Faculty Bibliography

Background/UNASSIGNED:While societal acceptance for sexual and gender minority (SGM) individuals is increasing, this group continues to face barriers to quality healthcare. Little is known about clinicians' experiences with SGM patients in the oncology setting. To address this, a mixed method survey was administered to members of the ECOG-ACRIN Cancer Research Group. Materials and methods/UNASSIGNED:We report results from the open-ended portion of the survey. Four questions asked clinicians to describe experiences with SGM patients, reservations in caring for them, suggestions for improvement in SGM cancer care, and additional comments. Data were analyzed using content analysis and the constant comparison method. Results/UNASSIGNED:The majority of respondents noted they had no or little familiarity with SGM patients. A minority of respondents noted experience with gay and lesbian patients, but not transgender patients; many who reported experience with transgender patients also noted difficulty navigating the correct use of pronouns. Many respondents also highlighted positive experiences with SGM patients. Suggestions for improvement in SGM cancer care included providing widespread training, attending to unique end-of-life care issues among SGM patients, and engaging in efforts to build trust. Conclusion/UNASSIGNED:Clinicians have minimal experiences with SGM patients with cancer but desire training. Training the entire workforce may improve trust with, outreach efforts to, and cancer care delivery to the SGM community.

Objective/UNASSIGNED:This study aimed at determining the various types of home-based remedies, mode of administration, prevalence of use, and their relevance in reducing the risk of infection, hospital admission, severe disease, and death. Methods/UNASSIGNED:The study design is an open cohort of all participants who presented for testing for COVID-19 at the Infectious Disease Treatment Centre (Tamale) and were followed up for a period of six weeks. A nested case-control study was designed. Numerical data were analysed using STATA version 14, and qualitative data were thematically analysed. Results/UNASSIGNED: = 2)). Participants who practiced any form of home-based therapy were protected from SARS-CoV-2 infection (OR = 0.28 (0.20-0.39)), severe/critical COVID-19 (OR = 0.15 (0.05-0.48)), hospital admission (OR = 0.15 (0.06-0.38)), and death (OR = 0.31 (0.07-1.38)). Analysis of the various subgroups of the home-based therapies, however, demonstrated that not all the home-based remedies were effective. Steam inhalation and herbal baths were associated with 26.6 (95% CI = 6.10-116.24) and 2.7 (95% CI = 0.49-14.78) times increased risk of infection, respectively. However, change in diet (AOR = 0.01 (0.00-0.13)) and physical exercise (AOR = 0.02 (0.00-0.26)) remained significantly associated with a reduced risk of infection. We described results of thematic content analysis regarding the common ingredients in the drinks, diets, and other home-based methods administered. Conclusion/UNASSIGNED:Almost a third of persons presenting for COVID-19 test were involved in some form of home-based remedy to prevent COVID-19. Steam inhalation and herbal baths increased risk of COVID-19 infection, while physical exercise and dietary changes were protective against COVID-19 infection and hospital admission. Future protocols might consider inclusion of physical activity and dietary changes based on demonstrated health gains.

Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year. Medications for OUD (MOUD) are the gold standard treatment for OUD however early dropout remains a major challenge for improving clinical outcomes. A Cascade of Care (CoC) framework, first popularized as a public health accountability strategy to stem the spread of HIV, has been adapted specifically for OUD. The CoC framework has been promoted by the NIH and several states and jurisdictions for organizing quality improvement efforts through clinical, policy, and administrative levers to improve OUD treatment initiation and retention. This roadmap details CoC design domains based on available data and potential linkages as individual state agencies and health systems typically rely on limited datasets subject to diverse legal and regulatory requirements constraining options for evaluations. Both graphical decision trees and catalogued studies are provided to help guide efforts by state agencies and health systems to improve data collection and monitoring efforts under the OUD CoC framework.

Aims/UNASSIGNED:We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. Methods/UNASSIGNED:We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. Results/UNASSIGNED:CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. Conclusion/UNASSIGNED:Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.

Background: Electronic cigarettes (EC) have been proposed as a harm-reducing alternative in smokers with COPD. Racial and ethnic differences can affect the extent to which smokers in the general population switch from combustible cigarettes (CC) to EC. To help design a targeted intervention for smokers with COPD, we conducted a mixed methods study assessing the relationship between race/ethnicity and switching from CC to EC; and evaluated whether it is mediated by social norms, risk perception, and overall opinions of CC and EC.
Method(s): We recruited patients with COPD, aged 21 to 75, listed as current smokers in the NYU Langone Health electronic health record by phone, mail, and My Chart. Smokers who had moderate COPD (based on the COPD Assessment Test score (CAT)), who smoked >=5 CC a day at least 4 days a week and were interested in quitting were eligible. We randomized participants to EC or nicotine replacement therapy (NRT) for switching from CC. Over 12 weeks, participants received 5 counseling sessions and were asked about their COPD symptoms, CC use, NRT/EC use, and nicotine withdrawal symptoms. We used Ecological Momentary Assessment (four text messages/day) to assess current EC/NRT and CC use. We analyzed the influence of race and ethnicity on switching, considering social norms, risk perception, media influence and overall opinions of tobacco and EC as possible mediators. We conducted in-depth interviews to gain descriptive explanations of study experience and reasons for switching or lack thereof. We used chi squared tests to compare categorical variables and analysis of variance for continuous ones.
Result(s): Among the 48 participants, the average age was 60 (STD 8.2) years and 54% were female. Races/ethnicities were 8% Black; 8% Hispanic/Latino; 81% White; and 3% Other/Not Reported. There was a trend towards decreased dyspnea and COPD symptoms, as well as decreased CC use, in the EC arm compared to the NRT arm. We are still collecting the qualitative data on switching perceptions.
Conclusion(s): Understanding the extent to which racial and ethnic differences in switching from CC to EC can be attributed to social norms, risk perception, media influence, and overall opinions of tobacco and EC; may allow us to design a more effective, more engaging smoking cessation intervention