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At least 19 recordsLinked to original sources

The public hospital and its local ecology in the United States: some relationships between the "plight of the public hospital" and the "plight of the cities".

The "plight" of the public hospital in the United States is examined from the point of view of its relationship to the "plight" of the cities. Fifty-five large cities are examined and for 38 of these cities that have such hospitals the relationships of levels of public hospital services to local demographic, government fiscal, and tax structure conditions are analyzed. The principal findings point to the existence of some strong relationships and the implications for public policy of these associations are discussed.

Catchment Area, Health

Disparities in Outcomes for Patients With Inflammatory Bowel Disease at a Private vs Public Hospital in New York City.

BACKGROUND: In patients with inflammatory bowel disease (IBD), social determinants of health contribute to health inequalities. We aimed to compare patients with IBD treated at a private nonprofit vs public hospital in New York City. METHODS: We performed a retrospective study of adult patients with Crohn's disease or ulcerative colitis with established IBD care. Patient demographics, disease characteristics, healthcare utilization, treatment modalities, and clinical outcomes were collected. Using a series of linear mixed and logistic models, the differences between care at a private nonprofit vs public hospital were assessed while controlling for factors that differed between them. RESULTS: Our study included 418 patients with IBD, 209 from each hospital. Compared with public hospital patients, private hospital patients were more likely to be White, be non-Hispanic, and have private insurance (all P&#x2009;=&#x2009;.0005) and less likely to face housing instability (P&#x2009;<&#x2009;.0001), face unemployment (P&#x2009;=&#x2009;.0004), be current smokers (P&#x2009;=&#x2009;.03), or be foreign born (P&#x2009;<&#x2009;.0001). Patients at the private hospital were more likely to have multiple anti-tumor necrosis factor (P&#x2009;=&#x2009;.0001) and biologic use (P&#x2009;<&#x2009;.0001). Public hospital patients were less likely to be considered endoscopically adherent (odds ratio [OR], 0.377; P&#x2009;=&#x2009;.001) and more likely to visit the emergency department (OR, 5.01; P&#x2009;<&#x2009;.0001) and be hospitalized (OR, 1.92; P&#x2009;=&#x2009;.05). CONCLUSIONS: Our study is the first to identify significant differences in patient demographics, disease phenotype, treatments and clinical outcomes between patients treated for IBD at a private nonprofit vs public hospital. Our data suggest that social determinants of health drive disparities in the utilization of healthcare facilities.

Humans

Mastectomy in a large public hospital.

Thirty women undergoing mastectomy for carcinoma of the breast in a large teaching hospital were interviewed. All indicated a very real need to discuss their experiences, and felt that the interview had been beneficial to them. Most had found the "lump" themselves--but often described it as a "hardness", a "ridge", or a "thickening". More than half felt that the counselling afforded to them had been inadequate--especially in the realm of sexual adjustment--but, if their marriages had been stable before operation, subsequent deterioration was unlikely. The threat of malignancy, rather than that of breast loss, was uppermost in the minds of most patients. It should not be assumed that postmastectomy problems do not exist because patients do not mention them, especially in large busy follow-up clinics, where privacy may be inadequate. If doctors are unable or unwilling to afford this service to their mastectomy patients, it may be necessary to delegate it to other health professionals and mastectomy volunteers.

Adult

Uptake of germline testing for Lynch Syndrome in patients with deficient mismatch repair/ microsatellite-high colorectal cancer in the public hospital system in South Australia.

Lynch syndrome (LS) accounts for approximately 4% of colorectal cancer (CRC) cases and arises from pathogenic variants in mismatch repair (MMR) genes. Australian guidelines recommend universal MMR or microsatellite instability (MSI) screening in all CRC patients; however, real-world uptake remains variable. This study evaluated rates of MMR/MSI screening, germline testing, and genetics referrals across two major public hospitals in South Australia. A retrospective review of 1775 patients discussed at colorectal multidisciplinary team meetings in the Royal Adelaide and Queen Elizabeth hospitals between January 2021 and December 2023 was conducted to identify rates of MMR/MSI screening and subsequent referral of eligible patients to genetics. Of the 1129 colorectal cancer cases identified, MMR/MSI testing was performed in 93.2% (1052/1129), with deficiency detected in 12.5% (131/1052). Of these, 37% (49/131) were eligible for genetics referral after exclusion of somatic causes. Among eligible patients, 73.5% (36/49) were referred, and 43% (21/49) underwent germline testing. LS was confirmed in 12 patients (9% of deficient MMR CRC), while 9 patients (6.9%) were classified as having Lynch-like syndrome. Despite high screening rates, gaps remain in genetics referral and testing. Barriers included lack of reflex testing, loss to follow-up, and patient refusal. Targeted system-level interventions and improved genomic education are needed to enhance adherence to guidelines and optimise patient outcomes.

Humans