Yuma Oncology Center

BackgroundSexually transmitted infections are on the rise in older populations globally, including among older travellers. International retirement migrants are older people who have retired from the workforce and travel abroad seasonally, typically during the winter months in their home countries. The transnational nature of this practice may challenge public health efforts to control the spread of sexually transmitted infection and encourage treatment. This study focuses on Yuma, Arizona, a popular destination for Canadian international retirement migrants who winter in the United States, to examine the sexual health risks associated with their seasonal travel.MethodsUtilizing a qualitative case study approach, this research involved semi-structured interviews conducted remotely with key informants in Yuma (n = 10) who held various health care and administrative roles. Participants provided insights into sexual health risks based on their extensive interactions with Canadian seasonal migrants and their knowledge of the social dynamics within retirement communities. Interviews were transcribed verbatim, coded using NVivo software, and thematically analyzed to identify risk factors for sexually transmitted infections among Canadian international retirement migrants wintering in Yuma.ResultsFindings revealed three main risks that may contribute to exposure to sexually transmitted infections and potential transmission: social dynamics within tight-knit retirement migrant communities that facilitate unsafe sexual practices (i.e., risky practices); barriers to accessing diagnostic services, such as costs and lack of established local care (i.e., risky care access); and challenges in following standard treatment and public health protocols due to logistical difficulties in ensuring follow-up (i.e., risky treatment decisions). Key informants noted that lifestyle choices, including the use of alcohol and drugs, can exacerbate these risks. Health care access barriers driven by travel health insurance and mobility limitations further complicate the diagnosis and treatment of sexually transmitted infections for Canadian international retirement migrants while abroad.ConclusionsThis study highlights the complex interplay of social behaviours and health care barriers that heighten the risk of sexually transmitted infection transmission among Canadian retirement migrants in the transnational context of Yuma. Extended diagnostic and treatment services, comprehensive sexual health education in pre- and post-travel consultations, as well as inclusive travel health insurance coverage could significantly improve the sexual health outcomes for this population.

Purpose: The purpose of this study was to evaluate the stability of angiotensin II in 0.9% sodium chloride for up to 5 days. Methods: We prepared angiotensin II dilutions, by aseptically diluting 2.5 mg (1 mL) in 249 mL 0.9% sodium chloride creating a solution of 10 000 ng/mL. Admixtures were stored under refrigeration (5 ± 3°C). Stability of the dilution was assessed by: preservation of clarity, consistency of pH, and retention of concentration. Solutions were sampled at times 0, 24, 48, 72, 96, 120 hours. Solutions were analyzed via High-Performance Liquid Chromatography (HPLC-UV) and Liquid Chromatography Mass Spectrometry (LC-MS/MS). Retention of concentration was set a priori at > 90% of initial concentration. Results: Clarity, color, and pH at all sample time points remained constant. Both methods of analysis confirmed similar results. When stored under refrigeration, the concentration of angiotensin II solution remained above 90% of initial concentration throughout the entire sampling period. Conclusions: Angiotensin II in 0.9% sodium chloride stored in infusion bags under refrigeration (5 ± 3°C) maintained at least 90% of their original concentrations for up to 5 days. Stability was also demonstrated based on turbidity, color, and pH assessment.

Lemierre's syndrome, also known as anaerobic post-anginal septicemia, necrobacillosis, and the "forgotten disease," is a rare manifestation. It is often presented with sepsis, sore throat, fever, neck pain, internal jugular vein thrombophlebitis/thrombosis, and septic emboli. The bacteria that are usually associated with the disease are Fusobacterium species, but it is also associated with Staphylococcus, Streptococcus, and other bacterial species. The diagnosis of Lemierre's syndrome is made based on evidence of septic thrombophlebitis, preceding oropharyngeal infection, and positive culture. Treatment usually consists of antibiotics directed towardthe causative organism. The use of anticoagulation, although controversial, is shown to be beneficial by several studies. We describe a middle-aged patient who presented with a sore throat, neck pain, and dysphagia. Imaging of the neck and chest revealed right jugular thrombosis along with septic emboli in the lungs. The culture of the blood and pus drained from the peritonsillar abscess grewStreptococcus anginosus. In this study, we have illustrated the effective management of Lemierre's syndrome with antibiotics, anticoagulants, and needle aspiration of abscess.

