scholarly journals Disparities in Access to Autologous Breast Reconstruction

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 281
Author(s):  
David J. Restrepo ◽  
Maria T. Huayllani ◽  
Daniel Boczar ◽  
Andrea Sisti ◽  
Minh-Doan T. Nguyen ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Access To Health Care ◽  
Multivariable Analysis ◽  
The State ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Lower Odds ◽  
Access To Health ◽  
Implant Reconstruction ◽  
Insurance Payer

Background and objectives: This study aimed to determine if age, race, region, insurance, and comorbidities affect the type of breast reconstruction that patients receive. Materials and methods: This analysis used the Florida Inpatient Discharge Dataset from 1 January 2013 to 30 September 2017, which contains deidentified patient-level administrative data from all acute care hospitals in the state of Florida. We included female patients, diagnosed with breast cancer, who underwent mastectomy and a subsequent breast reconstruction. We performed an χ2 test and logistic regression in this analysis. Results: On the multivariable analysis, we found that age, race, patient region, insurance payer, and Elixhauser score were all variables that significantly affected the type of reconstruction that patients received. Our results show that African American (odds ratio (OR): 0.68, 95%CI: 0.58–0.78, p < 0.001) and Hispanic or Latino (OR: 0.82, 95%CI: 0.72–0.93, p = 0.003) patients have significantly lower odds of receiving implant reconstruction when compared to white patients. Patients with Medicare (OR: 1.57, 95%CI: 1.33–1.86, p < 0.001) had significantly higher odds and patients with Medicaid (OR: 0.61, 95%CI: 0.51–0.74, p < 0.001) had significantly lower odds of getting autologous reconstruction when compared to patients with commercial insurance. Conclusions: Our study demonstrated that, in the state of Florida over the past years, variables, such as race, region, insurance, and comorbidities, play an important role in choosing the reconstruction modality. More efforts are needed to eradicate disparities and give all patients, despite their race, insurance payer, or region, equal access to health care.

How Does Autologous Breast Reconstruction Impact Downtime?

2018 ◽  
Vol 34 (07) ◽  
pp. 530-536 ◽  
Author(s):  
Daniel Rais ◽  
Jian Farhadi ◽  
Giovanni Zoccali
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Superior Gluteal Artery ◽  
Free Flap Surgery ◽  
Recovery Times ◽  
Time Required ◽  
The Impact

Background Although autologous breast reconstruction is technically quite demanding, it offers the best outcomes in terms of durable results, patient perceptions, and postoperative pain. Many studies have focused on clinical outcomes and technical aspects of such procedures, but few have addressed the impact of various flaps on patient recovery times. This particular investigation entailed an assessment of commonly used flaps, examining the periods of time required to resume daily activities. Methods Multiple choice questionnaires were administered to 121 patients after recovery from autologous reconstruction to determine the times required in returning to specific physical activities. To analyze results, the analysis of variance F-test was applied, and odds ratios (ORs) were determined. Results Among the activities surveyed, recovery time was not always a function of free-flap surgery. Additional treatments and psychological effects also contributed. Adjuvant chemotherapy increased average downtime by 2 weeks, and postoperative irradiation prolonged recovery as much as 4 weeks. Patient downtime was unrelated to flap type, ranging from 2.9 to 21.3 weeks for various activities in question. Deep inferior epigastric perforator (DIEP) flaps yielded the highest OR and transverse upper gracilis (TUG) flaps the lowest. Conclusion Compared with superior gluteal artery perforator and TUG flaps, the DIEP flap was confirmed as the gold standard in autologous breast reconstruction, conferring the shortest recovery times. All adjuvant therapies served to prolong patient recovery as well. Surgical issues, patient lifestyles, and donor-site availability are other important aspects of flap selection.

scholarly journals HEALTH UNDER OCCUPATION Counter Strategies and Resistance Tactics of Palestinians and the Health System in the State of Palestine

