Clinic Status Research Articles

Clinical characteristics of patients admitted to Samsun Training and Research Hospital from the Turkiye-Syria earthquake region

Aims: After the two major earthquakes that occurred in the Türkiye-Syria region on February 6th, 2023, earthquake casualties presented to hospitals in various centers across the country. This study aimed to analyze the characteristics of the presentations made to the emergency department and outpatient clinics of our tertiary hospital from the earthquake region after the earthquake. Methods: A total of 1534 earthquake casualties who were admitted to the Samsun Training and Research Hospital emergency department and outpatient clinics with the diagnosis code X-34 were included in the study. The data of the patients were scanned retrospectively through the online system and age, sex, presentation date, clinic and hospitalization status were recorded. Results: The mean age of the patients was 24.6±25.9 (range: 0-98) years. Six hundred eighty-six (44.7%) patients were male, 441 (28.7%) were age under 18 years, and 1199 (78.2%) were admitted or brought to the emergency room or intensive care units (ICUs). A total of 210 (13.7%) patients were hospitalized after being admitted or brought to the hospital. No fatalities were recorded among the earthquake casualties who presented. A total of 730 (47.6%) patients were admitted to our hospital within the first 30 days after the earthquake. The highest presentation peak period was between days 5 and 9. The mean age in women, inpatients, patients presnting to outpatient clinics, and patients from Adana, Hatay, Kahramanmaraş and Osmaniye provinces was significantly higher than the other groups (p<0.001 for each). The rates of hospitalized patients were found to be significantly higher in women (p=0.002), patients presenting to outpatient clinics (p<0.001), and patients presenting within the first 30 days after the earthquake compared to other groups (p<0.001). The rates of patients presenting to emergency rooms or ICUs were significantly higher in men (p=0.011) and in those who presented within the first 7 days after the earthquake compared with the other groups (p=0.001). Conclusion: The findings obtained from our study indicated that the prognosis was good for earthquake casualties who presented to our hospital, which is far from the center of a major earthquake, that the highest number of presentations was between the 5th and 9th days, the period between the earthquake and the hospital admission was a determining factor in terms of the clinic presented and hospitalization, and the proximity to the center of the earthquake did not affect the prognosis in presentations. Our findings also show that the age group is an important factor in terms of the clinic of presentation, hospitalization, the period after the earthquake, and the province from which the presentation is made.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic.

During the COVID-19 pandemic, hypertensive patients had increased infection and healthcare disruption in many low- and middle-income countries (LMICs) with limited vaccine access. The objective of this report is to describe COVID-19 experiences and vaccination uptake among hypertensive patients in Colombia and Jamaica. A cross-sectional study of patients with hypertension was conducted in primary care clinics in both countries between 2021 and 2022. Trained interviewers used a telephone-administered questionnaire to assess COVID-19 experiences (infection, vaccination, and healthcare access). A total of 576 patients (68.5% female, mean age: 67.5 years) participated. Health service disruption affecting access to care was low (<10%). Compared to Jamaica, more participants from Colombia reported testing positive for COVID-19, having family members or friends testing positive, losing family members or friends due to COVID-19, and being vaccinated. In logistic regression models, adjusted for age, sex, education, and rural/urban clinic status, fear of COVID-19 (OR 2.7, 95% CI: 1.2-6.1) and residence in Colombia (OR 5.9, 95% CI: 2.4-14.6) were associated with higher vaccination uptake. Disparities in access to COVID-19 testing and diagnosis may have influenced these country differences including fear of COVID-19 and vaccine uptake. Other factors need to be better understood to prepare for future pandemic responses.

