Rural Centers Research Articles

Quality of Life before and after Radiotherapy in Head and Neck Squamous Cell Cancer Patients Measured Using an Updated Head-Neck Specific EORTC QLQ-H&N43 at a Rural Tertiary Cancer Care Center

Background Quality of life (QOL) in head and neck squamous cell cancer (HNSCC) patients from rural area is sparsely studied. Aim of this study was to evaluate the QOL before (pre-) and at first follow-up after radiotherapy (RT) (post-RT) in patients of HNSCC at a rural tertiary cancer care center (RTCCC). Materials and Methods This analytical study commenced after an institutional ethics committee approval included HSCCC patients registered at a RTCCC from June 2019 to January 2022. Marathi version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ), EORTC QLQ-C30 (v3.0), and an updated head-neck specific EORTC QLQ-H&N43 were served to the eligible patients pre- and post-RT. Clinicodemographic details were collected from prospectively maintained hospital records. Graph-Pad, Instat-3 (California Inc) was used for statistical analysis. Effect size and minimal important change were noted. Results A total of 100 patients completed both the pre- and post-RT (6–18 weeks post-RT) QLQ. Median age was 53 years (range: 30–78 years) and man to woman gender ratio was 4.56:1. Majority of the patients were farmer (46%), tobacco users (92%), and from middle socioeconomic class (57%). Oral cavity was the most common subsite involved (62%) and majority presented in locally advanced stage (82%) of disease.Global health status improved significantly after treatment with a large effect size (ES = –0.84). QOL was significantly improved after treatment except for parameters depicting treatment-related toxicities, that is, dryness of mouth and sticky saliva (ES = –1.75), problem with senses (ES = –1.31), and skin (ES = –1.38).Coronavirus disease pandemic and limitations of QLQ were few shortcomings of this study. Conclusion There is considerable improvement in QOL in HNSCC patients post-RT except for the treatment-related toxicity domains.

Does digital technology service foster income gains in rural villages? Evidence from China’s third agricultural census

The application of digital technology service like rural e-commerce service centers (RESCs) has captured considerable attention in China, but existing literature has not yet provided solid empirical evidence regarding its potential to foster rural income gains. Utilizing large-scale survey data from the Third National Agricultural Census (TNAC) of China, this study attempts to investigate the impact and underlying mechanisms of RESCs on income gains across 49,135 villages. The results indicate that RESCs significantly increase village income gains in rural China, which confirm the theory of “space of flows.” In addition, heterogeneity analysis reveals that this income increasing effect is significantly higher in eastern China, as well as in rural villages with migrant populations and college-graduate cadres. The conclusion remains robust even after conducting several robustness checks and instrumental variable estimation. Furthermore, mechanism analysis unveils that RESCs improve village income gains by promoting characteristic agricultural development, encouraging entrepreneurship, and enhancing government funding support. The findings shed light on policy implications for the design and implementation of rural digital technology policies in developing countries.

Pattern of Eye Disease in Nenwe Rural Eye Clinic, Nigeria: A Seven Year Review

Background: The establishment of eye clinics in the form of rural outreach centers as a means of educating and providing eye care to rural residents was made necessary by the lack of eye care services in rural areas within Nigeria and the need to increase the cataract surgical rate among ophthalmologists in training. Understanding patterns of eye diseases in rural areas and eye health-seeking behaviors is crucial to achieving the goals of Vision 2020 especially for aspiring ophthalmologists. Aim and objectives: To examine the types of eye conditions observed at Nenwe, a rural outreach post of a tertiary hospital, and to evaluate their distribution. Methodology: A retrospective analysis of all patients who were seen at the community eye clinic during seven years was carried out. Records of patients at the Nenwe outreach eye clinic dating from November 2016 to August 2023 were examined, yielding information on patients examined during the period of study. Results: Glaucoma was the most common eye condition to be diagnosed. Cataracts were the second most common eye condition accounting for 20.8%. Other common eye illnesses were refractive error (9%), pterygium (7%), and allergic eye disease (6%) with 129, 101, and 95 cases, respectively. Retinal detachment (51 cases), prebyopia (47 cases), corneal lesion (58 cases), and dry eye condition (47 cases) were less common. Conclusion: The results show the burden of eye disorders in the Nenwe rural community and the importance of community-based eye care services.