2019 ◽  
Author(s):  
Sigge Andersson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
The State ◽  
Health Determinants ◽  
Theory Approach ◽  
Access To Health ◽  
The Impact

The impact of occupation on health and access to health care is a significant issue for the state, health sector and citizens of Palestine, who struggle with difficulties related to an enduring sociopolitical stalemate. The study presents narratives from the field, conceptually exploring if and how occupation affects health and access to health care and how the situation is tackled by Palestinians in general and by health system actors specifically. A grounded theory approach analyzing in-depth interviews with health staff and field memos was used, with semi-quantification of emerging concepts through surveys of Hebron students that assessed health-related quality of life and health literacy with psychometric instruments (SF36 and GSE) and assumed health determinants. One key theme in the data analysis was isolation as a result of multiple barriers, including the wall and checkpoints, imprisonment and violence, which have an impact on determinants of health and quality of life in Palestine. In the survey 54% (n=90) were affected by such factors of occupation. Barriers affect access to health care, especially in rural areas. Mentally and materially breaking free from barriers of occupation seems to be a common task in all levels of Palestinian society. Achieving this goal requires different counter strategies and tactics. Presently, Palestine depends on ad hoc coping strategies, including the use of mobile clinics. Other ways to cope emerged in the data as well. Results from this mixed-methods study suggest that isolation is a main concern for Palestinians, resulting from barriers in policies of occupation that affect health and access to health care. Another concept emerging from the analysis was tactics and strategies against occupation in society.

scholarly journals O cuidado na perspectiva singular das parteiras da região amazônica: estudo descritivo

2018 ◽  
Vol 16 (3) ◽  
pp. 256
Author(s):  
Angela Carla da Rocha Schiffler ◽  
Ana Lúcia Abrahão
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Focus Groups ◽  
Neonatal Mortality ◽  
Access To Health Care ◽  
The State ◽  
Creative Practice ◽  
The North ◽  
Access To Health ◽  
Core Sets

Problem:    geography  and  difficulty  of  access  to  health  care contribute to maternal and neonatal mortality in the North and Northeast of Brazil. Aim: to  identify  the  care  arrangements  used  during  labor  and  birth by  midwives  from  the Amazon.   Method:      15   midwives   from   the   cities   of   Manaus   and of   Vila   de Lindoia/Itacoatiara  region  took  part  in  two  focus  groups held  between  December  2015 and  March  2016.  Data  analysis  focused  on  three  cores  of  meaning and  the  use  of narratives.  Results:    most  of  the  arrangements  designed  to  assist women  occurred  in cities in the inner regions of the state of A mazonas, B razil. The midwives’ narratives were  based  around  three  core  sets  of  meanings:  Complicity  and  Recognition;  Midwife Memories,  and  Labor  and  Birth.  Conclusion:  midwives  build  a  logic  for  care  centered around women. It is an extensive and creative practice, available to sustain life during and after the birth.

Improving Access to Health Care

PEDIATRICS ◽  
1977 ◽  
Vol 60 (5) ◽  
pp. 775-776
Author(s):  
George M. Wheatley
Keyword(s):  
New York ◽  
Social Services ◽  
Access To Health Care ◽  
New York State ◽  
The State ◽  
Medicaid Program ◽  
Health Supervision ◽  
Access To Health ◽  
The Social ◽  
Services Implementation

Dr. Haggerty's commentary "Who Will Monitor Access?" (Pediatrics 57:169, February 1976) raises a question which the Medicaid program in New York State is making a valiant effort to answer through CHAP. CHAP stands for Child Health Assurance Program and is the State Department of Social Services' implementation of EPSDT. The Social Services District of each of the 56 counties in the state must, as part of CHAP, have provision not only to interview the parent of each eligible child at least every six months to offer and arrange for initial and periodic health supervision, but also to followup those who are found to need further diagnosis and treatment.

Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

2019 ◽  
Vol 35 (06) ◽  
pp. 445-451 ◽  
Author(s):  
George N. Kamel ◽  
David Nash ◽  
Joshua Jacobson ◽  
Robin Berk ◽  
Karan Mehta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Medical Center ◽  
Tissue Expander ◽  
Well Being ◽  
Minority Population ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Patient Reported

Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction. Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed. Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome. Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

Impact of insurance payer and socioeconomic status on type of autologous breast reconstruction

2021 ◽  
Vol 39 ◽  
pp. 101661
Author(s):  
Jacob Dinis ◽  
Alexandra Junn ◽  
Fouad Chouairi ◽  
Michael Mercier ◽  
Tomer Avraham ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Breast Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Insurance Payer

Intraoperative Microvascular Complications in Autologous Breast Reconstruction: The Effects of Resident Training on Microsurgical Outcomes

2020 ◽  
Author(s):  
Sumeet S. Teotia ◽  
Ryan M. Dickey ◽  
Yulun Liu ◽  
Avinash P. Jayaraman ◽  
Nicholas T. Haddock
Keyword(s):  
Breast Reconstruction ◽  
Operative Time ◽  
Microvascular Complications ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Intraoperative Complication ◽  
Total Operative Time ◽  
Ischemia Time ◽  
Flap Loss ◽  
Artery Perforator

Abstract Background Academic medical centers with large volumes of autologous breast reconstruction afford residents hand-on educational experience in microsurgical techniques. We present our experience with autologous reconstruction (deep inferior epigastric perforators, profunda artery perforator, lumbar artery perforator, bipedicled, and stacked) where a supervised trainee completed the microvascular anastomosis. Methods Retrospective chart review was performed on 413 flaps (190 patients) with microvascular anastomoses performed by postgraduate year (PGY)-4, PGY-5, PGY-6, PGY-7 (microsurgery fellow), or attending physician (AP). Comorbidities, intra-operative complications, revisions, operative time, ischemia time, return to operating room (OR), and flap losses were compared between training levels. Results Age and all comorbidities were equivalent between groups. Total operative time was highest for the AP group. Flap ischemia time, return to OR, and intraoperative complication were equivalent between groups. Percentage of flaps requiring at least one revision of the original anastomosis was significantly higher in PGY-4 and AP than in microsurgical fellows: PGY-4 (16%), PGY-5 (12%), PGY-6 (7%), PGY-7 (2.1%), and AP (16%), p = 0.041. Rates of flap loss were equivalent between groups, with overall flap loss between all groups 2/413 (<1%). Conclusion With regard to flap loss and microsurgical vessel compromise, lower PGYs did not significantly worsen surgical outcomes for patients. AP had the longest total operative time, likely due to flap selection bias. PGY-4 and AP groups had higher rates of revision of original anastomosis compared with PGY-7, though ultimately these differences did not impact overall operative time, complication rate, or flap losses. Hands-on supervised microsurgical education appears to be both safe for patients, and also an effective way of building technical proficiency in plastic surgery residents.

A Review of Data on the U.S. Health Sector Fall 2004

2005 ◽  
Vol 35 (2) ◽  
pp. 265-289 ◽  
Author(s):  
Ida Hellander
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Social Inequalities ◽  
Health Sector ◽  
The State ◽  
Term Care ◽  
Access To Health ◽  
Pharmaceutical Industries ◽  
The U.S

This report presents information on the state of the U.S. health sector in late 2004. It includes data on the uninsured and underinsured and their access to health care, underinsurance for long-term care and mental health, and the rising costs of health insurance and health care. The author presents data on the increasing social inequalities in health and access to health care; the role of corporate money in health and health care; and the hospital and pharmaceutical industries. The article also includes updates on the consequences of the Medicare prescription drug bill and the state of Medicare spending, and seniors' spending, on drugs; the results of some recent public opinion polls on health care; information on labor, labor unions, and health insurance; and some international comparisons of health insurance. The article concludes with some useful sources of information on single-payer, universal health care.

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