Effectiveness of Laboratory Tests in Tracking Severely COVID-19 Infections

Aim: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a virus that causes COVID-19 (Coronavirus Disease 2019), and poses serious difficulties in terms of healthcare systems and global public health. With the large number of publications on COVID-19, clinicians need a synthesis of evidence to provide guidance when dealing with patients with COVID-19. Emerging studies reveal the existence of numerous demographic, clinical, immunological, biochemical and radiographic data that may be useful for clinicians to predict the severity and mortality of COVID-19. The aim of this study; to determine laboratory parameters that can predict the course and severity of COVID-19 disease in patients, independently of the clinic status of selected patients and based on laboratory findings. Methods: This study is a retrospective cross-sectional study conducted at Karacabey State Hospital between January and April 2022. Among the patients who applied to the COVID-19 outpatient clinic, 469 patients (261 females, 208 males) over the age of 18 and positive for SARS-CoV-2 RT-PCR were included in the study. The patients were divided into groups as outpatients, inpatients and patients in need of intensive care (intensive care unit, ICU). Demographic data (age, gender), COVID-19 RT-PCR results, and simultaneous laboratory parameters of the patients were scanned retrospectively. Results: When CRP, urea, ferritin, LEU, NEU, MONO, RBC, HGB, HCT, MCV, NLR, PLR, CRP-NR, and SII index values were taken into consideration, a statistically significant difference was found between the groups. Creatinine, ALT, AST, LDH, troponin I, mass CK-MB, D dimer, LYM, EOS, PLT, ELR, and PNR values were not significantly different between the groups. Conclusion: Advantages of this study; Comparing the changes in the patient’s other laboratory findings based on a single positive PCR test result and finding meaningful rates in terms of serious covid risk. The disadvantage of this study is that it is a study independent of the patient’s clinic and disease stage. In this study, we found that particularly increased SII was associated with more severe disease progression in patients diagnosed with COVID-19 along with laboratory findings. CRP, urea, ferritin, and indexes such as NLR, PLR, CRP-NR, and SII index values can be used to predict the severity of the disease.

The primary health care environment and the performance of advanced antenatal care trained nurse-midwives in South Africa.

Transfer of learning in the workplace depends on various factors, one of which is the work environment. The aim of this study was to describe the interplay between the primary healthcare work environment, the performance of advanced antenatal care trained nurse-midwives, and birth outcomes. A cross-sectional, quantitative study was conducted in two purposely selected districts in South Africa. Document analyses were also completed. Statistical Analysis Software version 9.4 was used for descriptive statistical data analysis. The participating clinics, in the TM and LJ districts, both achieved ideal clinic status. The scores for the management of low- and high-risk pregnancies ranged between 86-89% and 87%, respectively. Babies born had Apgar scores of between 7-9 and 8-10 in 1 minute and 5 minutes after birth, respectively. Nurse-midwives scored low on interpreting assessment findings. Contrary to the Transfer of Learning Theory, nurse-midwives performed better in poorer work environments. The study suggests that the performance of advanced antenatal care trained nurse-midwives may not solely depend on a well-equipped work environment. Further studies should highlight the broader determinants of advanced antenatal care nurse-midwives services output.

851 Necrotising Otitis Externa Secondary to Ear Syringing in an Otherwise Healthy Patient: A Case Report

Abstract Introduction Unrelenting unilateral otalgia in an elderly or diabetic or immunocompromised patient is clinically suspicious for necrotising otitis externa (NOE). This is an advancement of normal diffuse OE that can complicate into a number of severe neurological pathologies, and it is becoming increasingly common1. We report a case here of NOE that became acutely apparent following ear syringing, due to the introduction of micro-organisms into the external auditory canal (EAC). Literature review shoes only 3 previous articles that have explored this pathological link. Case presentation A lady in her 90s with no known diabetes or immunocompromise, presented with a combination of otalgia, otorrhea and profound hearing loss. This plethora of symptoms had developed and persisted following ear syringing she underwent for chronic wax impaction. A diagnosis of NOE was made based on the clinical symptoms, presence of a polyp on the anterior aspect of the external auditory canal (EAC) as well as positive Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings. Prompt administration of intravenous (IV) antibiotics was initiated in addition to biopsy of the polyp to send for histological analysis. Her overall clinic status improved, and she was ultimately discharged with a prolonged IV antibiotic course alongside outpatient antibiotic team (OPAT) support and advice given on the avoidance of ear syringing/aural irrigation or at least a reduction in frequency of its use. Conclusions This rare case emphasises the significance of ear syringing in precipitating NOE by the transmission of Pseudomonas aeruginosa via irrigation fluid or lavage instrumentation.

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016-2021.

To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0-20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1-17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8-31.6% in patients aged 12-14 years) and decreased in a dose-response relationship by age to 8.4% (95% CI 7.4-9.4%) among patients aged 45-49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.