A series of atypical cases of exudative retinal detachment with diagnostic dilemma presenting to a rural eye care center in South India

Abstract Introduction: Retinal detachment results due to the accumulation of fluid in the subretinal space. Retinal detachment can be rhegmatogenous, exudative, or tractional detachment. Exudative detachment occurs due to various choroidal or retinal pathologies. We report a case series of exudative retinal detachment (ERD) with atypical presentation, who were diagnosed and treated in our retina clinic. The aim of our study was to stress on the timely etiological diagnosis in patients who present with ERD in achieving a good visual recovery. We also would like to emphasize thorough systemic evaluation in the management of such cases. Materials and Methods: In this case series, patients who presented to our institution with ERD underwent a comprehensive ocular and systemic evaluation in order to determine the underlying etiology. Results: Our study showed that inflammatory causes, whether infectious or noninfectious uveitic conditions and certain systemic conditions unrelated to uveitis can also cause ERD. Conclusion: A thorough examination of both ocular and systemic condition is crucial for identifying the cause of ERD, ultimately aiding in the preservation of vision. In addition, timely recognition and management of any underlying systemic conditions by the appropriate specialist can significantly decrease the morbidity and mortality in these patients. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge.

Evaluation of different modalities in prevention of seroma formation post-modified radical mastectomy – An observational study from a rural tertiary care center

Background: Seroma, a recognized complication of modified radical mastectomy (MRM) delays the administration of adjuvant therapy and also effects adverse events. Aims and Objectives: This study was conducted to study the sociodemographic and clinical profile of patients developing seroma post MRM and compare the effectiveness of different modalities of seroma prevention since there is a dearth of literature on this matter in our sub-Himalayan region. Materials and Methods: This was an observational study conducted from February 2021 to August 2022 on 60 women with carcinoma breast who underwent MRM. They were studied for sociodemographic profile, cancer characteristics, and seroma prevention techniques and followed up during the study period. Preventive modalities used were quilting, octreotide therapy, suction drains with early drain removal, passive low suction drains, sharp dissection technique, and sclerotherapy. The results were analyzed using the Statistical Package for the Social Sciences version 22. Results: The mean age was 49.7±9.4 years, 18.3% had hypertension and 10.0% diabetes mellitus, and 58.3% presented with breast lump. Overall incidence of seroma was 23.3%; the highest was observed in sclerotherapy (50%), and the lowest was in quilting (7.1%) (P=0.235). The presence of hypertension (P=0.026) and the non-administration of neoadjuvant chemotherapy (P=0.010) was significantly associated with developing seroma. Sharp dissection was associated with wound infection (33.3%), sclerotherapy with flap necrosis (50%), and quilting with shoulder stiffness (21.4%). Conclusion: The lowest incidence of seroma was in quilting and the highest in sclerotherapy. Adverse events such as wound infection, shoulder stiffness, and flap necrosis were the lowest among patients discharged with passive drains and highest in sclerotherapy.

The prevalence of the risk factors associated with cardiovascular diseases among Iranian adults: Findings of a cross-sectional study.

Cardiovascular diseases are among the leading causes of death worldwide. Lack of accurate estimation of the risk factors associated with these diseases can impair the designing of effective interventions in this field; the present study aimed to investigate the risk factors attributable to cardiovascular diseases in males and females visiting comprehensive health service centers in 2018. This cross-sectional study is part of the national health transformation plan shaped in response to the emerging epidemic of noncommunicable diseases. In the present study, 6,331 participants aged 30 years and older were randomly and census selected from comprehensive urban and rural health service centers in Naein County, in Isfahan, Iran, respectively. The data were collected using the electronic health record from the IraPEN program in two sections: demographic information and the prevalence of cardiovascular disease risk factors. They were then analyzed with Statistical Package for the Social Sciences (SPSS) 24 software using descriptive statistics, Chi-square test, one-way ANOVA, and logistic regression. The participants' mean age was 55.09 ± 16.11 years. The main risk factor was insufficient consumption of fruits and vegetables while smoking was a negligible risk factor. Low physical activity, diabetes, hypertension, hypercholesterolemia, and high body mass index were more prevalent in females than in males, whereas smoking was more frequently reported in males (P < 0.001). Risk factors such as age, gender, education level, place of residence, and marital status, played a significant role in determining CVD risk factors. More than half of Iranian adults had one or older cardiovascular disease-related risk factors, and the prevalence of such factors was higher in females than in males. Given the importance of gender differences in cardiovascular disease-related health habits, it is necessary to reduce the majority of these diseases in society, especially in women, by controlling modifiable risk factors.

