Delivering COVID-19 Vaccine via Trusted Social Services: Program Evaluation Results from the Chicagoland CEAL Program.

To describe the reach, implementation, and sustainability of COVID-19 vaccination programs delivered by social service community organizations. Five academic institutions in the Chicagoland CEAL (Community Engagement Alliance) program partnered with 17 community organizations from September 2021-April 2022. Interviews, community organizations program implementation tracking documents, and health department vaccination data were used to conduct the evaluation. A total of 269 events were held and 5,432 COVID-19 vaccines delivered from May 2021-April 2022. Strategies that worked best included offering vaccinations in community settings with flexible and reliable hours; pairing vaccinations with ongoing social services; giving community organizations flexibility to adjust programs; offering incentives; and vaccinating staff first. These strategies and partnership structures supported vaccine uptake, community organization alignment with their missions and communities' needs, and trust. Community organizations delivering social services are local community experts and trusted messengers. Pairing social service delivery with COVID-19 vaccination built individual and community agency. Giving COs creative control over program implementation enhanced trust and vaccine delivery. When given appropriate resources and control, community organizations can quickly deliver urgently needed health services in a public health crisis.

Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study.

BACKGROUND: Racial inequities in life expectancy, driven by structural racism, have been documented at the state and county levels; however, less information is available at the city level where local policy change generally happens. Furthermore, an assessment of life expectancy during the decade preceding COVID-19 provides a point of comparison for life expectancy estimates and trends post COVID-19 as cities recover. METHODS: Using National Vital Statistics System mortality data and American Community Survey population estimates, we calculated the average annual city-level life expectancies for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations. We then calculated the absolute difference between the Black and White life expectancies for each of the 30 cities and the U.S. We analyzed trends over four time periods (2008-2010, 2011-2013, 2014-2016, and 2017-2019). RESULTS: In 2017-2019, life expectancies ranged from 72.75 years in Detroit to 83.15 years in San Francisco (compared to 78.29 years for the U.S.). Black life expectancy ranged from 69.94 years in Houston to 79.04 years in New York, while White life expectancy ranged from 75.18 years in Jacksonville to 86.42 years in Washington, DC. Between 2008-2010 and 2017-2019, 17 of the biggest cities experienced a statistically significant improvement in life expectancy, while 9 cities experienced a significant decrease. Black life expectancy increased significantly in 14 cities and the U.S. but decreased significantly in 4 cities. White life expectancy increased significantly in 17 cities and the U.S. but decreased in 8 cities. In 2017-2019, the U.S. and all but one of the big cities had a significantly longer life expectancy for the White population compared to the Black population. There was more than a 13-year difference between Black and White life expectancies in Washington, DC (compared to 4.18 years at the national level). From 2008-2010 to 2017-2019, the racial gap decreased significantly for the U.S. and eight cities, while it increased in seven cities. CONCLUSION: Urban stakeholders and equity advocates need data on mortality inequities that are aligned with city jurisdictions to help guide the allocation of resources and implementation of interventions.

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities.

OBJECTIVES: To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade. METHODS: We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences. RESULTS: Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap. CONCLUSIONS: The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.

HIV mortality across the 30 largest U.S. cities: assessing overall trends and racial inequities.

BACKGROUND: Despite decreases in overall HIV mortality in the U.S., large racial inequities persist. Most previous analyses of HIV mortality and mortality inequities have utilized national- or state-level data. METHODS: Using vital statistics mortality data and American Community Survey population estimates, we calculated HIV mortality rates and Black:White HIV mortality rate ratios (RR) for the 30 most populous U.S. cities at two time points, 2010-2014 (T1) and 2015-2019 (T2). RESULTS: Almost all cities (28) had HIV mortality rates higher than the national rate at both time points. At T2, HIV mortality rates ranged from 0.8 per 100,000 (San Jose, CA) to 15.2 per 100,000 (Baltimore, MD). Across cities, Black people were approximately 2-8 times more likely to die from HIV compared to White people at both time points. Over the decade, these racial disparities decreased at the national level (T1: RR = 11.0, T2: RR = 9.8), and in one city (Charlotte, NC). DISCUSSION: We identified large geographic and racial inequities in HIV mortality in U.S. urban areas. These city-specific data may motivate change in cities and can help guide city leaders and other health advocates as they implement, test, and support policies and programming to decrease HIV mortality.