Validity and reliability of the hypoglycemia confidence scale for patients with type 1 diabetes

Background: This study aims to assess the validation and reliability of the Turkish adaptation of the Hypoglycemic Confident Scale and to investigate its relationship between the Hypoglycemia Fear survey, WHO Well-Being Index, Hba1c, sociodemographic characteristics and variables.&#x0D; Methods: The survey consists of a total of 81 questions concerning the sociodemographic status, clinic status variables, and the Hypoglycemic Confidence Scale formed by 35 standard questions and 46 scale questions. &#x0D; Result: In this study, assessment of the reliability of the scale was achieved by internal consistency and test-retest methods, and the Cronbach alpha internal consistency reliability coefficients were 0.814 in the first test and 0.885 in the second test. It was observed that the responses given to the items of the Hypoglycemic Confidence Scale at two separate times were consistent with one another. The overall correlation of the scale (r = 0.927, p &lt; 0.0001) was positive and highly significant (p &lt; 0001). A significant, inverse, and moderate correlation was found between HbA1c values and Hypoglycemic Confidence Scale total scores (p &lt; 0,0001, r = -0,479). Similarly, a higher hypoglycemic confidence score was observed to be associated with higher WHO Well-Being Index score and lower hypoglycemic fear. &#x0D; Conclusion: This study shows that the Hypoglycemia Confidence Scale created by Polonsky et al. is a valid and reliable scale that can be put into use in our country.1 The Hypoglycemic Confidence Scale may be beneficial in diabetic patient follow-up and achieving treatment goals in diabetic patients.

Feasibility and Implementation of an Oncology Rehabilitation Triage Clinic: Assessing Rehabilitation, Exercise Need, and Triage Pathways within the Alberta Cancer Exercise-Neuro-Oncology Study.

Individuals living with and beyond cancer face physical impairment and inactivity in survivorship. Neuro-oncology populations have especially high rates of sedentary behaviour and functional deficits, including impaired balance, motor skills, and cognition. Our purpose was to assess the rehabilitation and exercise needs of patients with brain tumours while examining the feasibility of a rehabilitation triage clinic as a part of the Alberta Cancer Exercise-Neuro-Oncology study, where patients were referred to a triage clinic, where health, neurologic, and functional status was assessed, followed by a referral to one or multiple resources, including exercise, physiotherapy, occupational therapy, or physiatry. Qualitative perception of the triage clinic was collected. Overall, the triage clinic was feasible and safe for participants, facilitating referral into rehabilitation and exercise resources. Pre-determined enrollment and attendance rates were met, but referral rates to the triage clinic were not met. Oncology clinic staff reported forgetting to refer patients or uncertainty of who was appropriate for rehabilitation as barriers. Oncology clinic-based screening may improve the identification of patients who are sedentary or have a physical impairment. A proposed screening tool, the Cancer Rehabilitation and Exercise Screening Tool (CREST), is presented within our Cancer Rehabilitation and Exercise Pathways Model. The CREST can identify patients who are sedentary or have a functional impairment, facilitating referral to appropriate rehabilitation resources and ultimately improving patient recovery and functioning.

Identification of Key Genes Related to Immune Cells in Patients with COVID-19 Via Integrated Bioinformatics-Based Analysis.

COVID-19 has spread all over the world which poses a serious threat to social economic development and public health. Despite enormous progress has been made in the prevention and treatment of COVID-19, the specific mechanism and biomarker related to disease severity or prognosis have not been clarified yet. Our study intended to further explore the diagnostic markers of COVID-19 and their relationship with serum immunology by bioinformatics analysis. The datasets about COVID-19 were downloaded from the Gene Expression Omnibus (GEO) dataset. The differentially expressed genes (DEGs) were selected via the limma package. Then, weighted gene co-expression network analysis (WGCNA) was conducted to identify the critical module associated with the clinic status. The intersection DEGs were processed for further enrichment analysis. The final diagnostic genes for COVID-19 were selected and verified through special bioinformatics algorithms. There were significant DEGs between the normal and COVID-19 patients. These genes were mainly enriched in cell cycle, complement and coagulation cascade, extracellular matrix (ECM) receptor interaction, and the P53 signaling pathway. As much as 357 common intersected DEGs were selected in the end. These DEGs were enriched in organelle fission, mitotic cell cycle phase transition, DNA helicase activity, cell cycle, cellular senescence, and P53 signaling pathway. Our study also identified CDC25A, PDCD6, and YWAHE were potential diagnostic markers of COVID-19 with the AUC (area under curve), 0.958 (95% CI 0.920-0.988), 0.941(95% CI 0.892-0.980), and 0.929 (95% CI 0.880-0.971). Moreover, CDC25A, PDCD6, and YWAHE were correlated with plasma cells, macrophages M0, T cells CD4 memory resting, T cells CD8, dendritic cells, and NK cells. Our study discovered that CDC25A, PDCD6, and YWAHE can be used as diagnostic markers for COVID-19. Moreover, these biomarkers were also closely associated with immune cell infiltration, which plays a pivotal role in the diagnosis and progression of COVID-19.

