Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. Results: Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84–0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72–0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. Conclusions: Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.

IntroductionImmune checkpoint inhibitors (CPIs) have changed the treatment landscape for many cancers, but also cause severe inflammatory side effects including enterocolitis. CPI-induced enterocolitis is treated empirically with corticosteroids, and infliximab (IFX) is used in corticosteroid-refractory cases. However, robust outcome data for these patients are scarce.MethodsWe conducted a multicenter (six cancer centers), cohort study of outcomes in patients treated with IFX for corticosteroid-refractory CPI-induced enterocolitis between 2007 and 2020. The primary outcome was corticosteroid-free clinical remission (CFCR) with Common Terminology Criteria for Adverse Events (CTCAE) grade 0 for diarrhea at 12 weeks after IFX initiation. We also assessed cancer outcomes at 1 year using RECIST V1.1 criteria.Results127 patients (73 male; median age 59 years) were treated with IFX for corticosteroid-refractory CPI-induced enterocolitis. Ninety-six (75.6%) patients had diarrhea CTCAE grade >2 and 115 (90.6%) required hospitalization for colitis. CFCR was 41.2% at 12 weeks and 50.9% at 26 weeks. In multivariable logistic regression, IFX-resistant enterocolitis was associated with rectal bleeding (OR 0.19; 95% CI 0.04 to 0.80; p=0.03) and absence of colonic crypt abscesses (OR 2.16; 95% CI 1.13 to 8.05; p=0.03). Cancer non-progression was significantly more common in patients with IFX-resistant enterocolitis (64.4%) as compared with patients with IFX-responsive enterocolitis (37.5%; p=0.013).ConclusionThis is the largest study to date reporting outcomes of IFX therapy in patients with corticosteroid-refractory CPI-induced enterocolitis. Using predefined robust endpoints, we have demonstrated that fewer than half of patients achieved CFCR. Our data also indicate that cancer outcomes may be better in patients developing prolonged and severe inflammatory side effects of CPI therapy.

ObjectiveTo evaluate the implementation of a novel algorithm-based discharge programme for the community follow-up of men with prostate cancer. Patients and MethodsMen with prostate cancer considered suitable for discharge were identified from consultant-led and clinical nursespecialist telephone clinics at Nottingham University Hospitals National Health Service Trust. Patients were discharged on to one of four discharge pathways: watchful waiting, androgen-deprivation therapy (ADT), postprostatectomy, and post-radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care after breach of predefined prostate-specific antigen (PSA) level threshold criteria. Reasons for non-compliance, re-referral, and cause of death were determined for all discharged men. ResultsIn all, 573 men were discharged across all four pathways; 169 on the watchful-waiting pathway, 229 on the ADT pathway, 95 on the post-prostatectomy pathway, and 80 on the postradiotherapy pathway. All patients had ≥12 months of followup. In all, 48 of 54 (88.9%) men were re-referred promptly after a PSA-threshold breach. Of the remaining six patients there were three refusals, one unrelated death before referral, and two late referrals at 4 months. Three patients were lost to follow-up due to database non-registration and were subsequently recalled, none of whom had a PSA-threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression, while one was due to a likely progressive PSA non-secreting tumour. ConclusionInitial results suggest the algorithm-based protocol is a viable, effective, and oncologically safe method for the controlled discharge of men from secondary to primary care. Longerterm follow-up, patient satisfaction and cost-effectiveness data are required to assess the true impact of the initiative.

Given the predicted need for continued SARS-CoV-2 diagnostic testing, as well as the evolving availability and types of diagnostic tests, off-site COVID-19 testing centers (OSCTC) leaders need timely guidance to ensure they are meeting the needs of their unique populations. This research discusses the challenges and offers considerations for healthcare organizations and others when setting up and running OSCTCs. It also provides a springboard to engage policy makers and leaders in the healthcare community in a discussion about emergency preparedness, and how to better respond to testing needs going forward.

Maternal obesity is associated with a lower BS, more difficult IOL process, and increased risk of failed IOL and CS.