Risk Factors for Mortality in Mechanically Ventilated Patients with COVID-19 in a Mississippi Community Health System.

OBJECTIVE: To evaluate differences between survivors versus nonsurvivors undergoing mechanical ventilation for coronavirus disease 2019 (COVID-19)-associated respiratory failure at two community medical centers. METHODS: This was a multicenter, retrospective cohort analysis of all adult patients mechanically ventilated for COVID-19-associated respiratory failure in two community hospital intensive care units in southern Mississippi from March 15, 2020 through October 10, 2020. RESULTS: Among 56 patients requiring mechanical ventilation, the mortality rate was 75% (42/56). Expired patients were intubated later (2 vs 5 days, 95% confidence interval [CI] 6.314-0.8041, P = 0.0983), had lower PaO2:FiO2 ratios (65 vs 77.5 mm Hg, 95% CI 36.08-59.03, P = 0.6305), and tolerated lower levels of positive end-expiratory pressure (7.9 vs 12.6 cm H2O, 95% CI 0.1373-6.722, P = 0.0415) at the time of intubation. CONCLUSIONS: Our results suggest that earlier intubation may be associated with reduced mortality in patients with COVID-19-associated respiratory failure and should be further evaluated in the form of a randomized controlled trial.

National Cancer Institute's Cancer Disparities Research Partnership Program: Experience and Lessons Learned.

PURPOSE: To increase access of underserved/health disparities communities to National Cancer Institute (NCI) clinical trials, the Radiation Research Program piloted a unique model - the Cancer Disparities Research Partnership (CDRP) program. CDRP targeted community hospitals with a limited past NCI funding history and provided funding to establish the infrastructure for their clinical research program. METHODS: Initially, 5-year planning phase funding was awarded to six CDRP institutions through a cooperative agreement (U56). Five were subsequently eligible to compete for 5-year implementation phase (U54) funding and three received a second award. Additionally, the NCI Center to Reduce Cancer Health Disparities supported their U56 patient navigation programs. RESULTS: Community-based hospitals with little or no clinical trials experience required at least a year to develop the infrastructure and establish community outreach/education and patient navigation programs before accrual to clinical trials could begin. Once established, CDRP sites increased their yearly patient accrual mainly to NCI-sponsored cooperative group trials (~60%) and Principal Investigator/mentor-initiated trials (~30%). The total number of patients accrued on all types of trials was 2,371, while 5,147 patients received navigation services. CONCLUSION: Despite a historical gap in participation in clinical cancer research, underserved communities are willing/eager to participate. Since a limited number of cooperative group trials address locally advanced diseases seen in health disparities populations; this shortcoming needs to be rectified. Sustainability for these programs remains a challenge. Addressing these gaps through research and public health mechanisms may have an important impact on their health, scientific progress, and efforts to increase diversity in NCI clinical trials.