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Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779489


Purpose: In the state of Wisconsin, breast cancer patients from African American (AAs) communities have lower survival rates compared to their Caucasian counterparts. Multiple inequities related to sociodemographic factors, delays in diagnosis, advanced disease stage at presentation and presence of comorbidities including higher body mass index (BMI) contribute to these disparities, many of which have only widened during the COVID-19 pandemic. This study examined specific factors related to prolonged hospital length of stay (LOS) for breast cancer patients admitted to inpatient units during the pandemic. Methods: This analysis includes initial CY20 LOS medical record data for hospitalized patients 18 years and older with a diagnosis of breast cancer from 1/1/2020-12/31/2020. Supplemental data included disease registry and diagnostic data, and SES data determined by patient zip code. Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 272 patients with breast cancer that were admitted to inpatient oncology units were identified. Demographics included White (72.4%), Black (22.4%), and others (5.1%). Other characteristics included: low SES (8.8%), medium-low (9.5%), medium (15.4%), medium-high (11.0%), high SES (4.4%), and others (non-SMilwaukee county) (50.7%), Medicaid (8.8%), Medicare (61.3%), Managed care (29.0%), and others (0.73%). Body mass varied among the patients;underweight (0.36%), overweight (30.8%), obese (41.5%). There were significant differences in LOSi: Black (LOSi=1.24, p=0.01), medium-low SES (LOSi=1.46, p=0.02), Medicaid (LOSi=1.40, p=0.00), underweight (LOSi=1.66, p=0.00), and overweight (LOSi=1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Conclusion: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS for breast cancer patients. Healthcare systems may benefit by addressing indicators and patients' factors to reduce hospital LOS, and ultimately healthcare costs.

Academic Emergency Medicine ; 28(SUPPL 1):S399, 2021.
Article in English | EMBASE | ID: covidwho-1255312


Intro/Background: Medical students who are matching in emergency medicine (EM) should be well prepared to start intern year with an understanding of the workup of common chief complaints. EM education opportunities vary among different medical schools. Students' educational experiences largely depended on didactics received or patients seen during their rotations, both of which have been limited by the COVID-19 pandemic. Purpose/Objective: We sought to create a free, open access, flipped classroom curriculum targeting EM-bound fourth-year medical students to prepare them with essential knowledge and practical management skills needed for intern year. We included vetted asynchronous resources for self-study paired with a robust, case-based, virtual EM elective that could be used by programs to offset limited clinical exposure imposed by COVID-19. Methods: Using the EM Model as a guide, a team of experienced EM educators identified essential learning topics to create an 8-week, self-paced, free open access asynchronous curriculum called Bridge to EM. Self-study content was paired with facilitated case-based virtual classroom experiences provided by Foundations of Emergency Medicine (FoEM). 1 The curriculum was published on Academic Life in EM,2 the FoEM website, and listed on the AAMC iCollaborative.3 Outcomes (if available): The Bridge curriculum was viewed 72,928 times from May-Dec 2020. Viewers were from 5650 cities in 127 countries. Chicago, New York City, Toronto, and Melbourne were the most common cities to access content. During the same time period, 44 discrete learning sites encompassing over 3,400 learners registered to use the formal virtual curriculum, which included the Bridge asynchronous content and the FoEM cases. Most of these sites were US based medical schools. Summary: We have created a flexible, online, freely available curriculum that can be used individually by medical students to prepare for intern year, or systematically by programs or medical schools to provide a virtual, case-based EM curriculum. Prior to development of the Bridge to EM, there was no existing online curriculum for students to use to prepare for the start of their intern year. The COVID-19 crisis created an urgent need for online and virtual learning materials while students were prohibited from EM rotations in most US medical schools. The Bridge curriculum was published during the early pandemic timeframe to meet the needs of both students and programs. Its release was met with enthusiasm from students and educators, and it was accessed around the world. The curriculum can be used to teach basic EM concepts as a supplement to a traditional EM clinical elective, or to replace it when in-person rotations are not possible. The curriculum uses principles of effective learning such as spaced repetition, application of content in a case-based context, flipped classroom learning, and interactive discussions. The Bridge platform can serve as a prototype or model for online curricula for other disciplines or for different target content areas or audiences.