A98 ASSOCIATIONS BETWEEN DISTANCE TO CLINIC AND PATIENT CHARACTERISTICS FOR YOUNG ADULTS WITH IBD AT THE TIME OF PEDIATRIC TO ADULT TRANSFER OF CARE

Abstract Background Patients with inflammatory bowel disease (IBD) in childhood are a vulnerable population. Compared to patients diagnosed in adulthood, they may present more often with extensive disease, delayed growth, and more frequently have perianal disease. Eventually, these patients will transfer care from the pediatric to the adult system, which has been associated with medication nonadherence and increase in health care utilization. Within the literature, travel distance has been cited as a barrier to accessing health care; however, understanding its’ impact on this vulnerable patient population has not been well-established. Purpose The study objective was to characterize differences between patients transferring from pediatric to adult care based on distance from an IBD center. To achieve this, the study aims to measure associations between distance to clinic and smoking status, anxiety and depression, history of surgery, and biologics at the time of first appointment in adult care. Method A retrospective cross-sectional study is ongoing using electronic medical charts for patients who transferred from pediatric to adult care from January 1, 2014 – October 4, 2022. Transfer was defined as the patient’s first appointment in adult care at the University of Alberta’s IBD clinic. Distance was measured by driving distance from the patient’s postal code to the postal code of the IBD clinic. Distance was categorized as being &amp;lt;50km from IBD clinic and &amp;gt;50km. Binary outcome variables collected at time of transfer included reported biologic use, anxiety and depression, smoking status, and history of surgeries. Descriptive and inferential statistics were used to analyze data. Result(s) Of the 185 electronic medical charts were reviewed, 46 (24.9%) patients lived &amp;gt;50km from clinic. The median age at diagnosis for the &amp;gt;50km group was 14.5 (IQR: 15.9-13.6), 41% were female sex, 54% had Crohn disease, 41% had ulcerative colitis (UC), and 26% had completed a fecal calprotectin within the last 6 months. The median age at diagnosis of the 139 patients living &amp;lt;50km from clinic was 14.3 (IQR:15.9-12.5), 45% were female sex, 60% had Crohn disease, 32% had UC, and 59% had completed a fecal calprotectin. Of those who had a fecal calprotectin, in group 1, 26% had a result over &amp;gt;250 ug/g, compared to 60% in the reference group. Univariate analysis (Table 1) showed that those living further than 50 km were more likely than those closer to engage in daily smoking (OR~4.7). Weaker and lack of associations were seen with anxiety and depression (OR~1); being on biologics (OR~0.7); history of surgical intervention (OR~2.2). Image Conclusion(s) When smoking status was reported, patients &amp;gt; 50km away from clinic were 4.7 times more likely to engage in daily smoking at time of transfer compared to those patients within 50km from the clinic. By acknowledging and understanding potential differences and similarities between patients characterized by geographical location, we can use this research to inform personalized care plans. Disclosure of Interest None Declared

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Pre-Assessment Criteria for the Needs of Patients in Palliative Care: The Role of Palliative Care by Age Groups

Introduction: We aimed to define the characteristics of patients hospitalised in a palliative care unit and evaluate the role of palliative care services in the geriatric age group. The priorities and treatment approaches needed according to age groups were also evaluated. Materials and Methods: The records of patients aged 18 years and older who followed up with palliative care between 01/2020-12/2021 were reviewed retrospectively. Patients aged 18-64 were defined as “group-1”, patients aged 65-75 as “group-2”, patients aged 76-90 as “group-3”, and patients aged 91 and over as “group-4”. The patient’s age, sex, diagnosis, comorbidities, length of stay in the clinic, prognosis, pressure ulcers and immobilisation status were recorded and compared according to age groups. Results: A total of 560 patients were included. The mean age was 73.14±14.22 years, and 53.2% were women. 48.2% of patients were transferred to the palliative care unit from the intensive care unit. Groups-1, 2, 3, and 4 consisted of 139 (24.8%), 129 (23%), 254 (45.4%), and 38 (6.8%) patients, respectively. When patients were examined according to age group, there was a statistically significant difference between the groups in terms of sex, pressure ulcers, immobilisation, mean hospital stay in the palliative care, and prognosis (p=0.026, p≤.001, p=0.006, p≤.001, p≤.001). While 72% of patients were discharged from the palliative care unit, 28% died during admission. The prognosis was better in group-1 compared to other groups. Conclusion: Geriatric age and presence of chronic disease were the primary groups receiving palliative care. Access and integration of these patients to palliative care must be expanded. Keywords: Palliative Care; Geriatrics; Critical Care; Chronic Diseases; Health Services Accessibility.

CLINICAL SIGNS AND QUALITY OF LIFE ANALYSIS IN THE PATIENTS WITH HYPOTHYREOSIS AND CHRONIC PANCREATITIS.

Aim: To analyze the clinical condition and evaluate the quality of life of patients with a comorbid course of Ht and CP and patients with isolated CP based on the results of testing according to the GSRS and SF-36 questionnaires. Materials and methods: Were examined 62 patients with comorbid course of Ht and CP. The comparison group consisted of 48 people with isolated CP, the control group consisted of 30 healthy people, comparable in age and sex. The average age of all patients was (51.4±26.7) years. Two questionnaires were used in the study: the GSRS (Gastrointestinal Symptom Rating Scale) questionnaire was used to assess the severity of gastroenterological symptoms and QoL, and the general SF-36 questionnaire was used to assess the clinic and health status. Results: Analyzing the data of the GSRS questionnaire, it was found that in patients with a comorbid course of Ht and CP, reflux, pain and dyspepsia syndromes took the leading place in the clinic of the disease (p>0.05). They should be considered as the main factor in reducing the quality of life in patients with a comorbid course of Ht and CP. According to the GSRS questionnaire, the comorbidity of Ht and CP caused a complication of the clinical condition compared to patients with isolated CP of a gastroenterological patient: according to the scale of gastric reflux - by 48.57%, according to the scale of dyspepsia - by 35.84%, diarrhea - by 26.94%, constipation - by 19.93%, abdominal pain - by 40.81% (p<0.05). As a result of the study, a significantly lower level of quality of life was established in patients with a comorbid course of Ht and CP. Conclusions: It has been proven that the quality of life of patients with a comorbid course of Ht and CP was significantly lower compared to that of isolated CP (the total difference between groups on all scales of the GSRS questionnaire was 33.59% (p<0.05)). According to the SF-36 questionnaire, the overall quality of life of patients with a comorbid course of Ht and CP, compared to the group of patients with isolated CP, was reduced by 34.9% and 20.9% on the scales of physical and psychological health (р<0, 05).

Down referral and assessing comprehensive diabetes care in primary care settings: An operational research from India

In this study, we aimed to refer eligible (patients with stable blood sugar and without any history of cardiovascular events or proliferative retinopathy) and willing persons with diabetes (PwDs) to primary healthcare centers (PHCs) from tertiary care and to compare the care indicators. This before-after interventional study was conducted among PwDs aged ≥18 years at a tertiary care hospital in South India. Care indicators (regularity to the clinic, waiting time, and blood sugar control status) were assessed before down referral and after three months of follow-ups at PHCs. Of 204 PwDs referred to PHCs. Among them, 88% (n=180) registered at PHCs for care and 46% (n=94, 95% CI 39.1-53.2%) were lost to follow-ups at PHCs. The main reason for loss to follow-ups was the unavailability of medicines at PHCs(n=41, 44%). Among those who were on regular follow-ups at PHCs, there was no significant difference in fasting blood glucose (FBG) control status compared to tertiary (52%-64.6%, p=0.083). However, there was a significant improvement in the regularity of clinic visits (75% vs. 100%, p<0.001), consultation waiting time (90 vs. 60min, p=0.028), and waiting time at pharmacy queues (120 vs. 30min, p<0.001) between tertiary care and PHCs. However, among those registered at PHCs, only 40.6% (n=73, 95% CI 33.3-48.1) were willing to continue care at PHCs for their diabetes management. Primary care was better than tertiary care in terms of PwD's regularity of clinic visits and waiting time for care.

Challenges in antenatal care utilization in Kandahar, Afghanistan: A cross-sectional analytical study.