Circadian Rhythm Dysregulation and Leukemia Development: The Role of Clock Genes as Promising Biomarkers.

The circadian clock (CC) is a daily system that regulates the oscillations of physiological processes and can respond to the external environment in order to maintain internal homeostasis. For the functioning of the CC, the clock genes (CG) act in different metabolic pathways through the clock-controlled genes (CCG), providing cellular regulation. The CC's interruption can result in the development of different diseases, such as neurodegenerative and metabolic disorders, as well as cancer. Leukemias correspond to a group of malignancies of the blood and bone marrow that occur when alterations in normal cellular regulatory processes cause the uncontrolled proliferation of hematopoietic stem cells. This review aimed to associate a deregulated CC with the manifestation of leukemia, looking for possible pathways involving CG and their possible role as leukemic biomarkers.

Stigma and cervical cancer prevention: A scoping review of the U.S. literature.

Cervical cancer is preventable through HPV vaccination and screening however, uptake falls below national targets. A scoping review was conducted to describe stigmas related to HPV infection and vaccination and cervical cancer and screening in the US. Results were organized into the domains proposed by Stangl and colleagues' Health Stigma and Discrimination Framework. Common drivers of stigma were fear of social judgement and rejection, self-blame, and shame. Positive facilitators included social norms that provided motivation to receive HPV vaccination and screening. Gender and social norms were notable negative facilitators of stigma. HPV infection and cervical cancer resulted in stigma marking through the belief that both result from incautious behavior-either multiple sexual partners or failing to get screening. Stereotyping and prejudice were stigma practices attributed to HPV infection and cervical cancer through these same behaviors. Stigma experiences related to HPV infection, cervical cancer, and abnormal screening results included altered self-image based on perceived/anticipated stigma, as well as discrimination. This review advances understanding of the multiple dimensions of stigma associated with these outcomes in the US population. Three areas warrant additional consideration. Future studies should 1) assess how stigma dimensions affect uptake of cervical cancer preventions efforts; 2) focus on US women most affected by cervical cancer incidence and mortality to identify potential differences in these dimensions and tailor interventions accordingly; 3) include women from geographic areas of the US with high rates of cervical cancer to adapt interventions that address potential regional variations in resources and need.

Barriers and facilitators to HPV vaccine uptake among US rural populations: a scoping review.

PURPOSE: Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings. METHODS: A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases. RESULTS: A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign. CONCLUSION: Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and community research, as well as interventions and policy efforts.

Did the Affordable Care Act Decrease Veteran Enrollment in the Veterans Health Administration?

BACKGROUND: Provisions of the Affordable Care Act (ACA) provided nonelderly individuals, including Veterans, with additional health care coverage options. This may impact enrollment for health care through the Veterans Health Administration (VHA). National enrollment data was used to: (1) compare characteristics of enrollees at 3 time points in relation to the implementation of ACA insurance provisions (2012); and (2) examine enrollment trends. METHODS: The study population included a 10% sample of Veterans under age 65 who were VHA enrollees between January 2012 and September 2015. Demographic and baseline characteristics were compared between 3 enrollment groups: pre-2012, pre-ACA (2012-2013), and post-ACA (2014-2015). Using an interrupted time series approach, we employed pooled logistic regression to assess trends in new VHA enrollment, overall, and by select enrollee characteristics. RESULTS: A total of 429,833 enrollees were identified. Compared with pre-ACA enrollees, post-ACA enrollees were more likely to be older, have a service-connected disability, live further away from a VHA medical center, but less likely to use primary care within 6 months. The post-ACA quarterly trend in the odds of being a new enrollee was 3% lower (95% confidence interval: 0.96, 0.98) as compared with the pre-ACA trend. This decline was consistent across sex, geography, (all but 1) priority group, and state Medicaid-expansion subgroups. CONCLUSIONS: The ACA appears to have contributed to a decline in new VHA enrollment. In addition, the profile of newer enrollees differs from that of pre-ACA enrollees. The VHA must continue to monitor trends in demand in order to continue delivering high-quality, efficient care.

