scholarly journals Impact of rurality on melanoma diagnosis in Utah

2021 ◽  
pp. MMT56
Author(s):  
Tawnya L Bowles ◽  
Carol Sweeney ◽  
John Snyder ◽  
Jesse Gygi ◽  
Brad Bott ◽  
...  
Keyword(s):  
Early Stage ◽  
Anatomic Site ◽  
Integrated Healthcare ◽  
Melanoma Diagnosis ◽  
Melanoma Incidence ◽  
Rural And Urban ◽  
Local Primary Care ◽  
The Impact ◽  
Rural Patients ◽  
Over Time

Aim: To analyze trends in Utah melanoma diagnosis and study the impact of rurality. Patients & methods: State-wide melanoma incidence was calculated using Surveillance, Epidemiology, and End Results data (2005–2013). A subset of 5199 patients treated in an integrated healthcare system was further stratified for urban or rural residence. Results: Early-stage tumors accounted for most of the increase in melanoma incidence over time. Age-adjusted melanoma incidence rate was higher in rural counties (46.7 vs 39.4). Anatomic site and stage did not differ between rural and urban patients. Rural patients were more commonly diagnosed by a local primary care provider. Conclusion: Rurality had an impact on melanoma diagnosis in the specialty and location of the diagnosing provider.

Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed

2020 ◽  
Vol 86 (9) ◽  
pp. 1078-1082
Author(s):  
Miles Landry ◽  
Rachel Lewis ◽  
Andrew Antill ◽  
R. Eric Heidel ◽  
Jessica Taylor ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cost Of Care ◽  
Longitudinal Impact ◽  
Anatomic Site ◽  
Elective Colorectal Surgery ◽  
Before And After ◽  
Eras Protocol ◽  
The Impact ◽  
Over Time

Background Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. Methods A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. Results A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days ( P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. Conclusion After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

scholarly journals Cumulative COVID-19 Disparities in Nursing Home: Focusing on Geographical Factors and Racial Components

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 869-870
Author(s):  
Sungjae Hong ◽  
Shannon Meija
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Disease Prevalence ◽  
Rural Nursing ◽  
Rural And Urban ◽  
Black Residents ◽  
The Impact ◽  
Over Time

Abstract The impact of COVID-19 has been greatest in vulnerable US populations. This study examines the cumulative geographical and racial disparities of COVID-19 cases in nursing homes. Analysis of COVID-19 Nursing Home Data from Centers for Medicare & Medicaid Services was limited to weekly reports from the nursing homes that reported the ratio of black residents, from 2020-05-31 to 2021-01-17 (N=268,222 from 8,026 nursing homes). The outcomes were weekly COVID-19 cases and death per 1,000 occupied beds. Nursing homes were categorized by a geographic (rural vs. urban) and racial composition (>50% of residents are black vs. else). Elapsed time and county-level weekly COVID-19 cases and deaths/1,000 people were the key covariates. Multilevel zero-inflated negative binomial regression revealed evidence of cumulative COVID-19 disparity between rural and urban nursing homes. At the earliest time, COVID-19 incidence was lower in rural nursing homes than in urban nursing homes (IRR=0.406 for cases, 0.034 for death). The significant interaction with time implied that, over and above evolving disease prevalence, rural nursing homes became more likely than urban nursing homes to experience COVID-19 over time (IRR=1.057 for cases, 1.193 for death). Nursing homes, with >50% black residents, were more likely to experience COVID-19 than their counterparts at the earliest time (IRR=1.339 for cases, 5.630 for death), but independent of local disease prevalence, this disparity decreased over time (IRR=0.973 for cases, 0.972 for death). Our findings suggest that racial and geographic factors contribute to the cumulation of disadvantage during the COVID-19 crisis at the second half of 2020.

Temporal changes in rural-urban treatment patterns for early-stage non-small cell lung cancer in North Carolina, 2006 to 2015.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 112-112
Author(s):  
Joshua Herb ◽  
Tzy-Mey Kuo ◽  
Vaibhav Kumar ◽  
Benjamin Wu ◽  
Mark Holmes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
North Carolina ◽  
Small Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Urban Status ◽  
Time Period ◽  
Rural Patients ◽  
Over Time

