Survival of the Hmong population diagnosed with colon and rectal cancers in the United States

BACKGROUND

The Hmong population constitutes an independent ethnic group historically dispersed throughout Southeast Asia; fallout from the Vietnam War led to their forced migration to the United States as refugees. This study seeks to investigate characteristics of the Hmong population diagnosed with in colorectal cancer (CRC) as well as survival within this population.

METHODS

Cases of colon and rectal adenocarcinoma diagnosed between 2004 and 2017 were identified from the National Cancer Database (NCDB). Summary statistics of demographic, clinical, socioeconomic, and treatment variables were generated with emphasis on age and stage at the time of diagnosis. Cox-proportional hazard models were constructed for survival analysis.

RESULTS

Of 881,243 total CRC cases within the NCDB, 120 were classified as Hmong. The average age of Hmong individuals at diagnosis was 58.9 years compared 68.7 years for Non-Hispanic White (NHW) individuals (p < 0.01). The distribution of analytic stage differed between the Hmong population and the reference NHW population, with 61.8% of Hmong individuals compared to 45.8% of NHW individuals with known stage being diagnosed at stage III or IV CRC compared to 0, I, or II (p = 0.001). However, there was no difference in OS when adjusting for potential confounders (HR 1.00 [0.77-1.33]; p = 0.998).

CONCLUSIONS

Hmong individuals are nearly a decade younger at the time of diagnosis of CRC compared to the NHW individuals. However, these data do not suggest an association between Hmong ethnicity and overall survival, when compared to the NHW population.

Survival of the Hmong population diagnosed with colorectal cancer in the United States

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Background: The Hmong people constitute an Asian-American subgroup, accounting for 0.1% of the United States (US) population. Originating from Laos and Vietnam, Hmong individuals fought as secret soldiers for the US during the Vietnam War and later immigrated to the US, with the largest settlements in Minnesota, Wisconsin, and California. The Hmong population has faced various health disparities in the domains of mental health, chronic disease, and cancer. This study seeks to investigate trends in colorectal cancer (CRC) survival in the US Hmong population. Methods: Cases of colon and rectal adenocarcinoma diagnosed between 2004-2017 were identified within the National Cancer Database. Summary statistics of demographic, clinical, socioeconomic, and treatment variables were calculated. Multiple Cox proportional hazard models were constructed using sets of demographic, clinical, socioeconomic, and treatment variables to identify factors associated with overall survival (OS) within the Hmong population diagnosed with CRC. Results: One hundred and twenty (0.01%) Hmong individuals were identified within a total of 881,243 CRC cases. Their average age at diagnosis was 58.9 years, compared 68.7 years for Non-Hispanic White (NHW) individuals (p < 0.01). Over half of Hmong individuals (52.5%) were diagnosed with Stage III or VI disease (NHW, 42.5%, p < 0.03), and they more frequently resided in the lowest median income quartile (p < 0.01), the lowest high school degree achievement quartile (p < 0.01), and had higher rates of Medicaid coverage (p < 0.01) compared to NHWs. When adjusting only for age, sex, stage, and Charlson-Deyo comorbidity score, Hmong individuals had a greater hazard of death compared to their NHW counterparts (HR 1.43, p < 0.01). However, in a multivariable model accounting for all variables suspected to be associated with CRC outcomes, OS was similar between these groups (HR 1.01, p < 0.93). Conclusions: Hmong individuals diagnosed with CRC appear to have similar overall survival to Non-Hispanic Whites despite belonging to lower socioeconomic groups, being diagnosed at a younger age and with a higher proportion of Stage III/VI disease. This may point to a robust response to treatment and resilience within the Hmong community. Future efforts will focus on disseminating this information and developing community-based approaches for health screening and prevention.

Building Implementation Science Capacity in Academic Pharmacy: Report of the 2020-2021 AACP Research and Graduate Affairs Committee

EXECUTIVE SUMMARY The 2020-2021 AACP Research and Graduate Affairs Committee (RGAC) continued the work begun by the 2019-2020 RGAC to increase awareness of and capacity for implementation research to advance practice transformation in academic pharmacy. AACP President Anne Lin charged the RGAC with developing resources and programs for training faculty and graduate students in implementation science. The committee was further charged with developing a mechanism to pair pharmacy faculty and implementation experts on practice advancement projects. In its work, the committee focused on generating near-term opportunities for pharmacy practice faculty to pursue projects while developing programs that would support ongoing career development and future implementation practice and research by pharmacy faculty and trainees.

Medication Regimen Complexity and A1C Goal Attainment in Underserved Adults With Type 2 Diabetes

BACKGROUND

From 2009 to 2012, 51.8% of American adults with diabetes had a hemoglobin A_1C (A1C) >7.0%. The complexity of antidiabetic medication regimens may have an impact on glycemic control.

OBJECTIVE

The primary objective was to test the hypothesis that higher diabetes-specific medication regimen complexity index (MRCI) was associated with lower attainment of A1C goal <7.0% in an underserved, predominantly Hispanic population of adults with type 2 diabetes. Secondary analyses included less stringent A1C goals of <8.0% and <9.0% and overall patient-level MRCI.

METHODS

This study was a retrospective, observational, cross-sectional study of individuals with type 2 diabetes from January 2011 to January 2016. Data was obtained from the electronic medical record and MRCI was calculated using the 65-item validated Microsoft Access Version 1.0 medication regimen complexity electronic data capture tool. Logistic regression was used to compute unadjusted and adjusted odds ratios.

RESULTS

A total of 368 patients were included in the analysis. High diabetes-specific MRCI was associated with lower attainment of A1C goal <7.0% (adjusted OR = 0.09; 95% CI = 0.04-0.18) controlling for age, gender, ethnicity, insurance, body mass index, smoking status, hypertension, and hyperlipidemia. Similar results were obtained for the less stringent A1C goals. However, results for overall patient-level MRCI were mixed.

CONCLUSIONS

Higher diabetes-specific medication regimen complexity was associated with poorer glycemic control. Simplifying antidiabetic medication regimens, especially where the treatment guidelines give no preference, could be a step toward achieving treatment goals.

Medication regimen complexity and readmissions after hospitalization for heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease

Objectives:

Readmission rate is increasingly being viewed as a key indicator of health system performance. Medication regimen complexity index scores may be predictive of readmissions; however, few studies have examined this potential association. The primary objective of this study was to determine whether medication regimen complexity index is associated with all-cause 30-day readmission after admission for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease.

Methods:

This study was an institutional review board–approved, multi-center, case–control study. Patients admitted with a primary diagnosis of heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease were randomly selected for inclusion. Patients were excluded if they discharged against medical advice or expired during their index visit. Block randomization was utilized for equal representation of index diagnosis and site. Discharge medication regimen complexity index scores were compared between subjects with readmission versus those without. Medication regimen complexity index score was then used as a predictor in logistic regression modeling for readmission.

Results:

Seven hundred and fifty-six patients were randomly selected for inclusion, and 101 (13.4%) readmitted within 30 days. The readmission group had higher medication regimen complexity index scores than the no-readmission group (p < 0.01). However, after controlling for demographics, disease state, length of stay, site, and medication count, medication regimen complexity index was no longer a significant predictor of readmission (odds ratio 0.99, 95% confidence interval 0.97–1.01) or revisit (odds ratio 0.99, 95% confidence interval 0.98–1.02).

Conclusion:

There is little evidence to support the use of medication regimen complexity index in readmission prediction when other measures are available. Medication regimen complexity index may lack sufficient sensitivity to capture an effect of medication regimen complexity on all-cause readmission.

A randomized prospective study on outcomes of an empathy intervention among second-year student pharmacists

OBJECTIVE

To determine the impact of a single, 3-day intervention on empathy levels as measured by the validated Jefferson Scale of Empathy-Health Profession Students version (JSE-HPS).

METHODS

Forty second-year student pharmacists were recruited to participate in a non-blinded prospective study. Subjects were randomized to an intervention group (n=20) or control group (n=20) and completed the JSE-HPS at baseline, 7 days postintervention, and 90 days postintervention. The intervention group consisted of a 3-day simulation, each day including a designated activity with loss of dominant hand usage, vision, and speech.

RESULTS

The 3-day simulation increased empathy levels in the intervention group compared to the control group 7 days postintervention (p=0.035). However, there were no effects on empathy levels 90 days postintervention (p=0.38).

CONCLUSION

Empathy scores increased but were not sustained in the long-term with a 3-day empathy intervention.