Secondary Prevention Among Uninsured Stroke Patients: A Free Clinic Study

OBJECTIVES: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. METHODS: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. RESULTS: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p \u3c 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. CONCLUSIONS: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics

Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised

Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of inflammatory conditions and are associated with risks of invasive infections. We present a diagnostically challenging patient with unique comorbidities and travel history. A 53-year-old man with a history of polysubstance abuse and psoriasis on adalimumab presented to our hospital directly from the airport with fever, dyspnea, and cough. He had been living in Costa Rica and engaged in many outdoor activities. Within 6 hours and a limited history, he was intubated; vasopressors and antimicrobials were promptly administered. An extensive infectious disease investigation was undertaken, considering potential travel-related exposures and his immunosuppressive state. However, multi-organ failure with worsening disseminated intravascular coagulation ensued, and within four days of admission, the patient passed away. Five days after his death, the urine Histoplasma antigen resulted positive. Disseminated histoplasmosis should be suspected in a patient on anti-TNF therapy, with a severe febrile illness and pneumonia refractory to antibacterial therapy. A high index of suspicion is necessary to make the diagnosis and initiate prompt treatment. Keywords: Histoplasmosis, Traveler, Tropical infections, Tumor necrosis facto

Demographic Characteristics and Management of Uninsured Patients with a History of Melanoma

Aims and Objectives: Patients diagnosed with malignant melanoma often undergo regular follow-up care and skin checks to reduce the likelihood of recurrence. Yearly exams are more inconsistent and likely to be missed due to a lack of healthcare access and resources among the uninsured population. This study determined demographic characteristics of uninsured patients with a history of malignant melanoma. Follow-up was assessed in order to improve and ensure the highest quality of long-term care. Methods: Demographics and chronic disease diagnoses were extracted from 8,857 patients managed at eight free-clinics from the Tampa Bay Area during 2016 and 2017. Patients diagnosed with malignant melanoma were specifically chosen for further chart review. A retrospective analysis of the follow-up care and health outcomes are reported. Results: A total of 200 of 8,857 reported a history of malignancy; ten patients (5%) were diagnosed with malignant melanoma. The average age of these patients was 52-years-old, 70% (N=7) of whom were female. Initial treatment for 2 patients (20%) was surgical excision. Remaining patients were either observed (N=2) or did not mention treatment to their free clinic provider (N=6). Postoperative follow-up for recurrent lesions varied between patients but a commonly cited reason that prevented proper follow-up with a dermatologist in eight of the ten patients (80%) was financial restraint. Conclusions: Free-clinics should be cognizant of local dermatologists who provide subsidized services to those in need due to the higher prevalence of melanoma among the uninsured. Patients should also be directed to free clinics immediately after surgery to receive recommended follow-up skin checks. With education, free-clinics can deliver higher quality dermatology management to patients by following recommended standard

Demographic Characteristics and Management of Uninsured Patients with a History of Melanoma

Aims and Objectives: Patients diagnosed with malignant melanoma often undergo regular follow-up care and skin checks to reduce the likelihood of recurrence. Yearly exams are more inconsistent and likely to be missed due to a lack of healthcare access and resources among the uninsured population. This study determined demographic characteristics of uninsured patients with a history of malignant melanoma. Follow-up was assessed in order to improve and ensure the highest quality of long-term care. Methods: Demographics and chronic disease diagnoses were extracted from 8,857 patients managed at eight free-clinics from the Tampa Bay Area during 2016 and 2017. Patients diagnosed with malignant melanoma were specifically chosen for further chart review. A retrospective analysis of the follow-up care and health outcomes are reported. Results: A total of 200 of 8,857 reported a history of malignancy; ten patients (5%) were diagnosed with malignant melanoma. The average age of these patients was 52-years-old, 70% (N=7) of whom were female. Initial treatment for 2 patients (20%) was surgical excision. Remaining patients were either observed (N=2) or did not mention treatment to their free clinic provider (N=6). Postoperative follow-up for recurrent lesions varied between patients but a commonly cited reason that prevented proper follow-up with a dermatologist in eight of the ten patients (80%) was financial restraint. Conclusions: Free-clinics should be cognizant of local dermatologists who provide subsidized services to those in need due to the higher prevalence of melanoma among the uninsured. Patients should also be directed to free clinics immediately after surgery to receive recommended follow-up skin checks. With education, free-clinics can deliver higher quality dermatology management to patients by following recommended standard

Aspirin use for Cardiovascular Disease Prevention in the Uninsured Population

Introduction: Aspirin is an effective anti-inflammatory and antiplatelet agent as an irreversible inhibitor of cyclooxygenase. In 2016, the U.S. Preventive Services Task Force recommended aspirin for primary prevention of cardiovascular disease in patients aged 50–69 years with a 10% or greater 10-year cardiovascular disease risk. Current guidelines for patients with prior myocardial infarction or coronary artery disease recommend aspirin use for the secondary prevention of cardiovascular disease. Due to the lack of literature describing adherence to these recommendations in the uninsured patient population, we studied aspirin use for cardiovascular disease prevention in free medical clinics. Methods: We conducted a cross sectional study of uninsured patients who visited nine free medical clinics in 2016–2017. Data from the records of 8857 patients were combined into a database for analysis. 10-year Framingham risk scores for coronary artery disease were calculated for the 50–69-year-old population to evaluate which patients qualified for aspirin usage. Aspirin use was assessed for patients with prior myocardial infarction or coronary artery disease. Results: In total, 1443 patients met the criteria to take aspirin for primary prevention of cardiovascular disease, but just 17% of these patients aged 50–59 years were on the medication. About 15% of the patients aged 60–69 years were taking aspirin. Of the 297 patients who had prior myocardial infarction or coronary artery disease, 50% were taking aspirin for secondary prevention. Conclusion: Among the uninsured population, there are low rates of aspirin use for risk reduction of cardiovascular disease. This study demonstrates that improvements are needed to increase adherence to current guidelines and address barriers uninsured patients may face in maintaining their cardiovascular health

