We present the case of a 39-year-old G5P5 woman who presented to the emergency department with complaints of shortness of breath, lightheadedness, and excessive uterine bleeding for 14 days, with a heart rate of 123 and a blood pressure of 137/65. Menses had been heavy for several months. A hemoglobin of 1.8 g/dL was discovered. An ultrasound revealed an 11.8 cm fibroid uterus, and the patient was transfused with 6 units of blood and placed on oral contraceptive pills.

No abstract

No abstract

No abstract

61 Background: To determine differences in palliative care (PC) needs in newly diagnosed cancer patients from an inner-city academic facility compared to a suburban, community facility. Also, to identify ways to improve PC for cancer patients in these locations. Methods: 270 subjects with cancer were prospectively identified, 85 from an inner city academic facility (Site A), and 185 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. Master’s level Social Workers asked all subjects to complete a standardized, validated questionnaire to determine their palliative care needs prior to treatment. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods. Results: Site A patients were younger (56.3 vs 61.5years) less likely to be caucasian (35/85, 41.2% vs 114/185, 61.6%) and less likely to have private insurance (28/85, 32.9% vs 187/185, 47%). Site B patients were more likely to express a fear of pain, (112/185, 60.5% vs 28/85,32.9%) dying, (112/185, 60.5% vs 18/85, 21.2%) being alone, (112/185(60.5% vs 15/85, 17.7%) or nausea (117/185, 63.2% vs 10/85, 11.8%). Site A patients were more likely to express fear of not having transportation, (35/85, 41.2% vs 42/185, 22.1%) inability to pay for prescriptions, (28/85, 32.9% vs 40/185, 21.6%) or child care (13/85, 15.3% vs 9/185, 4.9%). All differences were significant at a p < 0.05. Conclusions: There are major differences in the PC needs of patients presenting to an inner-city academic vs suburban community facility. To be most effective, PC programs must be tailored to the community. Interventions proposed for the suburban community facility include early access to: 1) grief counseling, 2) support groups, 3) Nurse-Navigators. Interventions proposed for the inner city academic facility include early access to: 1) Medication cost assistance programs (local philanthropies, facility-based pharmacy discounts) 2) travel services (cab vouchers, coordination with public transportation schedules) 3) on-site child care facilities.