Possibilities for Rural Queer Liberation: Toward a Queer Rural Place-Based Pedagogy

Combining queer pedagogy and critical pedagogy of place, a queer rural place-based pedagogy centers rural queer student experiences to foster rural queer liberation.

“Male’s Perception About Menstruation, it’s Associated Problems and Menstrual Hygiene in their Female Partners: A Qualitative Study”

Aim: Present study was conducted to assess the knowledge and perception of men about menstruation and it’s associated problems in their female partners. Background: Menstruation is considered a social stigma in many low- and middle-income countries. Objectives: To assess men’s attitudes, beliefs, understandings, and knowledge about menstruation. Methods: The study involved interviews of 80 male partners of females attending the Obstetrics and Gynaecology Department of the rural tertiary center of Southern India for various complaints over one year. Data obtained was analyzed using thematic analysis. Four themes with sub-themes reflecting responses to key questions were formed: men’s perception and knowledge about menstruation, cultural and societal issues, men’s observation and attitude towards their wives during menstruation, and the father’s role in generating awareness. Results: Of 80 participants, 92.5% were comfortable, 6.25% uncomfortable and 1.25% were not sure about the interview. Their feelings about menstruation varied from nothing, disgusting/bad, to normal. Men’s knowledge about menstruation was restricted and the majority were hesitant to discuss it. Almost everyone was aware of cultural taboos being followed at home, with most responses revealing menstruating women as untouchable/impure. Men observed changes in mood, sleep, and sexual desire of their partners before and during menstruation. The majority wanted their children to know about menstruation, but they don’t want to teach. Overall feedback about the interview was positive. Conclusion: Ignorance and secrecy related to menstruation, stop men from understanding the problems faced by women. Educating boys about menstruation and menstrual hygiene is the only way to uproot the long-standing stigma attached to menstruation.

The Management and Outcomes in Blunt Splenic Injury: A Comparison Between a Rural and Urban Trauma Center

Introduction: The management of blunt splenic trauma (BST) has evolved over the last 20 years, with nonoperative management in hemodynamically stable patients prevailing as the standard of care. Nonoperative management includes angioembolization of the splenic artery. Although non-operative management has increased in use, there is limited standardization of practices for the management of blunt splenic trauma. The objective was to compare outcomes for BST and the use of angioembolization between a Level 1 urban trauma center, Ascension St. John Hospital, Detroit MI (ASJH) and a Level 2 rural trauma center, Munson Medical Center, Traverse City MI (MMC). Methods: Our study used registry data comprising all patients from 1/2015-12/2021 who presented to ASJH and MMC with BST. Patients were divided into operative intervention versus non-operative management groups. Data collected included timing of intervention, length of stay, severity scores, blood product requirements and concomitant injuries. The management and outcomes between the two institutions were compared. Data were analyzed using Student’s t-test, the χ2 test, the Mann-Whitney U test and logistic regression. Results: Data were collected on 93 patients from ASJH and 189 patients from MMC. Splenic injury grade was scored from one to five, with 60.0% of patients scoring grade three or higher and 62.1% of patients having active blush identified on imaging. Eighty-four patients (28.4%) had operative intervention and 24 patients (8.5%) underwent angioembolization. ASJH had an angioembolization rate of 15.1% vs 5.3% at MMC (p=0.006). When comparing the two hospitals, patient groups were different in terms of race (p=0.001), fresh frozen plasma administered (p=0.046) and presenting systolic blood pressure (p=0.001). In patients with active blush, after adjusting for hemoglobin on arrival, ASJH patients were 3.8 times more likely to have angioembolization than patients at Munson (p=0.02). TRISS and race dropped out of the model. Conclusions: There is a significant difference in the rate of non-operative management between the hospitals. Higher rates of angioembolization at an urban center may reflect a difference in resource distribution between urban and rural centers.

