The impact of the affordable care act on breast cancer care in the USA: A multi-institutional analysis.

There are less data available on the effect of the ACA on breast cancer care beyond the screening level. A retrospective review at participating iCaRe2/BCCR institutions was completed before and after ACA. Post-ACA, patients were older, more urban, and more likely to be insured through Medicaid. Increased imaging use was noted post-ACA. These patients were less likely to be diagnosed with late-stage cancers, received fewer mastectomies, and were more likely to have radiation.

Incarceration among adults who are in the public mental health system: rates, risk factors, and short-term outcomes.

OBJECTIVE: Incarceration of people with mental illness has become a major social, clinical, and economic concern, with an estimated 2.1 million incarcerations in 2007. Prior studies have primarily focused on mental illness rates among incarcerated persons. This study examined rates of and risk factors for incarceration and reincarceration, as well as short-term outcomes after incarceration, among patients in a large public mental health system. METHODS: The data set included 39,463 patient records combined with 4,544 matching incarceration records from the county jail system during fiscal year 2005-2006. Risk factors for incarceration and reincarceration were analyzed with logistic regression. Time after release from the index incarceration until receiving services was examined with survival analysis. RESULTS: During the year, 11.5% of patients (N=4,544) were incarcerated. Risk factors for incarceration included prior incarcerations; co-occurring substance-related diagnoses; homelessness; schizophrenia, bipolar, or other psychotic disorder diagnoses; male gender; no Medicaid insurance; and being African American. Patients older than 45, Medicaid beneficiaries, and those from Latino, Asian, and other non-Euro-American racial-ethnic groups were less likely to be incarcerated. Risk factors for reincarceration included co-occurring substance-related diagnoses; prior incarceration; diagnosed schizophrenia or bipolar disorder; homelessness; and incarceration for three or fewer days. Patients whose first service after release from incarceration was outpatient or case management were less likely to receive subsequent emergency services or to be reincarcerated within 90 days. CONCLUSIONS: Modifiable factors affecting incarceration risk include homelessness, substance abuse, lack of medical insurance, and timely receipt of outpatient or case management services after release from incarceration.

A peer-driven mentoring case management community reentry model: an application for jails and prisons.

Welcome Home Ministries (WHM) is a peer-driven reentry program for women reentering the community from jail and prison. One of the major contributing factors to a high recidivism rate is the presenting issue of co-occurring disorders stemming from early childhood abuse and trauma found in 85% of the women seeking the assistance of WHM. The peers within WHM, having experienced mental health issues, substance abuse, and incarceration themselves, identified and developed a specific reentry program for this population. This article presents the results of a yearlong study that addresses the following: (1) the issue of co-occurring disorders; (2) the impact of early childhood trauma and abuse on the rate of incarceration; (3) the outcomes for restoration and recovery; and (4) the desire of the women to give back to the community.

A multicenter, randomized trial of long-acting octreotide for the optimum prevention of chemotherapy-induced diarrhea: results of the STOP trial.

Diarrhea is a well-recognized side effect of chemotherapy and can result in chemotherapy delay and/or dose reduction, potentially reducing the therapeutic benefit of treatment. Octreotide has been shown to be effective in controlling chemotherapy-induced diarrhea (CID). In this open-label, randomized, multicenter study, designed to asses the effects of two dose levels of octreotide long-acting release (LAR), patients with active or prior CID and scheduled for chemotherapy were randomized to receive up to six doses of either 30 or 40 mg of octreotide LAR. The primary endpoint was the proportion of patients experiencing severe diarrhea during the trial. Secondary endpoints included the proportion of patients requiring IV fluids due to diarrhea, unscheduled visits to healthcare professionals due to diarrhea, and changes in primary therapy, as well as treatment satisfaction and quality of life. In total, 147 patients were randomized and received at least 1 dose; 124 patients were efficacy-evaluable. Baseline characters were balanced in the 30-mg and 40-mg groups with the exception of gender. Fewer patients in the 40-mg group compared with those in the 30-mg group experienced severe diarrhea (61.7% vs 48.4%; P = 0.14), required IV fluid (31.7% vs 18.8%; P = 0.10), and had diarrhea-related unscheduled healthcare visits (41.7% vs. 28.1 %; P = 0.11); however, these differences were not statistically significant. No significant differences were observed between the treatment groups in either measured quality of life or treatment satisfaction. Adverse events were balanced between the two groups. No specific recommendations can be made from this trial regarding the use of 30 mg versus 40 mg of octreotide LAR for CID.