BACKGROUND The incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in the United States. However, the increases in different racial and socioeconomic groups have not been homogeneous. Access to healthcare based on socioeconomic status and cost of living index (COLI), especially in HCC management, is under characterized. AIM The aim was to investigate the relationship between the COLI and tumor characteristics, treatment modalities, and survival of HCC patients in the United States. METHODS A retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HCC between 2007 and 2015 using site code C22.0 and the International Classification of Disease for Oncology, 3rd edition (ICD-O-3) codes 8170-8173, and 8175. Cases of fibrolamellar HCC were excluded. Variables collected included demographics, COLI, insurance status, marital status, stage, treatment, tumor size, and survival data. Interquartile ranges for COLI were obtained. Based on the COLI, the study population was separated into four groups: COLI ≤ 901, 902-1044, 1045-1169, ≥ 1070. The χ 2 test was used to compare categorical variables, and the Kruskal-Wallis test was used to compare continuous variables without normal distributions. Survival was estimated by the Kaplan-Meier method. We defined P < 0.05 as statistically significant. RESULTS We identified 47,894 patients with HCC. Patients from the highest COLI areas were older (63 vs 61 years of age), more likely to be married (52.8% vs 48.0%), female (23.7% vs 21.1%), and of Asian and Pacific Islander descent (32.7% vs 4.8%). The patients were more likely to have stage I disease (34.2% vs 32.6%), tumor size ≤ 30 mm (27.1% vs 23.1%), received locoregional therapy (11.5% vs 6.1%), and undergone surgical resection (10.7% vs 7.0%) when compared with the lowest quartile. The majority of patients with higher COLIs resided in California, Connecticut, Hawaii, and New Jersey. Patients with lower COLIs were more likely to be uninsured (5.7% vs 3.4%), have stage IV disease (15.2% vs 13%), and have received a liver transplant (6.6% vs 4.4%) compared with patients from with the highest COLI. Median survival increased with COLI from 8 (95%CI: 7-8), to 10 (10-11), 11 (11-12), and 14 (14-15) mo ( P < 0.001) among patients with COLIs of ≤ 901, 902-1044, 1045-1169, ≥ 1070, respectively. After stratifying by year, a survival trend was present: 2007-2009, 2010-2012, and 2013-2015. CONCLUSION Our study suggested that there w...
Disparities have emerged as an important issue in many aspects of healthcare in developed countries and may be based on race, ethnicity, sex, geographical location, and socioeconomic status. For liver disease specifically, these potential disparities can affect access to care and outcome in viral hepatitis, chronic liver disease, and hepatocellular carcinoma. Shortages in hepatologists and medical providers versed in liver disease may amplify these disparities by compromising early detection of liver disease, surveillance for hepatocellular carcinoma, and prompt referral to subspecialists and transplant centers. In the United States, continued efforts have been made to address some of these disparities with better education of healthcare providers, use of telehealth to enhance access to specialists, reminders in electronic medical records, and modifying organ allocation systems for liver transplantation. This review will detail the current status of disparities in liver disease and describe current efforts to minimize these disparities.
Background:Acute gastroenteritis (AGE) is a common reason for emergency department visits and hospitalizations. The role of antibiotics in AGE is unclear, as the current literature shows only a minor impact on the duration of symptoms and the overall clinical course. Our goal was to assess whether antibiotic therapy in patients with AGE affects the length of hospital stay (LOS).Methods:In a retrospective study, we evaluated 479 patients admitted to the hospital with a diagnosis of AGE. The study compared the 219 patients (46%) treated with antibiotics to the remainder treated with supportive therapy. The diagnosis of AGE was made either clinically or based on imaging findings. The primary outcome of this study was to compare the LOS in days between both groups.Results:Patients treated with antibiotics had a similar LOS to those treated with supportive therapy (2.62 vs. 2.66 days, P=0.77). Patients with presumed sepsis had a higher likelihood of receiving antibiotics compared to those without presumed sepsis (risk ratio 1.49, 62.5% vs. 41.95%; P<0.001). In this subgroup, patients who received antibiotics had a slightly shorter LOS than those who received only supportive therapy, but the difference was not statistically significant (2.09 vs. 2.54 days, P=0.69).Conclusion:We found no difference in the LOS for hospitalized patients with AGE treated with antibiotics when compared to supportive therapy. This calls into question the role of antibiotics in the management of AGE.
INTRODUCTION: The DDW is an international gathering of physicians around the globe in the fields of GI. Collectively sponsored by few of the largest GI societies. Nowadays, social media is widely used to deliver information and business marketing. Twitter is a social network site that rapidly gained worldwide popularity. With over 300 million users, and over 500 million Tweets sent daily, there is a great opportunity to spread ideas to a global audience. In this study, we are aiming to analyze the use of Twitter during DDW. METHODS: The Symplur Signals, a specialized healthcare social media analytics platform was used to analyse the hashtag #DDW19, the official hashtag of the DDW 2019 meeting. The analysis was conducted on tweets during the meeting days between May 18-21, 2019. The number of tweets, participants, impressions, average tweets per hour and average tweets per participant was determined. Advanced search on Twitter was also conducted using the hashtag #DDW19 with time frame between May 18-21. The resulted tweets were sorted by category “top tweets”. The top 50 tweets were categorized by content to scientific, social, administrative, industry promotion, or irrelevant. RESULTS: DDW 2019 had over 14,000 attendees from around the world. The number of people who participated in the hashtag #DDW was 3,924 (28% of the attendees) sending 15,350 tweets during the meeting days, with an average of 4 tweets per participant and 160 tweets/hour, leaving 71.594 million impression. The hashtag activity reached a peak of 4,815 tweets on the 2nd day of the meeting, May 19th. 60% of the top tweets were from physicians, 10% by medical journalist, and 30% by medical society/organizations. 42% of the top 50 tweets had social content such as group photos or appreciation of other presenters. Whereas 40% were scientific content. However administrative tweets were 10%. Only 8% of content was industrial promotions. There were no irrelevant tweets. CONCLUSION: Social Media has become the most effective medium to reach an enormous audience. With over 71 Million impressions produced during the recent DDW. Twitter has successfully promoted the event worldwide and disseminated medical information in a quick and cost-effective method. It has communicated to millions of individuals, including non-medical professionals, in a way that is difficult for traditional media sources to achieve. In order to create a more informative and influential post, it is encouraged that users tweet more on scientific and medical contents.
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