Background: Some research has been done into using mobile phones as a means of communication with patients. It has been shown to improve medication adherence among chronically ill patients. As of December 2012 , more than 89% of the US inhabitants have mobile broadband subscriptions .This opens up the potential for Smartphone applications and also patient portals, above and beyond text messaging for patient communication. Objectives: To assess the readiness, interest and barriers of low income minority patients with diabetes mellitus (DM) and cardiovascular disease (CVD) towards adopting 1) Text messaging , Smartphone applications , Patient portals as means of communication with providers. 2)Compare technology adoption in immigrant versus non-immigrant populations. Methods: This study is part of the Office- Guidelines Applied to Practice (Office-GAP) project, designed to improve secondary prevention of heart disease for DM and CVD patients in FQHCs (Federally Qualified Health Centers) in Michigan. We analyzed 119 out of the 242 patients that participated in Office-GAP group visits (June 2013-January 2014) and completed the questionnaire. The questionnaire evaluated their readiness , interest and barriers towards electronic means of communication . Chart abstraction was performed for relevant data by trained research assistants. Descriptive analysis was performed on the cross sectional data thus obtained. Results: Study population is 53 % (63 of 119) non-immigrant , 47% (56 of 119) immigrant. Mean age is 53.69 (33.07% males) and 57.1% (68 of 119) of our patient population has a cellphone with non-immigrants having higher access (74.6 vs 37.5%) compared to immigrants. Text messages can be sent and received by 37.8% (45 of 119) with 21.1% (25 of 118) having to pay extra charges for texts and 25.7% (30 of 117) want texts from the doctors office. A landline is available to 54% (64 of 119) and 48.2% (56 of 116) want voicemails. Out of our population with both a landline and cellphone 57 %(60 of 106) prefer landline. Only 10 % (12 of 119) of our population can use a computer very well and 55% (65 of 119) cannot use a computer at all , 35%(42 of 119) have access to internet and email and 52.3%(22 of 42) want emails from their doctors office. Seven percent (4 of 58) would like to have access to their medical information online by means of a patient portal. Three percent (2 of 58) have a smartphone and 1.7% (1 of 58) would like a Smartphone application for accessing their medical records. Conclusion: Minority and low-income patients with DM and CVD may eventually be ready for adopting more technology as a means of communication with their provider as technology gets cheaper and trivialized . Current readiness and interest to adoption is lower among immigrant compared to non immigrant population. More research is needed to determine the barriers to adopting technology for secondary prevention of heart disease.
646 Background: Multiple studies have shown the superiority of biliary metal compared with plastic stents for pre-operative (preop) biliary drainage in pancreatic cancer (PDAC). Despite the importance of preop cross-sectional imaging, particularly in the era of neoadjuvant treatment, there is no data on the impact of such stents on the quality of preop cross-sectional imaging. We hypothesis, that biliary metal stents negatively impact the accuracy of preop cross-sectional imaging in pancreatic cancer, with unknown impact for the adequacy of surgical candidacy. Methods: Data of all patients undergoing pancreatic resection for PDAC between 1/1/2012 and 1/1/2018 was retrospectively abstracted. Clinical staging based on preop cross-sectional imaging following biliary stent placement (within 2 months prior surgical resection) was compared with the surgical pathology (staging gold standard). Accuracy of clinical and surgical pathology staging was compared. Logistic regression was performed to control for biliary stent type, neoadjuvant treatment and patient baseline characteristics including BMI and type of imaging. Results: 312 patients underwent pancreatic resections. 118 patients required preop biliary drainage in setting of PDAC, including 92 ERCPs of which 83 were successful (46 plastic and 37 metal stents). 76 patients underwent neoadjuvant chemoradiation therapy. Surgical pathology revealed following stages: 0 n = 4, 1A n = 5, 1B n = 8, 2A n = 20, 2B n = 24, 3 n = 1, 4 n = 14. 96% underwent preop CT and 4% MRI pancreas protocol imaging. Exact correlation between clinical and surgical pathology was present in only 48% of cases (57% plastic, 46% metal stent), with 28% of clinical T overstaging, 4% clinical T understaging, 16% clinical N understaging and 4% unable to stage due to artefacts. More importantly, 8% patients were incorrectly staged to be surgical candidates (14% plastic, 6% metal). Controlling for stent type, neoadjuvant treatment and BMI did not impact preop cross-sectional imaging accuracy. Conclusions: Despite their impact on preop cross-imaging biliary metal stents did not negatively impact the accuracy and patient selection for surgical candidacy compared with biliary plastic stents in PDAC.
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