Patients with end-stage renal disease (ESRD) should choose a treatment modality, such as hemodialysis (HD) or conservative medical management (CMM), to improve their symptoms with the goal of attaining a good quality of life (QOL), a concept highly aligned with palliative care principles. This article aims to answer if elderly patients with ESRD have improved QOL with CMM compared with HD. Conservative medical management focuses on managing symptoms, rather than invasive procedures such as HD, with more focus on holistic care. Research concludes that CMM in elderly patients with ESRD leads to a maintained QOL at the expense of a reduced survival rate compared with those who are treated with dialysis. A patient's wishes regarding QOL need to be considered when choosing a treatment modality; integrating palliative care as an extra layer of support can help providers, patients, and caregivers decide and implement the treatment that best aligns with the patient's health care goals.
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Obesity in the pediatric population is increasing with 19.3% of adolescents having a body mass index (BMI) at or above 95th percentile. Childhood obesity impacts physical and psychological health, increasing the risk of developing various diseases. Studies show that prevalence of gender diverse (GD) adolescents is increasing and is estimated to be 7 per 1000 in the US. GD adolescents are at increased risk for cardiovascular disease and mental health disorders. GD adolescents who are diagnosed with obesity are at an increased risk for poor health outcomes. There is a lack of research regarding the prevalence of obesity and the impact of hormone therapy in GD adolescents. A retrospective chart review was conducted at Renown Regional Medical Center in Reno, NV. A total of 119 adolescents, aged 8-21, diagnosed with gender dysphoria prior to June 2021, were enrolled using ICD-10 codes. Patient demographics including age, sex assigned at birth, gender identity, BMI, and use of puberty blockers or hormone therapy were retrieved. Patients were categorized into two groups - no treatment and treatment with puberty blockers and/or testosterone. Average change in BMI was calculated. Fisher exact tests were conducted using SAS version 9.4. Nineteen of the 119 GD patients enrolled were classified as obese using age and sex appropriate BMI charts (15.9%). Thirteen participants were assigned female at birth (AFAB) and six were assigned male at birth (AMAB). Of these participants, 12 had no medical interventions and 7 were treated with puberty blockers and/or without testosterone. No participants received estrogen therapy. The average change in BMI was +1.84 (no treatment group) and + 3.70 (treatment group). The average change in BMI for AFAB participants was +2.24 and +3.16 for AMAB participants. Association of obesity with treatment compared to no treatment was not found to be statistically significant (p=0.4125). The prevalence of obesity in this population was similar to the prevalence of obesity in non-GD adolescents regionally. In Nevada, obesity in adolescents age 10-17 increased from 12.9% to 16% from 2018-2021. We expected to observe a higher prevalence of obesity in the adolescent GD population compared to the non-GD pediatric population. Additionally, we expected to see a greater increase in BMI in the group of GD patients receiving treatment. Although the results were not statistically significant, patients undergoing treatments did experience a greater average increase in BMI compared to those who had no medical intervention. The lack of statistical significance is likely due to having a small sample size. Further research is needed to observe obesity trends in adolescent GD populations, as well as the effects of hormone therapy on BMI. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
Background: Implementation of genomic assays has led to treatment of early-stage breast cancers with high risk of recurrence with adjuvant systemic chemotherapy while sparing those with a low risk of recurrence from systemic therapy with minimal benefit. Genomic assays are becoming a more widely used tool, evident by the eighth edition of the American Joint Committee on Cancer (AJCC) Breast Cancer Staging System, which includes recurrence score as part of the treatment algorithm in certain subgroups of tumors. Our institution identified the time to assay result as a quality improvement opportunity. We instituted a protocol to have a reflex testing of Oncotype DX based on certain criteria to decrease time to assay results and ultimately time to treatment. Methods: Our Multidisciplinary Breast Leadership Committee instituted a policy for reflex Oncotype DX testing on patients under the age of 70 with estrogen receptor positive, HER2-neu protein–negative, and node-negative invasive breast cancers measuring between 0.5 cm to 5 cm in January 2018. We compared our data available from pre- and postimplementation using the single factor analysis of variance (ANOVA) as well as an independent t-test and a post-hoc Tukey-Kramer test. Results: We have observed 45 cases that met the criteria for reflex Oncotype Dx testing since the initiation of this quality improvement protocol. The recurrence scores ranged from 0 to 55. There was a statistically significant difference in the number of days from operation to result day from 2016 to 2018 (55 days vs 18 days; P<.001). The number of days from the test order date to result date also saw a significant improvement from 2016 to 2018 (12 vs 9 days; P<.05). Conclusions: Breast cancer treatment options continue to evolve, particularly with the use of genomic assays. Our single institution review confirms the utility of our reflex Oncotype DX protocol with a decreased time to result with reflex testing of patients in the appropriate clinical setting. Further development of similar pathways may be necessary to streamline our patients’ care in the treatment of breast cancer.
In the United States, one out of every four adults is living with at least one chronic disease. Treatment of these chronic conditions accounts for 84% of healthcare spending. Successful treatment of chronic diseases involves support from family, the community, and the healthcare system. In this descriptive report, we outline the beginning steps of implementing a new program aimed at addressing a pervasive chronic disease in the population seen at our student-run clinic. The Rowan University School of Osteopathic Medicine’s Camden Community Health Center in conjunction with the Camden Area Health Education Center gathered information from a community needs assessment and focus group to better direct efforts at optimizing healthcare delivery to the priorities of the community. After collecting the data, a chronic disease management pilot program targeting patients with chronic hypertension was created. The program included a course run over a six-week period, in which a peer-run educational group focused on lifestyle changes and medical management of hypertension. This plan utilized community health workers, a “buddy system,†and family support. At the end of the program, participants were provided with a weekly blood pressure log, action plan for their disease management, and specific follow-up appointments. Furthermore, we briefly share preliminary data that allowed us to gauge success of the pilot program and form the basis for a larger, more comprehensive follow-up study.
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