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Primary Care Clinician Perspectives on Barriers to Postpartum Transition to Primary Care.
No full textBackground: The transition from obstetric to primary care is often suboptimal, particularly for individuals with barriers to accessing care. We aimed to understand experiences of primary care clinicians regarding provision of care and their perceptions of barriers to the transition of care in this critical period. Methods: We conducted focus groups with primary care clinicians recruited from diverse, urban health care settings, including an academic medical center, private practice, and federally qualified health centers. Groups were conducted in person or virtually (December 2019 to February 2021) using a semi-structured approach. Data were analyzed using the constant comparative method to identify themes regarding barriers to providing primary care to postpartum individuals. Results: The study included 28 primary care clinicians (26 physicians and two advanced practice providers) who participated in eight focus groups. Clinicians identified multiple barriers to the successful transition from obstetric to primary care in the postpartum period. Clinician-based barriers included the lack of a clear hand-off from the obstetric care team and limited capacity to adequately address social determinants of health. Clinician perceptions of patient-based barriers included adverse social determinants of health such as lack of childcare and financial and transportation limitations, challenges addressing ongoing health needs (such as persistence of postpartum medical conditions), and limited health care engagement. Conclusions: Our results illustrate multiple complex and interrelated challenges to providing optimal primary care during and after the postpartum period that are related to a fragmented health care system, suboptimal support for complex social needs, and insufficient communication between obstetric and primary care clinicians
Detection of MRD positivity as an indicator of CNS relapse in AML and therapeutic approach.
No full textAcute myeloid leukaemia (AML) poses intricate diagnostic and therapeutic dilemmas. This report delves into the infrequent manifestation of central nervous system (CNS) involvement in AML, an elusive facet of the disease\u27s clinical spectrum. We present the case of a young female who attained morphological remission following induction therapy and an allogeneic haematopoietic stem cell transplant (HSCT). Intriguingly, despite the absence of morphological AML in the bone marrow, persistent minimal residual disease (MRD) positivity led to a comprehensive evaluation, ultimately revealing CNS leukaemia. Effective treatment for CNS leukaemia, including intrathecal methotrexate, chemotherapy and craniospinal irradiation, was administered. After achieving remission, a second HSCT was performed, and she currently receives maintenance therapy. This case underscores the intricate diagnostic landscape of CNS leukaemia in AML and prompts inquiries about the potential nexus between MRD positivity and extramedullary disease
Expert Perspectives on Controversies and Critical Knowledge Gaps in Breast Cancer Management: Proceedings of the First Bridging the Gaps in Breast Cancer Symposium.
No full textPURPOSE: Breast cancer is the most common type of cancer for women in the United States and accounts for nearly 25% of all cancers and 16% of cancer deaths worldwide. New treatment options continue to emerge offering improved management options for patients with breast cancer. However, as these new treatments become available, clinicians are left with many questions regarding how to best utilize these treatments and improve outcomes for patients with breast cancer.
MATERIALS AND METHOD: The Bridging the Gaps in Breast Cancer panel was assembled to address challenges in the management of breast cancer. Bridging the Gaps in Breast Cancer co-chairs and session moderators identified areas of controversy and uncertainty in breast cancer management and were responsible for organizing the presentations and discussion with the expert panel of faculty throughout the meeting.
RESULTS: The Bridging the Gaps in Breast Cancer panel discussions are presented. Key critical knowledge gaps surrounding the evolving breast cancer treatment landscape identified include how to identify which patients will benefit the most from therapeutic intervention, the mechanism of resistance to newly approved therapies, which therapies may be safely omitted from a treatment regimen without harm to the patient, and the most important metric(s) in defining successful treatment in various stages and subtypes of breast cancer.
CONCLUSIONS: The treatment armamentarium for the management of breast cancer continues to grow and evolve. With those new treatment options, new questions continue to arise for clinicians. Future studies are needed to address these critical gaps in knowledge about how to best utilize treatments for improved patient outcomes
The Impact of RN Resident Saturation on Patient Outcomes and Experience in a Large Hospital System.
No full textOBJECTIVE: The aim of this study was to investigate the relationship between new graduate RN (NGRN) saturation and nurse-sensitive patient outcomes and experiences.
BACKGROUND: Many nurse leaders believe that the number of NGRNs should be limited to ensure high-quality care. To our knowledge, there is no previous evidence quantifying the impact of NGRNs\u27 saturation on patient outcomes.
METHODS: Researchers analyzed nurse staffing metrics and patient outcomes from 79 distinct medical-surgical units within 22 hospitals, from 2017 to 2022. Outcomes included fall rates, catheter-associated urinary tract infections, central line-associated bloodstream infections extracted from the electronic health record, and patient experience metrics collected via survey.
RESULTS: The researchers identified no statistically significant relationships between NGRN saturation and patient outcomes or experiences.
CONCLUSIONS: These findings do not support limiting the number of NGRNs on medical-surgical units out of concern for negative impact on nurse-sensitive quality of care outcomes
Errors Between Reported Equations and an Excel Calculator for Computing Cardiac Biometry and z-Scores Between 18 and 34 Weeks of Gestation.
No full textEffect of HLA restriction on racial and ethnic disparities in access to immune therapies for advanced synovial sarcoma.
No full textPurpose: Synovial sarcoma (SS) is aggressive with poor outcomes. Cellular therapies are now FDA-approved for advanced disease, but are restricted to certain HLA-A*02 alleles. We estimate eligibility for cellular therapies by race and ethnicity.
Materials and methods: Demographic and clinical features of SS cases from 2001 to 2020 were obtained from the United States Cancer Statistics (USCS; NPCR-SEER). Survival analyses were performed overall and by race/ethnicity. The proportion eligible for cellular therapy was estimated by race/ethnicity using previously published data on HLA-A*02 status and MAGE-A4 positivity.
Results: From 2001 to 2020, 10 605 patients (48% female, 64% Non-Hispanic White, 17% Hispanic) with SS were identified. The incidence rate was 1.5-1.8/million/person-years and was stable over time, corresponding to an average of 530 new cases annually. The most common primary site was the extremity (n = 5877; 58%), and most patients presented with localized disease (n = 5753; 54%). The 5-year cause-specific survival was 60% across all races/ethnicities and 79% for localized, 57% for regional, and 12% for distant disease. Differences by race and ethnicity were found in the proportions of patients expected to be eligible for HLA-restricted cellular therapies targeting MAGE-A4. People of European/European descent had the highest estimated proportion (25%-39%), and people of Asian/Pacific Islander descent had the lowest (11%-17%).
Conclusion: Engineered T-cells targeting MAGE-A4 have shown encouraging safety and efficacy in advanced SS; however, eligibility restrictions will lead to racial and ethnic disparities. HLA-independent solutions must be developed to counter disparities and ensure all patients have access