Building integrated photovoltaic with hydrogen storage as a sustainable solution in Iranian rural healthcare centers

The reliable and sustainable energy source for supplying energy demand of rural health clinic centers (RHCC) is very important especially in Coronavirus Disease 2019 (COVID-19) epidemic. However, diesel generator due to the fuel supply and environmental challenges can’t be a sustainable source. In this regard a standalone energy system based on solar with hydrogen storage/fuel cell system is proposed to solve this issue. In the present study, five regions with different climatic conditions in Iran are considered and the layout are evaluated for the first time in RHCC with a load demand of about 10 kWh/day. HOMER software is used to optimize the size of the equipment. The results showed the capacity factor (CF) of photovoltaic panels is about 17.4–20.4%, while the CF of electrolyzers is 17–25%. The CF of fuel cell remains similar at about 36–37%. The net present value of the systems ranges 22,000–27,000$ and the levelized cost of electricity ranges 0.28–0.34 $/kWh, with the lowest (highest) values in Kerman(Gylan). The proposed system reduced the consumption of approximately 1,830 L of diesel, resulting in significant environmental benefits. The hybrid renewable energy system combining solar and hydrogen storage can be considered as sustainable solution in RHCC in Iran.

A new intuitionistic fuzzy scheme of data envelopment analysis for evaluating rural comprehensive health service centers

In this study, the classical CCR-IO DEA model (an input-oriented form of the DEA model of Charnes, Cooper, and Rhodes [24] is extended to an intuitionistic fuzzy environment. For this aim, the trapezoidal intuitionistic fuzzy numbers are used to show the values of inputs and outputs. An intuitionistic fuzzy number is characterized by membership, non-membership, and hesitancy degrees. Therefore, such type of fuzzy numbers is more complete and contains more information to reflect a fuzzy type of uncertainty comparing to the conventional fuzzy values. In order to solve the proposed intuitionistic fuzzy CCR-IO model, for the first time a possibility-based approach is developed for the intuitionistic fuzzy DEA models. In this approach for the first time the ME measure of fuzzy events is extended to intuitionistic fuzzy DEA models, therefore, some new definitions and propositions are presented and clarified. This measure is more flexible and effective comparing to the other measures such as credibility, necessity, and possibility measures. A case study from the health care sector of Iran is considered to evaluate the proposed solution approach numerically. The case study is solved under different scenarios, a full sensitivity analysis is performed, and finally some useful managerial insights are presented. In addition, the results of the proposed intuitionistic CCR-IO model are compared to the classical models of the literature.

Environmental quality of the Paraim River springs, far south of Piauí

The small flows of runoff give rise to water bodies which, through their multiple uses, contribute to satisfying the basic vital needs of animals, plants and ecosystems. Spring areas play an important role in maintaining the environmental quality of the basin. To this end, it is essential that these areas have an effective conservation policy. The aim of this study was to determine the environmental quality of the Paraim River's spring areas, emphasizing the physical-chemical and biological quality of the water and characterizing local environmental conditions through macroscopic assessment. Visits were made to seven of the Paraim River's perennial springs and the macroscopic assessment made it possible to identify the impacts observed in the springs and permanent preservation areas, access conditions, proximity to rural centers and types of use of the springs. The physical-chemical and microbiological parameters of the water were assessed and compared with Resolution 357/2005 of the National Environment Council (CONAMA) and the Water Quality Index (IQA). The macroscopic assessment of the springs showed that 57.1% of the springs were rated as "excellent" or "good" and only one spring was rated as "very bad". Determining the WQI of the springs resulted in values varying between 59 and 86 in the dry season and between 56 and 89 in the rainy season. This shows that all the springs evaluated had satisfactory WQIs ("good" or "excellent"). The assessment of water quality made it possible to observe the relationship between the quality parameters, as well as their influence on the macroscopic characteristics of the springs. In this way, the information obtained indicates that, despite the good quality of the water, the assessment of the environmental situation of the springs warns of the need for future strategies aimed at planning for land use and environmental management of micro-watersheds.

Association of Household Food Insecurity with Stunting and Underweight Among Iranian Children Aged 2 - 5 Years old

Background: Although previous literature has assessed the association of household food insecurity with nutritional outcomes among children, the findings are inconsistent across different study populations. Objectives: We aimed to evaluate the association of household food insecurity with nutritional outcomes among children residing in Khalkhal city, Iran. Methods: The present cross-sectional study was conducted on 300 Iranian children aged 2 - 5 years who visited urban and rural health care centers between November 2021 and March 2022. Subjects were included in the survey using multi-stage cluster sampling. Household food security status was assessed using the United States Department of Agriculture (USDA) 18-item food security questionnaire. Odds ratios (95% confidence interval) for stunting according to the food insecurity score were estimated using multivariable logistic regression in three models. Results: In the present study, 39% of participants had food security, while the prevalence of food insecurity without hunger, food insecurity with moderate hunger, and food insecurity with severe hunger were 22.3%, 23%, and 15.7%, respectively. In all models, both categorized and continuous food insecurity scores correlated negatively with weight (P for all &lt; 0.001). Food insecurity did not predict the risk of stunting in all subjects before and after adjustment (Model 1: OR (CI) = 1.008 (0.96-1.05), P = 0.72; Model 2: OR (CI) = 1.01 (0.96 - 1.05), P = 0.65; Model 3: OR (CI) = 0.98 (0.92-1.04), P = 0.53). Conclusions: In the current study, we found that Iranian families with the lowest income had the highest food insecurity scores. Household food insecurity was negatively correlated with weight status among children aged 2 - 5 years.

Effects of dental insurance and dental care utilization on oral health-related daily life activities among federally qualified healthcare center patients in the United States.

To assess the association between dental insurance, dental care utilization and oral health-related impact on daily activities among patients visiting Health Resources and Services Administration (HRSA)-funded health centers in the United States. This cross-sectional study examined the 2014 Health Center Patient Survey (HCPS), a survey of patients who received care at US health centers. Logistic regression analyses were conducted to explore the likelihood of the oral health-related impact on daily activities domains such as school/work performance, sleeping, eating/chewing, social and home activities considering sociodemographic, dental insurance, and dental care utilization. Among 7002 total participants, 6890 self-reported oral health-related impact on daily activities. Adults aged 18-44 were 2.6 times more likely to report an overall impact on everyday life activities compared to children and adolescents. After adjusting for sociodemographics, Hispanic patients were less likely to report any oral health-related impacts, while patients visiting rural centres reported higher odds of oral health related impairment. Patients who experienced delays in receiving dental care or were unable to access dental care when needed were 4.5 times more likely to encounter difficulties in their daily activities. This study linked limited dental insurance and care to increased oral health issues impacting daily life, particularly among adults, rural populations, and those facing delay in dental care. This highlights the need for policy reforms and interventions aimed at improving dental care access to mitigate the detrimental effects of poor oral health on daily functions for vulnerable populations.

Implementation of a Multidisciplinary Team to Improve the Quality of Care for Older Surgical Patients at a Rural Academic Medical Center.

For the first time in history, people age older than 65 years make up >20% of the non-metro population, compared with 16% of the metro population. From 2010 to 2020 the nonmetro population age older than 65 years grew by 22%, while the working-age population declined by 4.9%, and the population aged under 18 years declined by 5.7%.1,2 Multidisciplinary geriatric surgical programs are an increasingly recognized approach to the care of older surgical patients and preliminary data suggest they can reduce length of stay. Although rural areas have the greatest proportion of patients age older than 65 years, implementation of such programs faces special challenges in rural settings with limited resources. Dartmouth-Hitchcock Medical Center is one of the most rural academic centers in the United States. Challenges include a shortage of geriatric-trained providers, long distances to access primary care and subspecialists, and extremely limited postacute care options and skilled nursing facility beds. To address the unique needs of our provider and patient population we began with a development period where we conducted stakeholder interviews. Using these data, we mapped out a workflow and developed pilot projects to address different portions of the workflow, such as preoperative screening for frailty and cognitive impairment, interdisciplinary weekly case conferences, proactive case management, delirium and geriatric surgery postoperative pathway order sets, and a variety of tools for reorientation and delirium management. Herein we describe the process of development and pragmatic clinical implementation of geriatric-focused care for older surgical patients in our rural tertiary center, including some of the main challenges we faced and the strategies we undertook to overcome them, and some of our early patient centered and clinical outcomes. This information may assist other institutions as they design geriatric-focused surgical programs to address the growing population of older adults and the need for compliance with state legislation. The clinical program described is not a research study, and the outcome data we report is for the purpose of description, and should not be interpreted as a rigorous research investigation of the effect of our intervention.

Comparing Hospital Length of Stay Between Persons With LEP and English-Speaking Patients in a Large Rural Academic Medical Center.

Patients with limited English proficiency that are hospitalized without regular access to professional medical interpreters have a longer length of stay (LOS).1 The authors studied the difference in LOS between English-speaking patients and patients with limited English proficiency in New Hampshire's only academic trauma medical center. The authors also examined race, ethnicity, and distance of residence from hospital. Retrospective data were queried from EPIC, the electronic medical record system used by the authors. Queried data focused on inpatient hospitalizations between January 1, 2019, and December 31, 2021. Patient primary language was grouped into English, Spanish, and other non-English language. Spanish-speaking patients live on average 39.6 miles farther from a hospital than English-speaking patients and have a 0.34 lower case mix index. After English, Spanish is the second-most frequently spoken language. Regression analyses found language to be a significant factor in LOS, LOS variance, and case mix index. A 2.34-day longer LOS for Spanish-speaking patients demonstrates an important health care disparity warranting further attention.

Effects of the March 2021 Allocation Policy Change on Key Deceased-donor Kidney Transplant Metrics.

A major change to deceased-donor kidney allocation in the United States, Kidney Allocation System 250 (KAS250), was implemented on March 15, 2021. Evaluating the consequences of this policy on critical system performance metrics is critical to determining its success. We performed a retrospective analysis of critical performance measures of the kidney transplant system by reviewing all organs procured during a 4-y period in the United States. To mitigate against possible effects of the COVID-19 pandemic, Scientific Registry of Transplant Recipients records were stratified into 2 pre- and 2 post-KAS250 eras: (1) 2019; (2) January 1, 2020-March14, 2021; (3) March 15, 2021-December 31, 2021; and (4) 2022. Between-era differences in rates of key metrics were analyzed using chi-square tests with pairwise z-tests. Multivariable logistic regression and analysis of variations methods were used to evaluate the effects of the policy on rural and urban centers. Over the period examined, among kidneys recovered for transplant, nonuse increased from 19.7% to 26.4% (all between-era P < 0.05) and among all Kidney Donor Profile Index strata. Cold ischemia times increased (P < 0.001); however, the distance between donor and recipient hospitals decreased (P < 0.05). Kidneys from small-metropolitan or nonmetropolitan hospitals were more likely to not be used over all times (P < 0.05). Implementation of KAS250 was associated with increased nonuse rates across all Kidney Donor Profile Index strata, increased cold ischemic times, and shorter distance traveled.

Characterization of social determinants of health in patients considered for participation in treatment clinical trials at a community cancer center serving the Great Plains.

e13704 Background: Avera Cancer Institute, a community-based cancer network comprised of six rural cancer centers in SD and MN, provides care to a five-state region in the upper mid-west covering 72,000 square miles and offers several clinical trials to patients to offer access to advanced treatment for malignancies. Malignances are known to disproportionally affect patients that are older, rural, minorities, and have lower socioeconomic status, which are all less likely to enroll into clinical trials. Methods: Patients evaluated for participation in clinical trials from 2018-2022 were identified in an institutional database. Trial type was designated as either a treatment or nontreatment trial. Status of trial involvement was designated between enrolled or screened. Their demographic information was obtained from the electronic health record (EHR). Demographic information obtained from the EHR includes race, ethnicity, language spoken, gender, employment status, insurance type, and if they live in an urban or rural area as defined by the US Census Bureau. Clinical trial portfolio during this time includes trials for breast, gynecological, gastrointestinal, lung, and hematologic malignancies. Results: 4,397 patients were considered for participation in a clinical trial at our institution in the studied timeframe. Of these patients, 1887 were screened for treatment trials and of that group, 773 were enrolled. 35% of participants considered for clinical trials were from urban areas while 65% considered were rural. 48% of the urban population ultimately were enrolled on a clinical trial while 44% of rural population participated. Participants who lived in an urban area 25-50 miles from our study site had an enrollment rate of 49% compared to rural enrollment of 33%, from 50-100 miles rates of 53% and 37%, from 100-250 miles rates of 29% and 41%, and from greater than 250 miles rates of 44% and 33%, respectively. 99.5% of the population was non-Hispanic, 97% were White, and 99% were English speaking. 74% of the total population were female and 26% were male. Females had an enrollment rate of 51% while males had an enrollment of 29%. Patients with no insurance enrolled in trial 62% compared to 36% of those with commercial insurance The average national Area Deprivation Index percentile for screened patients was 57 vs 59 for enrolled patients. Conclusions: This retrospective study demonstrates a greater likelihood for females, urban patients, and white, English-speaking patients to enroll into clinical trials. Our data also demonstrate a preference for uninsured patients to enroll into clinical trials, possibly due to the financial benefits they may provide. Further directions include comparing our patients considered for clinical trials to all patients treated at our institution to identify potential disparities in care.

A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome

ABSTRACT Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P &lt; 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P &lt; 0.01). The difference in mortality rates between patients with and without co-morbidity (P &lt; 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

Lutetium-177–PSMA-617 experience in Appalachian patients with advanced prostate cancer at West Virginia University Health Science Center.

e17045 Background: Lutetium Lu-177 vipivotide tetraxetan (Lu-177) allowed for improved biochemical and radiographic response rate with relatively low toxicity for metastatic castration-resistant prostate cancer (PC) after multiple lines of therapy. In the 2021 VISION study (DOI: 10.1056/NEJMoa2107322), Lu-177 was reported to have a median overall survival (OS) of 15.3 months in patients (pts) with advanced prostate cancer (PC). We reviewed the result with Lu-177 for the treatment of advanced PC at a rural tertiary academic center at West Virginia University Health Science Center (WVU-HSC). Methods: All PC pts receiving one or more doses of Lu-177 at WVU-HSC were retrospectively reviewed. Pts were followed until death or the last clinic visit. All pts were established patients at WVU-HSC for management of the advanced PC between July 2022 and February 2024. Data was tabulated with descriptive statistics and median survival was calculated from Kaplan-Meier method. Results: Over an eighteen months period 34 pts received 126 doses of Lu-177. 26 pts were referred from outside the WVU-HSC specifically for Lu-177. Demographics from data collection showed predominantly Caucasian pts (91% Caucasian). The time from the initial PC diagnosis to the first dose of Lu-177 was a median of 67 months (range: 10 months-367 months). The median age at the first dose of Lu-177 was 65 years (range: 45-80). 18 patients (53%) remain alive as of Feb 2024. 14 pts (41%) completed 6 cycles of Lu-177 and 11 pts (32%) remain alive. The Kaplan-Meier median OS for these 34 pts starting from the first cycle of Lu-177 was 10 months. Conclusions: A 2022 estimated cost for Lu-177 was $42,500 per dose (excludes administration) so “payors” may have been charged more than $5,000,000 for the Lu-177 for these patients. Lu-177 may be of more benefit earlier in the PC disease spectrum, or perhaps pre-treatment PSMA imaging can better target patients who will benefit from Lu-177. Our observed median OS of 10 months did not match the 15.3 reported in the VISION study (DOI: 10.1056/NEJMoa2107322). Further data evaluation and collection are warranted from different communities to investigate the differences observed in the survival data reported in the literature and observed in the clinic setting. [Table: see text]