Background
Integration of palliative care services into the surgical treatment plan is important for holistic patient care. We sought to examine the association between patient race/ethnicity and ...county-level vulnerability relative to patterns of hospice utilization.
Patients and Methods
Medicare Standard Analytic Files were used to identify patients undergoing lung, esophageal, pancreatic, colon, or rectal cancer surgery between 2013 and 2017. Data were merged with the Centers for Disease Control and Prevention’s social vulnerability index (SVI). Logistic regression was utilized to identify factors associated with overall hospice utilization among deceased individuals.
Results
A total of 54,256 Medicare beneficiaries underwent lung (
n
= 16,645, 30.7%), esophageal (
n
= 1427, 2.6%), pancreatic (
n
= 6183, 11.4%), colon (
n
= 26,827, 49.4%), or rectal (
n
= 3174, 5.9%) cancer resection. Median patient age was 76 years (IQR 71–82 years), and 28,887 patients (53.2%) were male; the majority of individuals were White (91.1%,
n
= 49,443), while a smaller subset was Black or Latino (racial/ethnic minority:
n
= 4813, 8.9%). Overall, 35,416 (65.3%) patients utilized hospice services prior to death. Median SVI was 52.8 interquartile range (IQR) 30.3–71.2. White patients were more likely to utilize hospice care compared with minority patients (OR 1.24, 95% CI 1.17–1.31,
p
< 0.001). Unlike White patients, there was reduced odds of hospice utilization (OR 0.97, 95% CI 0.96–0.99) and early hospice initiation (OR 0.94, 95% CI 0.91–0.97) as SVI increased among minority patients.
Conclusions
Patients residing in counties with high social vulnerability were less likely to be enrolled in hospice care at the time of death, as well as be less likely to initiate hospice care early. The effects of increasing social vulnerability on hospice utilization were more profound among minority patients.
The aim of the current study was to determine the impact of neighborhood characteristics on textbook outcome (TO) following surgery.
Medicare beneficiaries undergoing AAA repair, CABG, colectomy, or ...lung resection. Neighborhood characteristics associated with TO were identified.
Among 852,128 Medicare beneficiaries, a 10% increase in the mean percentage of college or advanced degree residents (OR:1.04, 95% CI = 1.04–1.05) was associated with 4% greater odds of a TO, whereas 2% lower odds of TO were noted with a 10% increase in the mean percentage of single-parent households (OR: 0.98, 95% CI = 0.97–0.99). Of note, the highest odds of an extended LOS (OR:1.06, 95% CI: 1.05–1.06) and 90-d mortality (OR: 1.05, 95% CI: 1.04–1.06) were observed with single-parent households.
Among patients undergoing a range of common surgical procedures, increases in college or advanced degrees residents and a decrease in single-parent households led to significantly higher odds of achieving a TO.
•Neighborhood characteristics may be important drivers of postoperative outcomes.•College or advanced degree attainment associated with higher odds of textbook outcome.•Shorter commute time associated with higher odds of textbook outcome.•Fewer single-parent households associated with higher odds of textbook outcome.
Background
Racial/ethnic disparities in cancer outcomes may relate to variations in receipt of National Comprehensive Cancer Network (NCCN) guideline compliant care.
Patients and Methods
Patients ...undergoing resection of cholangiocarcinoma (CCA) between 2004 and 2015 were identified using the National Cancer Database (NCDB). Institutions treating Black and Hispanic patients within the top decile were categorized as minority-serving hospitals (MSH). Factors associated with receipt of NCCN-compliant care, and the impact of NCCN compliance on overall survival (OS), were evaluated.
Results
Among 16,108 patients who underwent resection of CCA, the majority of patients were treated at non-MSH (
n
= 14,779, 91.8%), while a smaller subset underwent resection of CCA at MSH (
n
= 1329, 8.2%). Patients treated at MSH facilities tended to be younger (MSH: 65 years versus non-MSH: 67 years), Black or Hispanic (MSH: 59.9% versus non-MSH: 13.4%), and uninsured (MSH: 11.6% versus non-MSH: 2.2%). While overall compliance with NCCN care was 73.0% (
n
= 11,762), guideline-compliant care was less common at MSH (MSH: 68.8% versus non-MSH: 73.4%;
p
< 0.001). On multivariable analyses, the odds of receiving non-NCCN compliant care remained lower at MSH (OR 0.76, 95% CI 0.65–0.88). While white patients had similar odds of NCCN-compliant care with minority patients when treated at MSH (OR 0.98, 95% CI 0.75–1.28), minority patients had lower odds of receiving guideline-compliant care when treated at non-MSH (OR 0.85, 95% CI 0.75–0.96). Failure to comply with NCCN guidelines was associated with worse long-term outcomes (HR 1.60, 95% CI 1.52–1.69).
Conclusions
Patients treated at MSH had decreased odds to receive NCCN-compliant care following resection of CCA. Failure to comply with guideline-based cancer care was associated with worse long-term outcomes.
Purpose
We sought to examine and categorize the current evidence on patient-physician relationships among marginalized patient populations within the context of cancer care using a systemic scoping ...review approach.
Methods
Web-based discovery services (e.g., Google Scholar) and discipline-specific databases (e.g., PubMed) were queried for articles on the patient-physician relationship among marginalized cancer patients. The marginalized populations of interest included (1) race and ethnicity, (2) gender, (3) sexual orientation and gender identity, (4) age, (5) disability, (6) socioeconomic status, and (7) geography (rural/urban). Study screening and data extraction were facilitated through the Covidence software platform.