Aspirin use for Cardiovascular Disease Prevention in the Uninsured Population

Introduction: Aspirin is an effective anti-inflammatory and antiplatelet agent as an irreversible inhibitor of cyclooxygenase. In 2016, the U.S. Preventive Services Task Force recommended aspirin for primary prevention of cardiovascular disease in patients aged 50–69 years with a 10% or greater 10-year cardiovascular disease risk. Current guidelines for patients with prior myocardial infarction or coronary artery disease recommend aspirin use for the secondary prevention of cardiovascular disease. Due to the lack of literature describing adherence to these recommendations in the uninsured patient population, we studied aspirin use for cardiovascular disease prevention in free medical clinics. Methods: We conducted a cross sectional study of uninsured patients who visited nine free medical clinics in 2016–2017. Data from the records of 8857 patients were combined into a database for analysis. 10-year Framingham risk scores for coronary artery disease were calculated for the 50–69-year-old population to evaluate which patients qualified for aspirin usage. Aspirin use was assessed for patients with prior myocardial infarction or coronary artery disease. Results: In total, 1443 patients met the criteria to take aspirin for primary prevention of cardiovascular disease, but just 17% of these patients aged 50–59 years were on the medication. About 15% of the patients aged 60–69 years were taking aspirin. Of the 297 patients who had prior myocardial infarction or coronary artery disease, 50% were taking aspirin for secondary prevention. Conclusion: Among the uninsured population, there are low rates of aspirin use for risk reduction of cardiovascular disease. This study demonstrates that improvements are needed to increase adherence to current guidelines and address barriers uninsured patients may face in maintaining their cardiovascular health

Substance Use in Uninsured Cancer Survivors: A Multicenter Cross-Sectional Study of Free Clinics.

Introduction Substance use disorders occur in about 5% of the cancer population and can decrease treatment adherence, impede pain management, and undermine a cancer survivor\u27s network of social support. Although current literature demonstrates substance use is associated with socioeconomic disparity, there is limited research on the prevalence of alcohol, tobacco, and illicit drug use among uninsured cancer survivors in the United States. Our multicenter cross-sectional study describes the prevalence of substance use in uninsured cancer survivors in the Tampa Bay Area. Methods A comprehensive retrospective chart review of electronic medical records and paper charts was conducted at nine free clinics in the Tampa Bay Area of Florida between January 1, 2016, and December 31, 2017. Substance use prevalence was compared between uninsured cancer survivors and uninsured patients without reported cancer history after adjusting for available demographic risk factors. Results There were 222 patients with a history of cancer and 6,768 patients without a history of cancer included for analysis. Cancer survivors had a median age of 55 years (interquartile range 48-61 years), were mostly female (n = 146, 66.1%), and of Hispanic ethnicity (n = 94, 52.5%). Cancer survivors were more likely to be current smokers (n = 42, 25.1%) compared to patients without a cancer history (n = 759, 16.1%). Patients with a history of cancer were more likely to be current drinkers (n = 34, 26%) compared to non-cancer patients (n = 942, 22.9%). There was no significant difference in illicit drug use history between the two groups. Conclusions Our study demonstrates that uninsured cancer survivors are more likely to be smokers and alcohol consumers than uninsured patients without a history of cancer. There was no significant difference in illicit drug use in cancer survivors and patients without a history of cancer. Future educational interventions should target substance use among uninsured cancer survivors

A Case Series of Elizabethkingia \u3cem\u3emeningosepticum\u3c/em\u3e Bacteremia in the Cancer Population

Background :Elizabethkingia meningosepticum (E. meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in immunocompromised patients such as cancer patients especially those with a history of prolonged hospital stay and frequent instrumentations. Methods: A retrospective chart review of all cases over 10 years in Moffitt Cancer Center showed a total of three patients with E. meningosepticum infection. Results: First patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumonia and blood culture positive for E. meningosepticum infection. He was treated with ciprofloxacin, cefoxitin, minocycline and metronidazole and was discharged in stable conditions after 10 days. The second patient (current acute myelogenous leukemia) had neutropenic fever in the setting of recent chest port infection. Blood culture from chest port showed E. meningosepticum and was treated with ciprofloxacin, meropenem and minocycline successfully. The third patient (history of esophageal adenocarcinoma and acute myelogenous leukemia) had history of recent pneumonia and cellulitis who came in with recurrent neutropenic fever. Blood culture was positive for E. meningosepticum and was treated with ciprofloxacin and minocycline. However, the infection was complicated by multiorgan failure and required tracheostomy. As these three cases illustrate, E. meningosepticum bacteremia has high 28- day mortality rate (41%). Conclusion: Early identification of the pathogen along with empiric treatment with a fluoroquinolone and/or minocycline is indicated to reduce morbidity and mortality