The COVID-19 pandemic impact on independent and provider-based rural health clinics' operations and cancer prevention and screening provision in the United States.

INTRODUCTION: The COVID-19 pandemic has disrupted cancer care, but it is unknown how the pandemic has affected care in Medicare-certified rural health clinics (RHCs) where cancer prevention and screening services are critical for their communities. This study examined how the provision of these cancer services changed pre- and peri-pandemic overall and by RHC type (independent and provider-based). METHODS: We administered a cross-sectional survey to a stratified random sample of RHCs to assess clinic characteristics, pandemic stressors, and the provision of cancer prevention and control services among RHCs pre- and peri-pandemic. We used McNemar's test and Wilcoxon signed rank tests to assess differences in the provision of cancer prevention and screening services pre- and peri-pandemic by RHC type. RESULTS: Of the 153 responding RHCs (response rate of 8%), 93 (60.8%) were provider-based and 60 (39.2%) were independent. Both RHC types were similar in their experience of pandemic stressors, though a higher proportion of independent RHCs reported financial concerns and challenges obtaining personal protective equipment. Both types of RHCs provided fewer cancer prevention and screening services peri-pandemic-5.8 to 4.2 for provider-based and 5.3 to 3.5 for independent (P<.05 for both). Across lung, cervical, breast, and colorectal cancer-related services, the proportion of both RHC groups providing services dropped peri-pandemic. DISCUSSION: The pandemic's impact on independent and provider-based RHCs and their patients was considerable. Going forward, greater resources should be targeted to RHCs-particularly independent RHCs-to ensure their ability to initiate and sustain evidence-based prevention and screening services.

Radiation Exposure during Prostatic Artery Embolization: A Single Institution Review.

ABSTRACT: Prostate artery embolization is a minimally invasive treatment for benign prostatic hyperplasia, and imaging is indispensable for the technical success of this procedure; however, imaging is a major source of radiation exposure for patients and healthcare providers. Radiation emission during prostate artery embolization procedures at a single institution was evaluated to determine radiation exposure with the goal to work toward minimizing exposure. All patients at a single institution that underwent outpatient unilateral/bilateral prostate artery embolization between 4 January 2019 and 16 November 2021 were retrospectively evaluated; data collected included body mass index, prostate volume, and indications for prostate artery embolization. Technical parameters recorded were air kerma, procedure time, fluoroscopy time, number of acquisitions, and intra-procedural imaging modalities. Fisher's t-test, ANOVA, and chi-square analyses were used as appropriate for statistical analysis (P < 0.05). Overall, 56 patients were included in the study. Body mass index (obesity; P = 0.0017) was a significant predictor of increased air kerma; prostate size and bilateral vs. unilateral prostate artery embolization were not significantly associated with increased air kerma despite the number of acquisitions being significantly different between bilateral and unilateral embolization (P = 0.0064). When evaluating radiation exposure during prostate artery embolization, increased body mass index significantly predicted increased air kerma. Contrary to the literature, the extent of embolization (bilateral vs. unilateral) was not associated with increased air kerma regardless of higher acquisitions and procedure time associated with bilateral prostate artery embolization. Increased radiation protection efforts should be considered for patients with higher body mass index to protect patients and practitioners.Health Phys. 124(0):000-000; 2023.

Capturing the pool dilution effect in group testing regression: A Bayesian approach.

Group (pooled) testing is becoming a popular strategy for screening large populations for infectious diseases. This popularity is owed to the cost savings that can be realized through implementing group testing methods. These methods involve physically combining biomaterial (eg, saliva, blood, urine) collected on individuals into pooled specimens which are tested for an infection of interest. Through testing these pooled specimens, group testing methods reduce the cost of diagnosing all individuals under study by reducing the number of tests performed. Even though group testing offers substantial cost reductions, some practitioners are hesitant to adopt group testing methods due to the so-called dilution effect. The dilution effect describes the phenomenon in which biomaterial from negative individuals dilute the contributions from positive individuals to such a degree that a pool is incorrectly classified. Ignoring the dilution effect can reduce classification accuracy and lead to bias in parameter estimates and inaccurate inference. To circumvent these issues, we propose a Bayesian regression methodology which directly acknowledges the dilution effect while accommodating data that arises from any group testing protocol. As a part of our estimation strategy, we are able to identify pool specific optimal classification thresholds which are aimed at maximizing the classification accuracy of the group testing protocol being implemented. These two features working in concert effectively alleviate the primary concerns raised by practitioners regarding group testing. The performance of our methodology is illustrated via an extensive simulation study and by being applied to Hepatitis B data collected on Irish prisoners.

Delayed Gastric Emptying Post-Esophagectomy: A Single-Institution Experience.

OBJECTIVE: Delayed gastric emptying (DGE) is a common functional disorder after esophagectomy in patients with esophageal carcinoma. Management of DGE varies widely and it is unclear how comorbidities influence the postoperative course. This study sought to determine factors that influence postoperative DGE. METHODS: This retrospective study evaluates patients who underwent esophagectomy with gastric pull-up between 2007 and 2019. The cohort was stratified in various ways to determine if postoperative care and outcomes differed, including patient demographics, comorbidities, intraoperative and postoperative procedures. RESULTS: During the study period, 149 patients underwent esophagectomy and 37 had diabetes. Overall incidence of DGE, as defined in this study, was 76.5%. Surgery type was significantly different between DGE and normal emptying cohorts (P = 0.005). Comparing diabetic and nondiabetic patients, there was no significant difference noted in DGE (P = 0.25). Additionally, there was no difference in presence of DGE for patients who underwent any intraoperative pyloric procedure compared to those who did not (P = 0.36). Of significance, all 16 patients with chronic obstructive pulmonary disease had a delay in gastric emptying (P = 0.01). CONCLUSIONS: A higher proportion of patients with DGE post-esophagectomy were identified compared to the literature. There is little consensus on a true definition of DGE, but we believe this definition identifies patients suffering in the immediate postoperative period and in follow-up. There is no evidence to support a different postoperative course for patients with diabetes, but the link between chronic obstructive pulmonary disease and DGE warrants further investigation.