Voriconazole exposure is linked to a higher incidence of skin cancer among organ transplant recipients, but the role of genetic variations in drug metabolism (specifically CYP2C19) was unclear until this study.
  • - A retrospective analysis of 1,739 transplant patients revealed that 134 had voriconazole exposure, and both exposure and metabolizer status significantly influenced skin cancer rates (p < 0.01).
  • - Rapid metabolizers of voriconazole exhibited a notably increased risk for developing squamous cell carcinomas (SCC), with faster cancer onset compared to non-exposed patients (hazard ratio of 1.78 for overall skin cancer and 1.83 for SCC specifically).
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Importance: Many patients will develop more than one skin cancer, however most research to date has examined only case status.

Objective: Describe the frequency and timing of the treatment of multiple skin cancers in individual patients over time.

Design: Longitudinal claims and electronic health record-based cohort study.

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Voriconazole exposure is associated with skin cancer, but it is unknown how the full spectrum of its metabolizer phenotypes impacts this association. We conducted a retrospective cohort study to determine how variation in metabolism of voriconazole as measured by metabolizer status of CYP2C19 is associated with the total number of skin cancers a patient develops and the rate of development of the first skin cancer after treatment. There were 1,739 organ transplant recipients with data on CYP2C19 phenotype.

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Acitretin, commonly used for severe psoriasis and keratinocyte carcinoma chemoprevention in high-risk patients, is contraindicated in patients with end-stage renal disease (ESRD) on haemodialysis (HD). However, these patients often lack medication choices and in certain clinical scenarios the benefits of acitretin may outweigh the potential risks. We identified 24 patients with ESRD on HD undergoing acitretin treatment from the Duke and Vanderbilt University Medical Centers.

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Multi-modal learning (e.g., integrating pathological images with genomic features) tends to improve the accuracy of cancer diagnosis and prognosis as compared to learning with a single modality.

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