112 Background: Rural-urban disparities in the receipt of surgery for early-stage non-small cell lung cancer (NSCLC) have been noted, but few studies have considered access to other available treatments (i.e. radiation) or examined changes over time. Rural hospital closures, regionalization and workforce changes could lead to temporal changes in treatment access. Therefore, the primary objective was to evaluate geographic disparities in lung cancer treatment modalities in North Carolina and to characterize how practice patterns are changing over time. We hypothesized that rural patients would be less likely to undergo treatment compared to urban patients with widening disparities over time. Methods: North Carolina cancer registry data linked with Medicaid, Medicare, and private insurance claims were used to identify patients with Stage I or II NSCLC from 2006-2015. The primary outcome was first course treatment modality: surgery, radiation, or no treatment. Rural-urban status was defined based on Rural-Urban Commuting Codes. Calendar years were split into early (2006-10) and late (2011-15) periods. Multivariable logistic regression was used to assess the association of rural/urban status and time period with surgery and any treatment (surgery or radiation) while controlling for clinical, demographic, and area-level factors. Results: Among 7532 patients, 4144 (56%) patients underwent surgery, 1991 (27%) received radiation, and 1397 (19%) had no therapy. Rural patients were as likely to undergo treatment in either time period as urban patients. Among rural patients, the odds of surgery decreased over time (2011-15 vs. 2006-10 OR 0.79, 95%CI 0.66,0.94) and the odds of radiation increased (2011-15 vs. 2006-10 OR 1.46, 95%CI 1.40,1.78). Meanwhile urban patients had no significant change in surgery over time, but also had an increase in likelihood of undergoing radiation (2011-15 vs. 2006-10 OR 1.34 95%CI 1.18,1.52). Conclusions: Between 2006-2015, nearly 1 in 5 insured patients in North Carolina did not receive any treatment for potentially curable lung cancer. Over time, rural patients are less likely to undergo surgery, the standard of care, while radiation use is increasing everywhere. As rural patients are less likely to undergo surgery over time, this may have downstream effects on rural-urban disparities in survival. Further work aims to understand the patient and system level drivers behind these trends.

scholarly journals Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study

10.2196/26960 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e26960
Author(s):  
Cherry Chu ◽  
Peter Cram ◽  
Andrea Pang ◽  
Vess Stamenova ◽  
Mina Tadrous ◽  
...  
Keyword(s):  
Age Groups ◽  
Cross Sectional Study ◽  
Rural Populations ◽  
Care Utilization ◽  
Sectional Study ◽  
Rural And Remote ◽  
Cross Sectional ◽  
Rural And Urban ◽  
The Impact ◽  
Rural Patients

Background The COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. Objective This study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. Methods We conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. Results Before the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). Conclusions Telemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes.

Efficacy of immune checkpoint inhibitors for the treatment of metastatic melanoma (MM) in patients with concurrent chronic lymphocytic leukemia (CLL).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22044-e22044
Author(s):  
Veronica Guerra ◽  
Gabriel O. Ologun ◽  
Lauren Elaine Haydu ◽  
Emily Zhi-Yun Keung ◽  
Elizabeth M. Burton ◽  
...  
Keyword(s):  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Early Stage ◽  
Objective Response ◽  
Cell Subset ◽  
Primary Objective ◽  
Lymphocytic Leukemia ◽  
Melanoma Diagnosis ◽  
The Impact

e22044 Background: Patients with CLL have immune impairment with abnormalities in T-cell subset composition and immune synapse formation. The impact of these defects on response to immune checkpoint inhibitors (CPI) is not known. Given the high incidence of melanoma in patients with CLL we sought to evaluate the response to CPI in patients with concomitant MM and CLL. Methods: Retrospective analysis of 24 patients (pts) with concurrent CLL and MM who received a total of 38 CPI therapies between July 1997 and July 2019. Primary objective was to determine objective response rate (ORR), defined as complete response (CR) or partial response (PR) by RECIST1.1. Secondary outcomes included event-free survival; overall survival (OS), and duration of response (DOR). Results: The median age at CLL and melanoma diagnosis was 62 and 63 years, respectively. 71% of patients were male. Most presented with early stage CLL at diagnosis (67%), 60% had mutated IGVH, and 47% had deletion of 13q by FISH. 71% remained on observation for their CLL. Median time from melanoma diagnosis to CPI initiation was 13.5 months. 83% had stage IV MM and 17% stage III MM at the time of therapy. 17% had increased LDH. The most common melanoma mutations were BRAF(35%), BRAFV600 (26%), TP53 (30%) and NRAS (26%). Median follow up was 37 months and the ORR was 24% (Table). Median DOR was 41 months and median OS is 26.4 months. Immune-mediated adverse events occurred in 42%, including 13% fever, 11% thrombotic events, 8% endocrine dysfunction. 13 pts are alive and 11 pts died (8 pts due to MM progression). There were no significant changes in absolute lymphocyte counts during CPI therapy. 2 pts received CPI while on ibrutinib or ibrutinib+venetoclax therapy with ongoing CLL responses. Conclusions: Our experience indicates that CPIs can be effective for the treatment of MM in patients with concurrent CLL, achieving durable responses. Immuno-mediated toxicities were frequently observed. A lower ORR was observed in first-line CPI in MM, however the numbers of pts are small. Further studies are needed to determine if initial or concurrent treatment for CLL could improve CPI outcomes and survival. Additional studies evaluating T cells function and tissue infiltration in these patients are ongoing. [Table: see text]

