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7 results

  • Chapter 19 - Lung Cancer

  • Edited by Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston, Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
  • Book:
    Caring for the Female Cancer Patient
    Published online:
    23 October 2024
    Print publication:
    17 October 2024, pp 331-345

  • Summary

    Lung cancer has emerged as a distinct disease in women, and women have unique risk factors as compared to men. Women are more likely to be diagnosed at a young age with adenocarcinoma, lack a significant smoking history and carry driver mutations. Current screening guidelines center around tobacco use, so health care disparities related to gender may impact those women who never smoked and/or prone to lung cancer from distinct etiologies. Molecular and immune markers are important in the workup for cancer, and new treatments with targeted and immune-mediated therapies are available. Women diagnosed with lung cancer have improved survival rates compared to men even while accounting for stage of diagnosis, age, smoking history and treatment modality. Lung cancer survivorship issues can contribute to significant symptom burden, and these can include cancer-related fatigue, reproductive issues, sexual health and sleep disruption. The impact of lung cancer and its’ therapies can affect quality of life especially when treatment-related complications are persistent.

  • 10 - Evidence and the Management of Health Care for Disadvantaged Populations

  • Mark Pauly, University of Pennsylvania, Flaura Winston, Mary Naylor, Kevin Volpp, Lawton Robert Burns, University of Pennsylvania, Ralph Muller, David Asch, University of Pennsylvania School of Medicine, Rachel Werner, University of Pennsylvania School of Medicine, Bimal Desai, University of Pennsylvania School of Medicine, Krisda Chaiyachati, University of Pennsylvania School of Medicine, Benjamin Chartock, Wharton School, University of Pennsylvania
  • Book:
    Seemed Like a Good Idea
    Published online:
    14 July 2022
    Print publication:
    28 July 2022, pp 332-368

  • Summary

    Uneven distribution of income, education, and wealth in the United States combined with racism and class discrimination result in parts of the population having worse health outcomes than others. Such disparities have been the focus of much talk and many serious efforts at documentation, but (as will be shown in this chapter) very little effective action to change them – both because of lack of evidence for change that is effective and lack of implementation of evidence-based changes. Although everyone knows that medical care alone cannot alter all of the disparities in observed health outcomes caused by centuries of discrimination, sometimes it can make a difference. To what extent could evidence about effective programs help health care managers or policymakers take a leadership role in reducing disparities for disadvantaged populations?1 Is it possible at least to identify actions that would help, and then implement them? The need to convert evidence-based management from an aspiration into reality is especially acute for this problem.

  • Socioeconomic status and the use of computed tomography in the emergency department

  • Rajesh Bhayana, Marian J. Vermeulen, Qi Li, Chelsea R. Hellings, Carl Berdahl, Michael J. Schull
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 16 / Issue 4 / July 2014
    Published online by Cambridge University Press:
    04 March 2015, pp. 288-295
    Print publication:
    July 2014
    • Article
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  • Background:

    Low socioeconomic status (SES) is associated with adverse health outcomes. Possible explanations include differences in health status, access to health care, and care provided by clinicians. We sought to determine whether SES is associated with computed tomography (CT) use in the emergency department (ED).

    Methods:

    A retrospective cohort study of all Ontario ED patients (April 1, 2009, to March 31, 2010) using administrative databases was conducted, and patients were stratified into SES quintiles based on median neighbourhood income. Using multivariate logistical regression, CT scan use within SES quintiles was compared for all patients and subgroups based on chief complaints: headache, abdominal pain, and complex abdominal pain (age ≥ 65 years, high acuity, and admittance to hospital).

    Results:

    We analyzed 4,551,101 patient visits, of which 52% were female. Overall, 8.2% underwent CT scanning. In adjusted analyses, the lowest SES patients were less likely to undergo CT scanning overall and in all clinical subgroups, except for complex abdominal pain. Compared to the lowest SES quintile, the adjusted odds ratios of CT scanning in the highest SES quintile were 1.08 (95% CI 1.07–1.09), 1.28 (95%CI 1.22–1.34), and 1.24 (95% CI 1.21–1.27) for all patients, headache pain patients, and abdominal pain patients, respectively. For patients presenting with complex abdominal pain, no significant difference in CT use was observed.

    Conclusion:

    Lowest SES ED patients were less likely to receive CT scans overall and in headache and abdominal pain subgroups. No difference was seen among complex abdominal pain patients, suggesting that as clinical indications for the test become more clearcut, use across SES quintiles differs less.

  • THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKING

  • Michelle van Ryn, Diana J. Burgess, John F. Dovidio, Sean M. Phelan, Somnath Saha, Jennifer Malat, Joan M. Griffin, Steven S. Fu, Sylvia Perry
  • Journal:
    Du Bois Review: Social Science Research on Race / Volume 8 / Issue 1 / Spring 2011
    Published online by Cambridge University Press:
    15 April 2011, pp. 199-218

  • Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians' behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians' behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations.