Assessing knowledge and barriers at the primary care provider level that contribute to disparities in inammatory breast cancer diagnosis and treatment

Background: Although recognized as the most lethal breast cancer, inflammatory breast cancer (IBC), a NCI designated rare cancer and a cancer health disparity, is severely understudied. Given the unique presentation of diffuse tumor spread without a solid mass, not easily detected by selfbreast exams or mammograms, IBC patients often face delays in diagnosis and treatment leading to poor outcomes. Moreover, reproductive risk factors in IBC and high incidence in younger women, minoritized and marginalized populations highlight the significance of primary care providers (PCP) who are often the first point of contact when patients begin to notice symptoms. Method(s): In this study, we evaluated the knowledge gaps and barriers amongst PCP (physicians, physician assistants, nurse practitioners) in their ability to recognize the signs and coordinate care effectively for IBC. To assess PCP experiences with IBC in their practices and overall breast cancer care during COVID, we first conducted semi-structured interviews (n=11) with providers selected from a convenience sample at Duke University and in the local clinics. Based on data from these interviews and additional cognitive interviews, we developed and disseminated a comprehensive online survey (n=78). Result(s): In this study, access to care was identified as the single most important barrier to treating rare cancers. Furthermore, majority of the PCPs in this cohort identified only a moderate ability to recognize IBC in patients (mean = 3.3, range 1-7), thereby limiting early diagnosis. From the semi-structured interviews, PCPs recognized that IBC is not likely to be part of typical differential diagnosis when patients present with mastitis or breast changes, and most had not seen IBC in their practice. Only 31% (n=78) reported ever suspecting IBC in a patient. Delays in referrals to specialized large clinical centers were also reported as a major barrier. In particular, 62.8% (n=49) reported some delay in referrals for diagnostic imaging. In addition, since the COVID-19 pandemic started, 33% reported diagnosing less breast cancer cases and 63% reported that they experienced breast cancer referral delays. When asked what methods providers would find most helpful to learn more about diagnosing and caring for patients with IBC, the top three modes of preferred education were online CME options (53%);lunchtime, or other in-service training (33%);and website for patients and providers (32%). Conclusion(s): We succeeded in developing a survey instrument and to our knowledge first mixed methods study to assess PCP knowledge gaps and barriers to timely diagnosis and care of IBC patients. Results underscore need to develop PCP training modules and care coordination tools to improve guideline-concordant care. This survey instrument also has the potential to serve as a blueprint to design, implement, and evaluate interventions for other rare cancers.

Multi-inquiry hybrid e-learning: Instructor-learner experiences

Background: Hybrid teaching methodologies involve the purposeful combination of traditional teaching with technology advances. Despite some challenges, they have gained popularity recently, especially during the coronavirus pandemic. This study evaluated hybrid e-learning with multiple inquiries involving students’ receptiveness, preferences, behaviours and instructor observations. Method: The methodology involved a mixed-method approach with a qualitative observational case study, surveys and interviews for problem-based learning alternatives to traditional lectures. Instruction included: 1) Assigned primary literature reading with study questions to be completed before class;2) Out-of-class online video-clips with visual, practical application (i.e. lithium and non-lithium induced tremor assessment) and online discussion in CANVAS Learning Management System;3) Start-of-class quiz in ExamSoft, in-class team-based application questions with instructor-led discussion;4) Out-of-class team final exam review assignment in CANVAS. Results: Qualitative themes were student engagement, flexibility, preferences, academic and non-academic stressors, etiquette, and defining responsibility for academic success. The majority of students preferred primary literature review, video clips, followed by online CANVAS discussions. Written assignments were the least desirable. Conclusion: These experiences are useful for qualitative evaluation of teaching and learning methods.

SARS-CoV-2 decontamination of skin with disinfectants active during and after application.

BACKGROUND: The coronavirus disease 2019 pandemic has resulted in high levels of exposure of medical workers to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Hand decontamination is one of the actions recommended to reduce the risk of infection. AIM: Two disinfectants - BIAKOS antimicrobial skin and wound cleanser (AWC) and AWC2 (Sanara MedTech, Fort Worth, TX, USA) - were tested to determine whether they can inactivate SARS-CoV-2 upon contact or as a coating applied before contact with the virus. METHODS: The ability of AWC and AWC2 to inactivate SARS-CoV-2 was tested in liquid and dried form on plastic surfaces and porcine skin. FINDINGS: AWC and AWC2 were effective in reducing the infectious titre of SARS-CoV-2 in liquid form during application and in dried form 4 h after application. Virus on skin was reduced up to 2 log10-fold and 3.5 log10-fold after treatment with AWC and AWC2, respectively. CONCLUSION: Application of AWC and AWC2 to skin reduces the level of SARS-CoV-2 and the risk of infection.