Management of Melanoma during Pregnancy: A Case Series of 11 Women Treated at NYU Langone Health

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 847-852
Author(s):  
Amelia E. Sawyers ◽  
Anna C. Pavlick ◽  
Jeffrey S. Weber ◽  
Iman Osman ◽  
Jennifer A. Stein
Keyword(s):  
Early Stage ◽  
Case Series ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Melanoma Diagnosis ◽  
Stage Disease ◽  
Treatment Plans ◽  
Melanoma Patients ◽  
The Impact

<b><i>Objectives:</i></b> Melanoma is one of the most common malignancies diagnosed during pregnancy. This study examined the impact of pregnancy on management decisions of melanoma patients treated at NYU Langone Health (NYULH). <b><i>Methods:</i></b> We analyzed data for patients who were pregnant at initial or recurrent melanoma diagnosis at NYULH from 2012 to 2019 with prospective protocol-driven follow-up. <b><i>Results:</i></b> Of the 900 female patients accrued during this period, 11 women in the childbearing range were pregnant at melanoma diagnosis. Six patients presented with early (stage 0 or I) disease and five with advanced (stage III or IV) melanoma. Women with early stage disease had normal deliveries and minimal changes to their treatment timeline and regimen. However, patients with more advanced stage disease opted for either termination of the pregnancy or early delivery and altered treatment timelines because of pregnancy. <b><i>Conclusion:</i></b> Both melanoma stage and gestational age at diagnosis contribute to the differences in the therapeutic management of melanoma in pregnant women. Given the complexity and variety of each case of melanoma during pregnancy, informed discussion between patients and physicians allows for individualized treatment plans that address each patient’s unique situation.

The Therapist’s Reaction to a Patient’s Suicide

Crisis ◽  
2011 ◽  
Vol 32 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Friedrich Martin Wurst ◽  
Isabella Kunz ◽  
Gregory Skipper ◽  
Manfred Wolfersdorf ◽  
Karl H. Beine ◽  
...  
Keyword(s):  
Emotional Responses ◽  
Well Being ◽  
Emotional Reaction ◽  
Emotional Reactions ◽  
Analog Scale ◽  
General Hospitals ◽  
Item Questionnaire ◽  
Retrospective Nature ◽  
The Impact ◽  
Over Time

Background: A substantial proportion of therapists experience the loss of a patient to suicide at some point during their professional life. Aims: To assess (1) the impact of a patient’s suicide on therapists distress and well-being over time, (2) which factors contribute to the reaction, and (3) which subgroup might need special interventions in the aftermath of suicide. Methods: A 63-item questionnaire was sent to all 185 Psychiatric Clinics at General Hospitals in Germany. The emotional reaction of therapists to patient’s suicide was measured immediately, after 2 weeks, and after 6 months. Results: Three out of ten therapists suffer from severe distress after a patients’ suicide. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. The emotional responses immediately after the suicide explained 43.5% of the variance of total distress in a regression analysis. Limitations: The retrospective nature of the study is its primary limitation. Conclusions: Our data suggest that identifying the severely distressed subgroup could be done using a visual analog scale for overall distress. As a consequence, more specific and intensified help could be provided to these professionals.

Has Aid Helped in Pakistan?

1997 ◽  
Vol 36 (4II) ◽  
pp. 947-957 ◽  
Author(s):  
Shahrukh Rafi Khan
Keyword(s):  
Economic Growth ◽  
Negative Impact ◽  
Negative Association ◽  
Causal Impact ◽  
The Impact ◽  
Over Time

This paper has a two-fold objective: first, to examine the terms on which Pakistan receives aid and whether its debt situation is sustainable, and second, to examine the impact of aid and debt on economic growth. It is found that there is little encouraging that can be said about how the terms on which Pakistan has received aid over time have changed, and its current debt situation is not sustainable. Also reported is the analysis done elsewhere which shows that aid has a negative (Granger) causal impact on GDP, and aid has a robust negative impact on economic growth after controlling for supplyside shocks. We provide various reasons for this negative association.

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