Introduction: Pneumocystis Pneumonia (PCP) is a common opportunistic infection among people living with the human immunodeficiency virus (HIV). This study’s objective was to assess temporal trends in PCP epidemiology among hospitalized patients with HIV/AIDS in the US and to compare data for hospitalizations with HIV with PCP to those without PCP. Methods: The national inpatient sample (NIS) data were analyzed from 2002–2014. The discharge coding identified hospitalized patients with HIV or AIDS and with or without PCP. Results: We identified 3,011,725 hospitalizations with HIV/AIDS during the study period; PCP was present in 5% of the patients with a diagnosis of HIV. The rates of PCP progressively declined from 6.7% in 2002 to 3.5 % in 2014 (p < 0.001). Overall mortality in patients with HIV was 3.3% and was significantly higher in those with PCP than without PCP (9.9% vs. 2.9%; p < 0.001). After adjusting for demographics and other comorbidities, PCP had higher odds of hospital mortality 3.082 (OR 3.082; 95% CI, 3.007 to 3.159; p < 0.001). Conclusion: From 2002 to 2014, the rate of PCP in HIV patients has decreased significantly in the United States but is associated with substantially higher mortality.

1563 Background: Clinical trials that require patients to have specific actionable mutations based on next generation sequencing (NGS) present unique problems, such as recruiting patients with rare mutations, low enrollment rates, and distance between patients and trial sites. Such barriers can slow the pace of trial enrollment and delay the development of new therapeutic options. Methods: Tempus Labs has partnered with experienced research sites and pharmaceutical companies with molecularly targeted clinical trials to create the TIME Trial Network. The study portfolio includes pharmaceutical sponsored phase I-III clinical trials across solid tumors and hematological malignancies, targeting actionable mutations. This network was established to ensure rapid just-in-time (JIT) activation of trials by streamlining start-up activities (i.e., execution of CTAs and study budgets/financial exhibits, regulatory paperwork, SIV planning and conduct, drug and study supply shipments, submission to the central IRB, and sponsor-specific requirements). Rapid activation begins upon receipt of an activation form from a site partner. “Site Activated” describes a site that has fulfilled all regulatory, documentation, contracting requirements, and has sponsor approval to screen and enroll patients. Results: In Q4 2020, JIT activations were completed for 6 unique interventional clinical trials across 10 sites in 8 US states in the TIME Trial Network. On average, sites were activated in 9.4 business days. Patients enrolled had rare NGS mutations and were from geographically diverse locations. In one urgent case, trial activation, patient consent, screening, and treatment were achieved in 5 business days. In total, 91.7% of patients consented to trial. The average timeline from activation to consent was 4.5 days (range 0 - 24 days), with half of patients consenting within 1 business day. 45.5% of patients who consented to trial received the study drug within 1 day of consent; 2 patients dosed on day of consent. Conclusions: Over a 3-month period, on average, TIME Trial sites were activated in 9.4 days (compared to the 20+ week industry-wide average), and patient consent was completed in 4.5 days. Rapid JIT activations through the TIME program provide significant improvements in trial enrollment timelines and increase access to therapies nationwide. JIT activations may be especially useful for rural, underserved communities, as sites can enroll diverse patient populations and help address the equity gap in clinical trials across ethnic groups.[Table: see text]

Community-based participatory research (CBPR) has been documented as an effective approach to research with underserved communities, particularly with racial and ethnic minority groups. However, much of the literature promoting the use of CBPR with underserved communities is written from the perspective of the researchers and not from the perspective of the community partner. The purpose of this article is to capture lessons learned from the community partners’ insight gained through their experiences with CBPR. A multi-investigator consensus method was used to qualitatively code the transcripts of a CBPR story-telling video series. Seven major themes were identified: (1) expectations for engaging in research, (2) cultural humility, (3) respecting the partnership, (4) open communication, (5) genuine commitment, (6) valuing strengths and recognizing capacities, and (7) collaborating to yield meaningful results. The themes drawn from the community partner’s voice align with the tenets of CBPR advanced in the academic literature. More opportunities to include the community voice when promoting CBPR should be undertaken to help introduce the concepts to potential community partners who may be research cautious.

The risk of developing secondary cancers (SCs) among patients with malignant thymoma in the US has not been estimated in the more recent time period.Methods:We extracted demographic and treatment data from the SEER database to estimate the standardized incidence ratios (SIRs).Results:Of 1570 patients with thymoma 211 (13.4%) had SCs. The overall risk of developing SCs was higher among patients with thymoma (SIR: 1.54, 95% CI: 1.34-1.76). The SIRs for cancers of lung, esophagus, sigmoid colon, soft tissue and heart, kidney, NHL and leukemia was significantly higher as compared to the general US population.Conclusions:Patients with thymoma are at modestly elevated risk of developing SCs as compared to the general US population. Although the overall risk has not changed after 14 additional years of follow up, the distribution of SCs has significantly broadened, with increased diversity across type and anatomic location of SCs.

