BackgroundPre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms.AimTo investigate associations in bladder cancer between: first, pre-existing condition count and advanced-stage diagnosis; and, second, comorbidities that share symptoms with bladder cancer and advanced-stage diagnosis.Design and settingThis observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage.MethodIncluded participants were aged ≥40 years with an incident diagnosis of bladder cancer between 1 January 2000 and 31 December 2015, and primary care records of attendance for haematuria, dysuria, or abdominal mass in the year before diagnosis. Stage at diagnosis (stage 1 or 2 versus stage 3 or 4) was the outcome variable. Putative explanatory variables using logistic regression were examined, including patient-level count of pre-existing conditions and ‘alternative-explanations’, indicating whether pre-existing condition(s) were plausible diagnostic alternatives for the index cancer symptom.ResultsIn total, 1468 patients (76.4% male) were studied, of which 399 (35.6%) males and 217 (62.5%) females had alternative explanations for their index cancer symptom, the most common being urinary tract infection with haematuria. Females were more likely than males to be diagnosed with advanced-stage cancer (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] = 1.20 to 2.18; P = 0.001). Alternative explanations were strongly associated with advanced-stage diagnosis in both sexes (aOR 1.69; 95% CI = 1.20 to 2.39; P = 0.003).ConclusionAlternative explanations were associated with advanced-stage diagnosis of bladder cancer. Females were more likely than males to be diagnosed with advanced-stage disease, but the effect was not driven entirely by alternative explanations.

The aim of this study was to evaluate the current barriers associated with gynecologic care as perceived by women who use wheelchairs. MethodsThis qualitative study evaluated the barriers to gynecologic healthcare as described by female wheelchair users. We recruited English-speaking female participants aged 18 years and older who primarily used a wheelchair for mobility through flyer and email distribution. Interviews were conducted by three investigators using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. ResultsThe thematic saturation was achieved with 16 interviews. The most common barrier cited was transferring to the exam table (n=16). Women reported that their providers lacked knowledge and experience with women who use wheelchairs (n= 11). ConclusionThere are many barriers to gynecologic care for women who use wheelchairs. Interventions are needed to improve accessibility to care for women who use wheelchairs.

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Introduction There is a growing concern regarding the unprecedented increase in morbidity and mortality related to the use of opioids. Prescription opioid abuse has been increasing dramatically in recent years. Prescription opioids have been shown to be favorable in perioperative management, however, their impact on chronic usage remains unclear. As an effort to help reduce opioid consumption following hospitalization for burn injuries, we look to evaluate the outpatient opioid consumption following hospital discharge at our institution. Methods After IRB approval, we obtained demographics, medical history, inpatient and outpatient opioid usage, treatment, and length of hospital stay of patients admitted with burn injuries who met study inclusion criteria (age ≥ 12 years and no history of opioid abuse prior to hospitalization) from January 1, 2011 to January 1, 2018. Data was analyzed using SAS v9.4. Results Our preliminary data included 210 patients with average age of 58 years, 75% non-Hispanic Caucasians and average total burn surface area of 18%. Medical histories observed included: hypertension (40%), diabetes (15%), hyperlipidemia (11%), depression (7%), and bipolar disorder (3%) among many others. 79% of patients had surgical intervention including excision and grafting, of which 32% had autografting procedures. All patients were treated with opioids during hospitalization, which included: fentanyl, hydromorphone, oxycodone-acetaminophen, morphine and oxycodone. 6% of patients had pain management consultation during hospitalization. 79% of patients were discharged with an opioid prescription, of which 21% had their opioid refilled during follow-up. There was no statistically significant difference in discharge opioid prescriptions (79% had surgical intervention versus 76% had no surgical intervention, p=0.69) and outpatient opioid prescription refills (17% had surgical intervention versus 17% had no surgical intervention, p=0.99) between patients who had surgical intervention for burn injuries versus those who did not. Conclusions This evaluation shows that there is no statistical difference in opioid usage between patients who had surgical intervention and those who did not for their burn injury treatments. Therefore, prescription opioids may not be necessary in postoperative care following hospital discharge. Applicability of Research to Practice With further research, we hope to evaluate the need for outpatient opioid prescriptions this treatment modality in effort of decreasing the order and use of opioids following hospital discharge in burn patients.

INTRODUCTION: Individuals with disabilities face significant barriers to healthcare and are at a higher risk of receiving inadequate care. Specifically, women with disabilities are more likely to be behind on routine screening examinations including Pap tests and screening mammography. This project aims to identify and explain the barriers that prevent female wheelchair users from obtaining standard gynecologic health care. METHODS: This IRB approved qualitative study was conducted to evaluate the barriers associated with seeking gynecologic health care among female wheelchair users. We recruited English-speaking female participants ages 18 and older who primarily used a wheelchair for mobility through flyer distribution and word of mouth. Interviews were conducted by a single investigator using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. RESULTS: The thematic saturation was achieved with sixteen interviews. The most common barrier cited was lack of proper positioning on the exam table to perform a pelvic exam (n=13). Furthermore, another common theme was that women felt that their providers lacked knowledge and experience with women who use wheelchairs (n=13). CONCLUSION: There are many barriers to OB/GYN care for women who use wheelchairs. This study has identified how current knowledge, attitudes, practices, and existing infrastructure serve as barriers to gynecologic care. Interventions are needed to improve accessibility to care for women who use wheelchairs.