Predictors of breast cancer mortality among white and black women in large United States cities: an ecologic study.

PURPOSE: We employed a city-level ecologic analysis to assess predictors of race-specific (black and white) breast cancer mortality rates. METHODS: We used data from the National Center for Health Statistics and the US Census Bureau to calculate 2010-2014 race-specific breast cancer mortality rates (BCMR) for 47 of the largest US cities. Data on potential city-level predictors (e.g., socioeconomic factors, health care resources) of race-specific BCMR were obtained from various publicly available datasets. We constructed race-specific multivariable negative binomial regression models to estimate rate ratios (RR) and 95% confidence intervals (CIs). RESULTS: Predictors of the white BCMR included white/black differences in education (RR 0.95; CI 0.91-0.99), number of religious congregations (RR 0.87; CI 0.77-0.97), and number of Medicare primary care physicians (RR 1.15; CI 1.04-1.28). Predictors of the black rate included white/black differences in household income (RR 1.03; CI 1.01-1.05), number of mammography facilities (RR 1.07; CI 1.03-1.12), and mammogram use (RR 0.93; CI 0.89-0.97). CONCLUSIONS: Our ecologic analysis found that predictors of breast cancer mortality differ for the black and white rate. The results of this analysis could help inform interventions at the local level.

Racial disparity in survival from estrogen and progesterone receptor-positive breast cancer: implications for reducing breast cancer mortality disparities.

INTRODUCTION: Non-Latina black breast cancer patients experience a shorter survival from breast cancer than their non-Latina white counterparts. We compared breast cancer-specific survival for the subset of black and white patients with estrogen and/or progesterone receptor-positive tumors that are generally targeted with endocrine therapy. METHODS: Using data collected from a population-based cohort of breast cancer patients from Chicago, IL, Kaplan-Meier survival curves and hazard functions were generated and proportional hazards models were estimated to determine the black/white disparity in time to death from breast cancer while adjusting for age at diagnosis, patient characteristics, treatment-related variables, and tumor grade and stage. RESULTS: In regression models, hazard of breast cancer death among ER/PR-positive patients was at least 4 times higher for black than for white patients in all models tested. Notably, even after adjusting for stage at diagnosis, tumor grade, and treatment variables (including initiation of systemic adjuvant therapies), the hazard ratio for death from ER/PR-positive breast cancer between black and white women was 4.39 (95% CI 1.76, 10.9, p = 0.001). CONCLUSIONS: We observed a racial disparity in breast cancer survival for patients diagnosed with ER/PR-positive tumors that did not appear to be due to differences in tumor stage, grade, or therapy initiation in black patients, suggesting that there may be racial differences in the molecular characteristics of hormone receptor-positive tumors, such that ER/PR-positive tumors in black patients may be less responsive to standard treatments.

Race/ethnicity and disparities in mastectomy practice in the Breast Cancer Care in Chicago study.