Quality antenatal care (ANC) is one of the four pillars of safe motherhood initiatives and improves the survival and health of mother and neonate. The main objective of this study was to assess the barriers in the utilization of ANC services in Kandahar, Afghanistan. This was a cross-sectional analytical study conducted over one year from December 2018-November 2019. Data were analyzed by descriptive statistics, Chi squared, and binary logistic regression. A total of 1524 women were recruited in this study with mean age of 30.3 years. Of these women, 848 (55.6%) were rural dwellers, 1450/1510 (96.0%) were illiterate, 438/608 (72.0%) belonged to low-income families, 1112/1508 (73.7%) lived in joint families, 1420/1484 (95.7%) lived in a house of >10 inhabitants, while 388/1494 (26.0%) had attended had at least one ANC visit during their last pregnancy. On univariate analysis, the main barriers in the utilization of ANC services were living in rural areas, being illiterate, having lower socio-economic status, remoteness of the health facility from home, bad behavior of clinic personnel, and unplanned pregnancy. Only lower socio-economic status and bad behavior of clinic personnel were independent explanatory variables in the regression model. Utilization of ANC services is inadequate in Kandahar province. Improving clinic staff professional behavior and status of women by expanding educational opportunities, and enhancing community awareness of the value of ANC are recommended.

INCREASED DISTANCE FROM THE CLINIC LEADS TO HIGHER LOSS TO FOLLOW-UP AFTER PARS PLANA VITRECTOMY IN DIABETIC PATIENTS.

The importance of consistent outpatient follow-up for management of diabetic eye disease has been well-established. The objective of this study was to identify patient factors associated with being lost to follow-up in postsurgical patients after undergoing pars plana vitrectomy for diabetic eye disease. The charts of diabetic patients undergoing pars plana vitrectomy for nonclearing vitreous hemorrhage at an academic medical center by a single surgeon between 2012 and 2019 were reviewed. The rates of loss to follow-up during the postoperative period were compared based on patient distance from the clinic and insurance status. A total of 144 patients met inclusion criteria. A total of 45 patients (31.25%) were lost to follow-up during the 3-month postoperative period. The rate of loss to follow-up increased with every postoperative visit and was significantly higher for patients living greater than 30 miles from the clinic versus patients living within 30 miles from the clinic. There was no statistically significant difference in loss to follow-up based on insurance status. Increased distance from the clinic presents a challenge to providing safe and effective postsurgical care to diabetic patients. This presents opportunities for comanagement or other creative strategies to improve postsurgical follow-up rates for at-risk patients.

Residential proximity to a fertility clinic is independently associated with likelihood of women having ART and IUI treatment.

Is geographic proximity to a fertility clinic associated with the likelihood of women of reproductive age undertaking different forms of medically assisted fertility treatment? After adjusting for socioeconomic status (SES) and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI treatment than those who lived further than 60 km away. In most countries, patients living outside of metropolitan areas are more likely to be more socio-economically disadvantaged and to have less equitable access to healthcare. However, how a woman's residential proximity to fertility clinics predicts utilization of high-cost/high-technology treatment (ART) and low-cost/low-technology treatment (IUI) is limited, and whether socio-economic disadvantage explains much of the hypothesized lower utilization is unknown. Australia's universal insurance scheme provides supportive reimbursement for almost all ART and IUI treatment regardless of age or number of cycles, providing a unique setting to investigate disparities in access to infertility treatment. National population-based observation study of ART and IUI treatment utilization by women across socio-economic gradients and Australian residential locations between August 2015 and December 2017. Universal insurance claims information on female patients who underwent ART or IUI were provided by Services Australia, comprising 67 670 female patients who accessed 162 795 ART treatments, and 10 211 female patients who accessed 19 615 IUI treatments over a 29-month period. Incidence rates by SES and proximity to fertility clinics were calculated to describe the number of women undergoing at least one ART or IUI treatment cycle per 1000 women of reproductive age (25-44). Treatment frequencies were calculated to describe the average number of ART or IUI treatment cycles per woman of reproductive age who had undergone at least one ART or IUI treatment during the study period. Poisson regression analyses were used to estimate the independent effect on accessibility to infertility treatment by geographic proximity (based on small area locations) to the closest fertility clinic after adjusting for SES, childbearing delay, remoteness area, and marital status. On average, 19.1 women per 1000 women of reproductive age underwent at least one fresh or frozen ART cycle, with an average 2.3 ART cycles each, while 3.0 women per 1000 women of reproductive age received at least one IUI cycle, with an average of 1.6 IUI cycles each. After adjusting for SES and other confounders including a proxy for the need for infertility treatment, women who lived within 15 km of a fertility clinic were 21% more likely to undergo ART treatment and 68% more likely to undergo IUI than those who lived over 60 km away. Regardless of geographic location, there was a steady and independent gradient in access to ART treatment based on increasing SES, with women residing in the most advantaged residential quartile having a 37% higher rate of receiving ART treatment compared to those in the most disadvantaged quartile. The negative effect of social disadvantage on ART use became more pronounced as distance from a fertility clinic grew, indicating that the barriers to access to ART care caused by distance were further compounded by the level of socioeconomic advantage of the women's residential location. In contrast, socioeconomic status did not modify the likelihood of using IUI over and above the distance from a fertility clinic. In relation to IUI treatment, differences in utilization by SES disappeared after adjusting for geographic proximity to a fertility clinic, childbearing delay, remoteness area, and marital status. Information is aggregated by small geographic areas and it therefore may not reflect individual characteristics. Australia provides partial but comparably supportive reimbursement for both ART and IUI through its universal healthcare system and thus the results may not be fully generalizable to other settings. Residential proximity to a fertility clinic is a persistent barrier to accessing ART and IUI treatment, regardless of SES, even in countries characterized by supportive public funding, such as Australia. SES is less of a barrier to accessing IUI than ART, presumably driven by the lower cost and fewer clinic visits required with IUI treatment. Safe and effective fertility treatment should be available to all women regardless of where they live. This work was supported by the Australian National University Research scholarship and by the Higher Degree Research Fee Merit Scholarship. The authors have no conflict of interest. N/A.