Results
Of the 397 screened studies, 37 met study criteria—most articles utilized quantitative methodologies (
n
= 28). The majority of studies focused on racial and ethnic cancer disparities (
n
= 27) with breast cancer (
n
= 20) as the most common cancer site. Trust and satisfaction with the provider were the most prevalent issues cited in the patient-physician relationship. Differences in patient-physician communication practices and quality were also frequently discussed. Overall, studies highlighted the need for increased culturally congruent care among providers.
Conclusion
Results from this review suggest marginalized cancer patients face significant barriers in establishing culturally and linguistically congruent patient-physician relationships. Future studies should focus on the intersectionality of multiple marginalized identities and optimization of the patient-physician relationship.
We sought to assess variations in outcomes among patients undergoing resection for hepatocellular carcinoma (HCC) at centers with varied accreditation status.
Patients undergoing resection for HCC ...from 2004 to 2016 were identified from the linked SEER-Medicare database. Short- and long-term outcomes as well as expenditures associated with receipt of surgery were examined based on cancer center accreditation.
Among 1390 patients, 46.1% (n = 641) were treated at unaccredited centers, 39.3% (n = 546) at CoC-accredited and 14.6% (n = 203) at NCI-designated centers. Patients undergoing resection of HCC at NCI-designated hospitals had lower odds of complications (OR = 0.66, 95%CI: 0.45–0.98) and 90-day mortality (OR = 0.31, 95%CI: 0.11–0.85) after major liver resection compared with individuals treated at CoC-accredited centers. Receipt of surgery at NCI-designated hospitals (ref: CoC-accredited; HR = 0.81, 95%CI: 0.66–0.99) was an independent predictor of improved survival. Medicare payments for liver resection were comparable at different accreditation status centers (NCI: $21,760 vs CoC: $24,059 vs unaccredited: $24,724, p = 0.18).
Patients undergoing resection of HCC at NCI-designated hospitals had improved outcomes for the same level of Medicare expenditure compared with patients treated at CoC-accredited centers.
•Lower odds of complications were noted after HCC resection at NCI- versus CoC-accredited centers.•Surgery at NCI-designated hospitals was an independent predictor of improved survival.•Medicare payments were comparable at different accreditation status centers.
Vascular anomalies are a diverse group of lesions, ranging from simple to complex, disfiguring anomalies. Our objective was to diagnose and provide comprehensive treatment to patients presenting with ...vascular anomalies, using a multi-disciplinary approach involving dermatologists, plastic surgeons, radiologists and pediatric surgeons.
Patients presenting with vascular anomalies to The Indus Hospital, Karachi, from January 2017 to March 2019 were enrolled, using a pre-defined questionnaire. Assessment, diagnostic work up, management and clinical and photographic follow up was maintained to monitor outcomes.
One hundred eighty seven patients with a mean age of 4.6 years, (females 62%) were enrolled. Diagnoses included vascular tumors (n=89, 47.6%), lymphatic malformations (n=38, 20.3%), capillary malformations (n=19, 10%), venous malformations (n=16, 8.5%), arterio-venous malformations (n=14, 7.5%) and mixed anomalies (n=11, 5.9%). Treatment modalities, in isolation or combination, included oral propranolol, topical timolol, pulsed dye laser and intra-lesional sclerotherapy. Mean follow up was in 7.1 months, with 27 patients achieving treatment completion. 26 children were lost to follow-up.
Vascular anomalies have mostly been managed successfully at VAC using single or multimodal treatment. Increasingly complex anomalies can be handled using a multi-disciplinary approach. Establishment of VAC has facilitated many patients who were earlier considered as diagnostic and therapeutic challenges.
Purpose
We aimed to understand the challenges facing children’s surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children’s surgery.
...Methods
Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children’s Surgery (GICS) with a geographically diverse panel representing four children’s surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes.
Results
The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs.
Conclusion
Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children’s surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.
Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not ...have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological disease in human patients in this country. Of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 105 were positive for WNV IgM antibodies, and 71 of these patients possessed WNV-specific neutralizing antibodies. Cross-reactivity of WNV IgM antibodies with Japanese encephalitis virus (JEV) occurred in 75 of these 105 patients. WNV co-infections with Dengue viruses were not a contributing factor for the severity of disease. Nor did prior exposure to dengue virus contribute to incidence of neurological involvement in WNV-infected patients. Patients with WNV infections were more likely to present with altered mental status, seizures, and reduced Glasgow Coma scores when compared with JEV-infected patients. Human WNV cases and vector numbers exhibited a temporal correlation with climate.
Malocclusion has a negative impact on oral health related quality of life. Orthodontists in routine have focused on the clinical-centred measures of outcome for orthodontic treatment, but now, ...attention to patient-based assessment has greatly increased in dental research. The purpose of study was to determine oral health-related quality of life in adults with malocclusion and its relationship with perceived oral health status and satisfaction. This crossectional study was conducted at orthodontics department, de'Montmorency College of Dentistry, Lahore from January 2015 to May 2015. The sample comprised of 100 adults (34 males and 66 females) with age range of 18 25 years and willing to participate in the study. The oral examination was done by three examiners to assess severity of malocclusion according to Dental Aesthetic Index (DAI). Information regarding oral health-related quality of life was collected by using a self-administered questionnaire. The results of study showed that males have highest Oral Health Impact Profile related to psychological problems followed by social and physical impacts whereas in females the highest impact profile was observed on social impacts followed by physical and psychological impacts. Body Satisfactory Scale was almost double in females as compared to males. Mean values from grade 1 to 1V DAI for females were nonsignificantly increased as compared to males. It was concluded that most common Oral Health Impact Profile of malocclusion was psychological and social followed by physical discomfort in males whereas females show highest impact profile on social followed by physical and psychological impacts.
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