181 Background: A grave illness like cancer can lead to substantial spiritual distress for patients and their care givers. Not meeting patients’ spiritual needs have been reported to lower ratings of quality and dissatisfaction with care. The FACIT-Sp-12 is used in research studies investigating health related quality of life (HRQOL) outcomes in cancer patients and has special focus on faith, meaning and peace. Methods: We introduced a unique model at the cancer center by having the chaplain resident and pain/palliative care physician evaluating and following patients together during the weekly Supportive Care Clinic. FACIT-Sp-12 score was also calculated for 92 patients on 164 visits during October 2016 till July 2017. Results: Overall, the FACIT-Sp-12 score was calculated for 92 (52 females and 40 males) patients with median age of 69 years (range 36-89). Sixty-eight (74%) were non-Hispanics while native language was English for 71 (77%) patients. The baseline FACIT-sp-12 score ranged between 16 and 48 with median score of 38. Thirty-two patients had follow up visits. 15 of these patients had improvement in their FACIT-Sp-12 score, 12 patients’ score had decreased and 5 patients’ scores were unchanged. There was an increase in FACIT-Sp-12 score in the males but after adjusting for gender, age, race, language and number of follow up visits, none of the variables could predict increase in the FACIT-Sp-12 score. Conclusions: We have successfully implemented this model of integrating spiritual support services to the delivery of cancer care. Decrease in FACIT score may coincide with distress associated with worsening symptoms or change in patient’s condition, and offers an opportunity to address the increased spiritual needs and assistance with coping during times of distress. Future prospective studies will prove instrumental in validating this approach and hopefully become a service reimbursable by health insurances, and thereby become universally accessible.

WHY ADOPT POPULATION HEALTH MANAGEMENT?Population health management has been the focus of many studies and articles as a critical strategy for success as the healthcare delivery system changes in response to government regulations and insurance industry shifts. It also is frequently cited as a tool to manage costs. Zenty and Bieber's feature article discusses how University Hospitals Health System's (UH) population health management initiative evolved through the experience of its various accountable care organizations (ACOs), which were formed to address the rising costs of their self-insured plans.In the other feature article for this issue, Kindig and Isham discuss the need to improve the health of our communities and close the lag in health outcomes across the United States compared to most developed countries. I believe their message that the challenge of population health improvement cannot be the sole responsibility of the healthcare industry is critical to understanding how we move forward.A recent article in the Journal of the American Medical Association, by Friedberg and colleagues (2014), complicates this discussion, however. Those authors suggest that the care offered in a patient-centered medical home (PCMH) environment, which is designed to coordinate resources to improve patient care, offers little benefit to the outcomes experienced by the patient or in reducing the cost of care. One might conclude from Friedberg and colleagues' findings that if a PCMH or another population health management tool produces no cost management or patient outcome benefits, why invest in the effort?These authors directly or indirecuy link population health management to the Triple Aim as articulated by the Institute for Healthcare Improvement (IHI): improvement of individuals' experience of care, improvement of the health of populations, and reduction of per capita cost of care for populations. Of these, in my opinion, that improvement of the individual experience of care could be the most significant factor influencing the achievement of health improvement and, eventually, cost management.The Perspective of a Critical Access Hospital/Rural Health ClinicYuma District Hospital and Clinics (YDHC) consists of a 12-bed critical access hospital and two rural health clinics offering family medicine, a specialty clinic that brings a variety of medical and surgical specialists to the community throughout the month, and a PhD-degreed psychologist and licensed professional counselor. We offer post-acute care through our swing-bed program and a home health agency. Our ten primary care providers are employees of the organization. Consider us a micro-integrated healthcare delivery system serving a population of approximately 14,000 people spread across a wide geographic area.In 2008, YDHC was invited to participate in an initiative led by the Commonwealth Fund, Qualis Health, and the MacCoil Center for Health Care Innovation at the Group Health Research Institute. The objective of the initiative was to develop and demonstrate a sustainable model to transform primary care safety net practices into PCMHs, thereby achieving the IHI Triple Aim goals. (For more detail about the initiative, refer to www.safetynet medicalhome.org.) We eagerly agreed to participate, with the simple thought that this would be a tool to improve patient care in our rural health clinic. The timing seemed right: We had recently moved into a newly constructed replacement facility to house our hospital and our main clinic, and we were midway through the rebuilding of our medical staff. It was our feeling that this would not be a long journey and that the care provided in our facilities was already close to that of a medical home environment. It did not take long for us to realize that we were just beginning.At the same time as we were moving forward with this initiative, we were faced with a population of patients who believed that their experience of care was not satisfactory. …