P17.14.B Strategy of the recurrent Glioblastoma treatment. Three neuro-oncology centers study

Abstract Background The prognosis for patients with Glioblastoma (GBM) remains dismal. The most aggressive multimodal therapy (maximally radical and safe tumor resection, followed by the Stupp protocol oncotherapy) has yielded the best treatment outcomes. Notwithstanding the slowly prolonged patient′s overall survival, this tumor inevitable recurs. An optimal therapy of the recurrent GBM is still a controversial theme.The aim of our study is to evaluate our treatment strategy of recurrent GBM. Material and Methods For this study, we retrospectively selected a group of resected recurrent GBM patients in a period from June 1, 2009 to December 31, 2019, which were treated in tree Czech neuro-oncologic centers. All patients underwent early post-surgical MRI (within 72 h) to determine resection radicality. Following resection, patients received periodic checkups with MRI every 3 months until death. Patients with psedoprogession were excluded. Information about all surgeries, oncotherapies, patient clinical condition, MRI, PET/CT, and results of histological, immunohistochemical, molecular genetic, and cytogenetic investigations was gathered.We consider surgery for recurrent GBM in case, if: 1.The tumor volume increasing &amp;gt; 20-30% or tumor rediscovery after radiologic disappearing. 2.Clinic condition - Karnofsky score (KS) ≥ 70% and Performance status (PS) WHO ≤ gr. 2. 3.Localized tumor, without multilfocality. 4.Assumed the least tumor volume reduction &amp;gt; 80%. Results We gathered 122 patients with recurrent GBM, 98,9% of tumors was determined as wild-type, age median was 53,36 years. All patients underwent Stupp protocol oncotherapy after prime surgery. Median of OS from prime surgery was 21 months (15.8, 29.6). The best results proved a surgery of GBM recurrency proceeding more than 6 months after diagnosis. OS2 (from redo up to the death) was 7.4 months (6.41, 11.3). 43.3% of patients recalled temozolomide chemotherapy. We confirmed positive link between OS and resection radicality, negative relations between OS and a postoperative neurologic deficits. Only limited relation was presented between OS and repeated oncotherapy. Relation to the further histologic, imunohistochemic, cytogenetic and molecular markers will be discussed. Conclusion Due to the common unfavorable outcomes of GBM therapy, out of despair, we often decided for repeated surgery. The aim of our study was avoid ineffective surgical overtreatment. The best results of surgery yield right selected recurrent GBMs. Surgery of GBM regrown during initial oncotherapy (6 months after prime surgery) presented unsatisfactory effects. Positive effect of the surgical radicality and clinic status were confirmed. Again, necessity of second-line oncotherapy has been emerged. Supported by Ministry of Health of the Czech Republic, grant nr. NV19- 04-00281 and grant nr. NU21-03-00195