PURPOSE: To examine racial/ethnic disparities in mastectomy practice and explore mediating factors to explain the disparity. METHODS: Participants included 989 females aged 30-79 years, from a population-based study of newly diagnosed (primary in situ/invasive) breast cancer patients, in Chicago, Illinois, from 2005 to 2008, who completed an interview. Medical records were also abstracted for tumor, diagnostic, and treatment information. Multivariable logistic regression models with model-based standardization were used to estimate risk differences. Differences in rescaled coefficients were used to estimate the proportion of the disparity that could be mediated by patient and tumor characteristics. RESULTS: Mastectomy prevalence overall was 40 %. Factors significantly associated with increased rates of mastectomy (p < 0.05) included the following: non-Hispanic (nH) black and Hispanic race/ethnicity; younger age at diagnosis; lower socioeconomic status (SES); lack of recency of and adherence to screening mammography; and higher tumor pathologic stage and grade. In adjusted models (age, body mass index, comorbidity), compared to nH white patients, mastectomy was increased by 10 % points in both nH black (95 % confidence interval [CI] 0.03, 0.18; p = 0.007) and Hispanic (95 % CI 0.01, 0.19; p = 0.028) patients. After accounting for the proportion of disparity mediated by tumor stage, the disparity was reduced by about a third in nH black (risk difference = 0.07, 95 % CI -0.01, 0.14) and half in Hispanic patients (risk difference = 0.04, 95 % CI -0.05, 0.13). Additional control for mediation by SES and other tumor-related factors almost completely eliminated the nH black:nH white disparity. CONCLUSIONS: The best approach to reducing the racial/ethnic disparity in mastectomy rates would be to intervene on factors that could affect stage at diagnosis.

Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis: The Mediating Effects of Health Care Facility Factors.

BACKGROUND: Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care. OBJECTIVES: We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors. RESEARCH DESIGN AND SUBJECTS: Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study. MEASURES: Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to: (1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis. RESULTS: Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P<0.0001). CONCLUSIONS: Initial presentation of breast cancer at higher resourced facilities can reduce diagnostic delays. Disparities in delay are partly due to a disproportionate presentation at lower resourced facilities by minorities.

Optimized expression conditions for enhancing production of two recombinant chitinolytic enzymes from different prokaryote domains.

Enhancing functional gene expression is key to high-level production of active chitinases. For this purpose, the effects of culture cell density, inducer concentration, post-induction time and induction temperatures on the functional expression of two different chitinases (HsChiA1p, a family 18 archaeal chitinase and PtChi19p, a family 19 bacterial chitinase) were comparatively investigated. Results showed that the effect of each parameter on the activity of both chitinases was specific to each enzyme. In addition, different Escherichia coli host strains compatible with the expression in pET systems were assayed for active protein overexpression. When using BL21 Star (DE3), a significant increase of 60% in expression was observed for the active archaeal chitinase HsChiA1p as compared to that found when using BL21 (DE3), indicating that the rne131 gene mutation efficiently stabilizes the mRNA for HsChiA1p. Using the Codon Adaptation Index value, rare codon analysis of the archaeal HschiA1 and bacterial Ptchi19 genes revealed that both DNA sequences were not optimal for maximal expression in E. coli. Different E. coli host strains possess extra copies of some of the tRNA genes for rare codons. For the Rosetta 2 (DE3) and the BL21 RP (DE3) strains, a significant increase of 40% was reached for the activity of HsChiA1p and PtChi19p. Finally, as part of the protein still remained insoluble, the best conditions for recovering biologically active protein from inclusion bodies were established for each enzyme.

Functional expression and characterization of a chitinase from the marine archaeon Halobacterium salinarum CECT 395 in Escherichia coli.

The HschiA1 gene of the archaeon Halobacterium salinarum CECT 395 was cloned and overexpressed as an active protein of 66.5 kDa in Escherichia coli. The protein called HsChiA1p has a modular structure consisting of a glycosyl hydrolase family 18 catalytic region, as well as a N-terminal family 5 carbohydrate-binding module and a polycystic kidney domain. The purified recombinant chitinase displayed optimum catalytic activity at pH 7.3 and 40 °C and showed high stability over broad pH (6-8.5) and temperature (25-45 °C) ranges. Protein activity was stimulated by the metal ions Mg(+2), K(+), and Ca(+2) and strongly inhibited by Mn(+2). HsChiA1p is salt-dependent with its highest activity in the presence of 1.5 M of NaCl, but retains 20% of its activity in the absence of salt. The recombinant enzyme hydrolysed p-NP-(GlcNAc)3, p-NP-(GlcNAc), crystalline chitin, and colloidal chitin. From its sequence features and biochemical properties, it can be identified as an exo-acting enzyme with potential interest regarding the biodegradation of chitin waste or its bioconversion into biologically active products.

