The Effect of Insurance and Race on Breast Cancer Tumor Biology and Short-Term Outcomes.

To determine whether low-income status as demonstrated by insurance type has any association with aggressive tumor biology and breast cancer outcomes. Retrospective review of 535 women with new diagnosis of breast cancer from January 2009 to March 2013 was performed. There was no significant association between race and stage at diagnosis. Women with Medicaid/Charity coverage were diagnosed at more advanced stages, more likely to have triple-negative breast cancer (TNBC), and had longer time to treatment. Rate of TNBC was higher in black women and younger patients. There was no significant difference in breast cancer recurrence or survival by race, insurance type, age, or tumor biology. In multivariable analysis, only black race (P = 0.003) and Medicaid/Charity Insurance (P = 0.0008) were the most significant predictors of TNBC. Presentation of aggressive tumor biology and advanced stage is strongly associated with socioeconomic factors as reflected by Medicaid funding and lack of insurance.

One hundred consecutive living kidney donors: modern issues and outcomes.

In order to define current issues and outcomes of living kidney donation, 100 consecutive living donors operated on between July 1996 and March 2001 were evaluated. The 64 women and 36 men ranged in age from 19 to 72 yr (mean 42.5 yr), and 65 were related to the recipient while 35 were unrelated donors. Hospital admission the morning of surgery and use of a minimal open approach to the donor kidney were standard, as were post-operative epidural pain control and plans for short hospital stay. The 100 donors were hospitalized for 2 (25), 3 (48), 4 (18), 5 (8), or 6 (1) days, with an average length of stay of 3.12 d (range 2-6 d). The mean charge for kidney donor hospitalization was 14,470 dollars (range 9671-22,808 dollars). There were no major intra or immediate post-operative complications. Six rehospitalizations occurred for post-donation nausea, vomiting, dehydration (n = 2); spinal headache; pneumonia and wound haematoma; and late wound reexploration (one hernia and one nerve entrapment). All donors returned to pre-operative functional status within 6 d to 6 wk of donation. All kidneys functioned immediately in the 100 recipients (50 women, 50 men) who averaged 46.6 yr of age (range 17-69 yr); recipient length of stay averaged 3.81 d (range 2-15 d). All donors survived in excellent health; recipient graft and patient survival, respectively, are 87 and 90% through the entire 5-yr period. Excellent long-term outcomes for living kidney donors may be accomplished using minimal open surgical technique, post-operative epidural pain control and plans for a brief hospitalization. Expansion of living donor resources in renal transplant programs may grow as unrelated kidney donation and non-directed donation as well as minimally invasive (open and laparoscopic) techniques evolve.

Education, pay, and job status: a national survey of transplant coordinators.

To identify education, pay, and job responsibilities, an informal 19-item survey was sent to 1661 transplant coordinators; 424 (26%) were returned. Respondents worked in all phases of transplantation. Education levels varied widely; most respondents had some formal nursing education. Full-time salaries were from $25,000 to $110,000 per year; 67% worked 40 to 50 hours and 19% worked more than 50 hours per week. Of 402 clinical coordinators, 280 (70%) took call, and 122 (30%) did not. Call frequency varied with rotations every second, third, and fourth week; 44% of those taking call did not receive additional on-call pay. Nurse-managed clinics (with physician availability) were the predominant workplace for clinical coordinators. Autonomy and contact with patients were the most liked aspects of the job, and the least-liked aspects were on-call status and paper-work. Increased salary and added support staff ranked top among desired changes in the job. Transplant coordinators appear to be committed professionals who are critical to all endeavors in organ transplantation.