Association of Title X clinic status with receipt of person-centered contraceptive counseling: A population-based study

To describe receipt of person-centered contraceptive counseling among reproductive-aged women in the United States who sought contraceptive care at Title X clinics, non-Title X public clinics, and private clinics. We conducted a secondary analysis of the 2017-2019 wave of the National Survey of Family Growth (NSFG). The sample included female respondents ages 15-49 who received contraceptive services in the past year and completed the Person-Centered Contraceptive Counseling (PCCC) measure, a quality metric evaluating interpersonal quality of the care received. We used multivariable logistic regression to estimate the predicted probability of receiving person-centered contraceptive counseling by source of care, adjusted for individual-level characteristics. Of 2225 (weighted n=26,599,620) eligible respondents, 6.9% received care at a Title X clinic, 8.2% at a non-Title X public clinic, and 84.9% at a private clinic. The adjusted predicted probability of receiving person-centered contraceptive counseling among respondents attending private clinics was 50.6% (95% CI 46.3%-54.8%) compared with 51.3% (95% CI 40.4%-62.3%) at Title X clinics and 52.4% (95% CI 44.0%-60.7%) at other public clinics. Respondents with incomes ≥300% above the federal poverty level (FPL) had higher odds of reporting receipt of person-centered counseling compared to those with incomes below 100% of the FPL (aOR=2.12; 95% CI 1.47-3.06). Non-Latina Black respondents had lower odds of receiving person-centered contraceptive counseling (aOR=0.69; 95% CI 0.51-0.94), compared to non-Latina white respondents. Title X clinics perform as well as the private sector in delivering person-centered contraceptive counseling. Title X clinics provide quality person-centered contraceptive counseling on par with the private sector, despite serving populations that are often less likely to report high quality care. Broad implementation of the PCCC measure will permit tracking person-centered contraceptive care across diverse practice settings and populations.

Abstract 5258: Mortality patterns among cancer survivors receiving care in dedicated survivorship clinics

Abstract Introduction: The number of deaths occurring among cancer survivors continues to be an outcome of concern. Our survivorship clinics provide risk stratification care for patients who have completed their curative treatment and are seen annually in a site-specific clinic. Here we describe mortality rates among adult patients receiving care in eleven site-specific survivorship clinics. Procedures: We conducted an analysis of 29,418 adult patients seen in our survivorship program from 2008-2021. Medical records were reviewed and categorized by each survivorship clinic. Eligibility criteria were: patients ≥18, treated for curative intent, completed their primary course of treatment, past the highest risk of recurrence, and transitioned based on site-specific survivorship algorithms. Descriptive statistics summarize the results. Results: There were 26475 survivors alive and 2943 deaths (Table 1). Of those alive, the greatest number were diagnosed with breast, genitourinary, and gastrointestinal malignancies. Death rates ranged from 2% to 38%, with the highest percent in stem cell transplant, head and neck, and gynecology malignancy survivors. 29% of deceased patients had died within one year of their transition from oncology care to survivorship clinics. Conclusions: Our results indicate differences in mortality risk among different cancer survivors; those who received transplants or were diagnosed with gynecologic or head/neck cancers had higher death rates. Survivors in these groups have short and long-term health risks which may require more proactive care. Current analyses are underway on the cause of death among patients who passed away within the first year of the transition to survivorship. Table 1. Total Number of Patients Seen by Clinic, Alive or Deceased Status, and Average Years Between First Appointment and Death (N=29418) Clinic Total No. No. Alive Percent Alive No. Deaths PercentDeaths Avg Years from First Appt to Death Breast 11972 11219 94% 753 6% 4 GI 837 787 94% 50 6% 3 GU 4264 3952 93% 312 7% 4 Gyn 1284 1175 91% 109 8% 4 Head &amp; Neck 2763 2482 90% 281 10% 3 Lymphoma 759 707 93% 52 7% 4 Melanoma 1234 1174 95% 60 5% 3 Sarcoma 87 85 98% 2 2% 1 Stem Cell Transplant 3141 1917 61% 1224 39% 1 Thoracic 489 461 94% 28 6% 2 Thyroid 2588 2516 97% 72 3% 4 Citation Format: Katherine R. Ramsey, Patricia H. Chapman, Guadalupe R. Palos, Maria A. Rodriguez. Mortality patterns among cancer survivors receiving care in dedicated survivorship clinics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5258.