Community-Based Organizations Leading Research Efforts: Preliminary Findings from the Chicagoland CEAL Program's COVID-19 Vaccine Uptake and Intention Survey.

BACKGROUND: To foster community engaged research in the communities most impacted by COVID-19, the National Institutes of Health (NIH) formed 21 teams of Community Engagement Alliance Against COVID-19 Disparities (CEAL). The national CEAL initiative developed a Common Survey to investigate attitudes and behaviors to the COVID-19 vaccine and clinical trials. This article describes survey implementation at the Chicagoland CEAL Program (CCP). METHODS: This community-based participatory research project was the result of a strong collaboration between academic institutions, and a community-based non-profit health equity-focused partner organization. The survey implementation was developed and refined with strong input from CHWs, participants, and staff in the partner organizations and institutions. Survey data were collected with Qualtrics, a web-based survey tool. RESULTS: Survey implementation resulted in data collection for 852 participants during the period 12/18/2021-02/18/2023. Excluding participants on the basis of missing data resulted in a sample of 690, 601 of which (87.10%) indicated that they had received at least one dose or intended to get vaccinated. Overall, 54 (7.83%) respondents reported that they had not received the vaccine and were not planning to. CONCLUSION: Hard to reach populations present two unique challenges in emerging infectious disease events. Reaching populations vulnerable to poor outcomes with vaccines was essential to addressing the COVID-19 pandemic. Additionally, learning about barriers and hesitancy toward vaccine uptake is difficult in these communities. CCP's partnership of five academic institutions, a community research center, and a community-based non-profit health equity-focused organization shows what is possible when traditional models of research and inquiry are reconsidered for community-based participatory research. Results shown here are drawn from a collaboratively designed and implemented survey, collected in person, with over 90% completion.

Advancing Precision Medicine: A Review of Innovative In Silico Approaches for Drug Development, Clinical Pharmacology and Personalized Healthcare.

The landscape of medical treatments is undergoing a transformative shift. Precision medicine has ushered in a revolutionary era in healthcare by individualizing diagnostics and treatments according to each patient's uniquely evolving health status. This groundbreaking method of tailoring disease prevention and treatment considers individual variations in genes, environments, and lifestyles. The goal of precision medicine is to target the "five rights": the right patient, the right drug, the right time, the right dose, and the right route. In this pursuit, in silico techniques have emerged as an anchor, driving precision medicine forward and making this a realistic and promising avenue for personalized therapies. With the advancements in high-throughput DNA sequencing technologies, genomic data, including genetic variants and their interactions with each other and the environment, can be incorporated into clinical decision-making. Pharmacometrics, gathering pharmacokinetic (PK) and pharmacodynamic (PD) data, and mathematical models further contribute to drug optimization, drug behavior prediction, and drug-drug interaction identification. Digital health, wearables, and computational tools offer continuous monitoring and real-time data collection, enabling treatment adjustments. Furthermore, the incorporation of extensive datasets in computational tools, such as electronic health records (EHRs) and omics data, is also another pathway to acquire meaningful information in this field. Although they are fairly new, machine learning (ML) algorithms and artificial intelligence (AI) techniques are also resources researchers use to analyze big data and develop predictive models. This review explores the interplay of these multiple in silico approaches in advancing precision medicine and fostering individual healthcare. Despite intrinsic challenges, such as ethical considerations, data protection, and the need for more comprehensive research, this marks a new era of patient-centered healthcare. Innovative in silico techniques hold the potential to reshape the future of medicine for generations to come.

Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines.

Conflicting study results with regards to racial/ethnic disparities in chemotherapy use among breast cancer patients may be due to the different sample populations, treatment data sources, and treatment eligibility definitions used. This study examined chemotherapy disparity in the context of changing treatment guidelines and explored factors that may help explain treatment differences observed. The data come from a population-based study that included interview and medical record data (including state cancer registry) from non-Hispanic (nH) White, nH Black, and Hispanic breast cancer patients diagnosed in 2005-2008. Logistic regression using model-based standardization was used to estimate age-adjusted risk differences and multivariate analysis was conducted to identify explanatory factors of the differences. Per the 2005/2006 National Comprehensive Cancer Network (NCCN) guidelines, minority patients appeared more likely than nH White patients to receive a chemotherapy recommendation (0.87 vs 0.75, p = 0.003). When eligibility was determined per the 2007 guidelines, there was no disparity because under these guidelines, nH White patients were more likely than minority patients to have tumors that no longer required chemotherapy. There was evidence that chemotherapy advances for breast cancer patients are implemented in the clinical setting well ahead of NCCN guidelines. Finally, among eligible patients, chemotherapy recommendation was very high and virtually always accepted and received, with no disparities found at these points of clinical care. The findings suggest that an evaluation of guideline-adherent chemotherapy treatment patterns must carefully consider the definition of treatment eligibility, given ongoing changes in treatment guidelines and early uptake of new diagnostic tools and treatments.

A Review of the Lidocaine in the Perioperative Period.

This review analyzes the controversies surrounding lidocaine (LIDO), a widely recognized local anesthetic, by exploring its multifaceted effects on pain control in the perioperative setting. The article critically analyzes debates about lidocaine's efficacy, safety, and optimal administration methods. While acknowledging its well-documented analgesic attributes, the text highlights the ongoing controversies in its application. The goal is to provide clinicians with a comprehensive understanding of the current discourse, enabling informed decisions about incorporating lidocaine into perioperative protocols. On the other hand, emphasizes the common uses of lidocaine and its potential role in personalized medicine. It discusses the medication's versatility, including its application in anesthesia, chronic pain, and cardiovascular diseases. The text recognizes lidocaine's widespread use in medical practice and its ability to be combined with other drugs, showcasing its adaptability for individualized treatments. Additionally, it explores the incorporation of lidocaine into hyaluronic acid injections and its impact on pharmacokinetics, signaling innovative approaches. The discussion centers on how lidocaine, within the realm of personalized medicine, can offer safer and more comfortable experiences for patients through tailored treatments.

Concurrent Hospice Healthcare Utilization in the Hematology/Oncology Veteran's Affairs Patient Population.

Objectives: Concurrent care is a unique care delivery system that allows patients to receive disease modifying treatments and other supportive interventions while also receiving the traditional benefits of hospice care. The objectives of our observational study were to examine health care utilization, use of cancer-directed therapies and palliative interventions, and location of death in patients enrolled in concurrent care. Methods: 72 hematology-oncology patients at the Hines Veteran's Affairs Medical Center (VAMC) who enrolled in concurrent care from 12/2018-4/2021 were reviewed. Data were summarized with descriptive statistics including medians and percentages. Results: A minority of patients received cytotoxic chemotherapy (27.8%), immunotherapy (20.8%), palliative radiation (20.9%), blood products (11.1%), or invasive pain procedures (4.2%). Patients also used fewer cancer-directed treatments as they approached end of life (24.4% within 30 days of death compared to 13.3% within 14 days of death). Most patients died at home (62.9%) or in inpatient hospice (12.9%) as opposed to the hospital (2.9%). Conclusions: A minority of concurrent care patients received cancer-directed therapies or additional types of health care interventions despite the option to do so. Cancer-directed treatment utilization also decreased as patients approached end of life. Patients enrolled in concurrent care were able to appreciate its benefits for longer, as the average length of stay on concurrent care was nearly 3 months.