Clinical trial participation assessed by age, sex, race, ethnicity, and socioeconomic status.

INTRODUCTION: Individual demographic data and socioeconomic status (SES) factors from Census block group data may help define groups with disadvantaged access to clinical trials. METHODS: Individual demographic data from the Aurora Cancer Registry and SES factors corresponding to the Census block group of the patient's address were studied for a six-year period ending July 31, 2019. RESULTS: The final study cohort included 39,968 patients (enrolled = 772, and not enrolled = 39,196). In univariate analysis, significantly fewer patients older than age 65 (p < 0.001) and fewer men (p < 0.001) were enrolled in clinical trials. Socioeconomic factors found to be significant during univariate analysis included: low household income (p < 0.001), percentage below the poverty line (p < 0.001), low percentage home ownership (p = 0.006), unemployment (p = 0.003), absence of a college degree (p = 0.037) and absence of a high school degree (p = 0.007). In multivariate analysis, patients older than age 65 were less likely to participate in a trial (odds ratio 0.574, p < 0.001) and men were less likely to participate (odds ratio = 0.703, p < 0.001). Only 1.4% of the variance in clinical trial participation was accounted for demographic and SES factors. CONCLUSIONS: The only groups with disadvantaged access to clinical trials in our institution were the elderly and men. Whether demographic or SES factors are related to accrual rates of clinical trials in other geographic regions or in other types of research studies warrants further investigation.

The effects of dry needling on the thumb: A case report.

INTRODUCTION: Dry needling has been identified as a potential intervention for a variety of diagnoses. Limited evidence exists to support the use of dry needling following surgical intervention of a distal radius fracture. This case report demonstrates the impact of dry needling in the thumb following a distal radius fracture. METHODS: The patient was a 31-year-old healthy female who sustained a distal radius fracture and required surgical intervention. The patient required a volar plate removal and extensor tenolysis. The patient attended traditional occupational therapy with one session of dry needling to assist in improving range of motion and decreasing pain. RESULTS: The patient benefited from the use of dry needling. The patient had no pain with functional grasping and pinching following dry needling and improved on the Kapandji score from eight to nine out of ten. The patient also reported a decrease in overall pain, from seven to two on the Numeric Pain Rating Scale. DISCUSSION: The patient benefited from dry needling in the thumb to improve both range of motion and pain symptoms. While the evidence is limited, dry needling may be an appropriate intervention to assist in recovery and reduce thumb pain following distal radius fractures.

Outcomes of an interdisciplinary work rehabilitation program.

BACKGROUND: Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient's RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge. OBJECTIVE: To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes. METHODS: A retrospective database analysis was conducted with a sample of 495 participants (Mage = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010. RESULTS: A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = -3.152, p = 0.002). The type of injury was not related to strength at the time of discharge. CONCLUSIONS: Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.

An Outpatient Heart Failure Clinic Reduces 30-Day Readmission and Mortality Rates for Discharged Patients: Process and Preliminary Outcomes.

BACKGROUND: The first outpatient heart failure clinic (HFC) in Western New York was developed within a large private cardiology practice with the objective of reducing 30-day all-cause rehospitalization and inpatient mortality. PURPOSE: The aim of this study was to analyze the process and patient outcomes of this independent outpatient HFC. The specific aims were to (a) describe the outpatient care strategies employed and (b) determine whether the HFC reduced 30-day all-cause rehospitalizations and inpatient mortality by comparing HFC data with census data. METHODS: This study used a retrospective chart analysis of 415 adults who had been enrolled in the target HFC after hospitalization for HF. Data were summarized using frequency comparisons and descriptive statistics. One-sample chi-square tests were conducted to test the observed values in the study sample against census data. RESULTS: Patients in the HFC were less likely to experience a readmission to hospital within 30 days of discharge (69% reduction within the study period, p < .001). Patients were seen acutely after discharge, had multiple medication adjustments, and received ongoing telephonic follow-up. The HFC had statistically lower inpatient mortality rates (1.2% vs. 11.6% national average, p < .001), likely a result of the HFC care regimen and referrals for palliative care (17%). CONCLUSIONS: The results of this analysis highlight the importance of developing an outpatient HFC in collaboration with hospitals that is aimed at reducing 30-day all-cause readmissions and inpatient mortality, with referral to palliative care when indicated.