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Amu-Nnadi CN, Ross ES, Garcia NH, Duncan ZN, Correya TA, Montgomery KB, Broman KK. Health System Integration and Cancer Center Access for Rural Hospitals. Am Surg 2024; 90:1023-1029. [PMID: 38073251 PMCID: PMC10984769 DOI: 10.1177/00031348231216497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Cancer centers provide superior care but are less accessible to rural populations. Health systems that integrate a cancer center may provide broader access to quality surgical care, but penetration to rural hospitals is unknown. METHODS Cancer center data were linked to health system data to describe health systems based on whether they included at least one accredited cancer center. Health systems with and without cancer centers were compared based on rural hospital presence. Bivariate tests and multivariable logistic regression were used with results reported as P-values and odds ratios (OR) with 95% confidence intervals (CIs). RESULTS Ninety percent of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems (P = .03) with more trainees (P = .03) more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%, P = .43; adjusted OR .69, 95% CI .28-1.70). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations (P = .02) in non-metropolitan areas (P = .03). DISCUSSION Health systems with rural hospitals are no more likely to have a cancer center. Ongoing health system integration will not necessarily expand rural patients' access to surgical care under existing health policy infrastructure and incentives.
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Affiliation(s)
| | - Elizabeth S. Ross
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Natalie H. Garcia
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zoey N. Duncan
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya A. Correya
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kristy K. Broman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Minton LE, Duncan ZN, Tzabari JH, Haynes W, Patel OU, Burge K, Van Wagoner N, Burgan CM. Assessing the debt and current state of financial literacy in a cohort of diagnostic & interventional radiology residents. Clin Imaging 2024; 107:110082. [PMID: 38246085 DOI: 10.1016/j.clinimag.2024.110082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/16/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to assess diagnostic and interventional radiology resident physicians' knowledge of core facets of financial literacy: loans, real estate, investments and retirement, and insurance, with the goal of determining the need for formal financial literacy education within radiology residency programs. METHODS From May 2021 to March 2022, surveys were sent to 196 diagnostic and 90 interventional radiology residency programs. Residents were asked 10 knowledge multiple choice questions to assess areas of financial literacy. Custom R programming was used to evaluate responses. RESULTS A total of 149 diagnostic radiology residents and 49 interventional radiology residents responded to portions of the survey, for a total of 198 respondents. Of the cohort with demographic data collected, 84 out of 141 residents (60 %) had over $100,000 of debt following medical school graduation, with 115 out of 146 DR residents (79 %) and 41 out of 47 (87 %) IR residents reporting no coursework in finance. CONCLUSIONS Many radiology resident physicians have a significant debt burden, no official financial education, and clear knowledge gaps in areas of financial literacy. A structured financial education curriculum could better prepare residents for the financial realities of post-residency life.
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Affiliation(s)
- Laura E Minton
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Zoey N Duncan
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA.
| | - Jordan H Tzabari
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Will Haynes
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Om U Patel
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Kaitlin Burge
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Nicholas Van Wagoner
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Constantine M Burgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35294, USA
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Duncan ZN, Summerlin D, West JT, Packard AT, Morgan DE, Galgano SJ. PET/MRI for evaluation of patients with pancreatic cancer. Abdom Radiol (NY) 2023; 48:3601-3609. [PMID: 37191756 DOI: 10.1007/s00261-023-03943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Abstract
Pancreatic cancers are the third leading cause of cancer-related death in the USA and outcomes remain poor despite improvements in imaging and treatment paradigms. Currently, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently utilized for staging and restaging of these malignancies, but positron emission tomography (PET)/CT can play a role in troubleshooting and improve whole-body staging. PET/MRI is a novel imaging modality that allows for simultaneous acquisition of PET and MRI images, leading to improved image quality and potential increased sensitivity. Early studies suggest that PET/MRI may play a larger role in pancreatic cancer imaging in future. This manuscript will briefly discuss current imaging approaches to pancreatic cancer and outline existing evidence and published data supporting the use of PET/MRI for pancreatic cancers.
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Affiliation(s)
- Zoey N Duncan
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - David Summerlin
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Janelle T West
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | | | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.
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Mott NM, Duncan ZN, Pesavento CM, Vastardis AF, Bredbeck BC, Harter CA, Dossett LA, Broman KK, Hughes TM. Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis. Am J Surg 2023; 225:335-340. [PMID: 36180302 DOI: 10.1016/j.amjsurg.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data suggest variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy (AT) for sentinel lymph node-positive melanoma. We aimed to explore how clinicians consider multidisciplinary treatment options. METHODS We conducted semi-structured interviews of surgical oncologists, medical oncologists, and otolaryngologists to produce a thematic analysis. RESULTS Participants (n = 26) described melanoma care as inherently "multidisciplinary," noting the importance of conversations facilitated by shared clinic days or space. Despite believing that their practice mirrored other clinicians, participants revealed diverging perspectives on CLND and AT. Multidisciplinary care presented challenges for surveillance as surgeons expressed desire to retain ownership of patients but did not feel comfortable overseeing AT needs. Participants questioned the fidelity of nodal ultrasounds, noted redundancy in their roles, and described a "surveillance burden" for patients. CONCLUSION Opportunities exist to improve multidisciplinary melanoma care through broader consensus of how to translate emerging data into patient care and delineating surveillance roles.
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Affiliation(s)
- Nicole M Mott
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA.
| | - Zoey N Duncan
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | | | | | - Brooke C Bredbeck
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA
| | | | - Lesly A Dossett
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA
| | - Kristy K Broman
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tasha M Hughes
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
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