Greater understanding of patient-reported barriers and facilitators to seeking and accessing sexual health services will help formulate strategies to assist gynecologic and breast cancer patients to ...overcome obstacles to accessing sexual health support because they typically do not seek sexual education and/or treatment when confronted with sexual concerns.
The objectives of this systematic review were to (i) explore the patient-reported barriers to seeking and accessing support for sexual problems in gynecologic and breast cancer survivors, and (ii) identify strategies used to successfully overcome the barriers to accessing sexual health information and/or treatment.
The main outcome measures included factors that prevent and/or facilitate gynecologic and breast cancer patients with sexual concerns seeking and accessing sexual health-related services.
Systematic searches of major electronic databases (Ovid MEDLINE, PsycINFO, CINAHL, ProQuest, and Chinese database CNKI) from January 2009 to July 2019 were used to identify the barriers and facilitators to seeking sexual education/treatment from the perspective of gynecologic and breast cancer survivors. A narrative synthesis was conducted.
20 studies met the inclusion criteria including 12 qualitative, 6 quantitative, and 2 mixed methods studies. 4 interconnected themes were derived from 13 subthemes relating to the barriers/facilitators to seeking and accessing sexual health support. The most common barriers were embarrassment/discomfort in discussing sexual concerns, perceived discomfort of healthcare providers in discussing sexual issues, limitations of the healthcare system to address sexual problems, and the multidimensional nature of sexuality. Help-seeking for sexual health concerns was facilitated by: (i) oncology health professionals initiating and conducting open, honest discussions around sexual concerns with patients; (ii) the availability of information in multiple forms; and (iii) appropriate timing of information provision according to women's preferences.
Oncology health professionals need to develop an open, honest, accepting communication style and be accessible to women with cancer and their partners within healthcare systems.
The systematic review was conducted in accordance with guidelines. Variability in the primary aims and outcomes of the included studies precluded a meta-analysis.
Training programs for providers of oncology care should enhance their knowledge of sexual issues in gynecologic and/or breast cancer, enhance their communication skills with patients, and improve their ability to consult or refer patients to psycho-oncologists or other mental health professionals. Dai Y, Cook OY, Yeganeh L, et al. Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors With Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies. J Sex Med 2020;17:1326-1358.
Tools have been developed to facilitate communication and support information exchange between people diagnosed with cancer and their physicians. Patient‐reported outcome measures, question prompt ...lists, patient‐held records, tape recordings of consultations, decision aids, and survivorship care plans have all been promoted as potential tools, and there is extensive literature exploring their impact on patient outcomes. Eleven systematic reviews of studies evaluating tools to facilitate patient‐physician communication were reviewed and summarized in this overview of systematic reviews. Across the systematic reviews, 87 publications reported on 84 primary studies involving 15,381 participants. Routine use of patient‐reported outcome measures and feedback of results to clinicians can improve pain management, physician‐patient communication, and symptom detection and control; increase utilization of supportive care; and increase patient involvement in care. Question prompt lists can increase the number of questions asked by patients without increasing consultation length and may encourage them to reflect and plan questions before the consultation. There is limited benefit in audio recording consultations or using patient‐held records during consultations. Physicians should be supported by adequately resourced health services to respond effectively to the range of clinical and broader patient needs identified through the routine use of tools to facilitate communication.
Children's use of appropriate techniques for remembering and the effectiveness of deliberate strategies improve throughout elementary school. However, relatively little is known about the contextual ...factors that may play a role in the development of these skills as children enter formal school. Building upon findings from the mother - child reminiscing literature, the current study was designed to examine concurrent and longitudinal associations between maternal elaborative reminiscing style, children's autobiographical memory, and children's deliberate memory skills. Fifty-one children entering kindergarten, drawn from three schools in the Southeastern region of the United States, were assessed with a battery that included tasks for measuring autobiographical memory and deliberate memory. In a parent - child reminiscing task , parent - child dyads discussed two jointly-experienced events, and parents were categorized as higher or lower in their elaborative reminiscing style. The results reveal an association between parents' reminiscing style and their children's performance on the Free Recall with Organizational Training Task , in which both spontaneous and trained strategy use and recall are measured. Although elaborative reminiscing style was not associated with children's spontaneous strategy use or recall performance at school entry, children with higher elaborative mothers displayed higher levels of strategy use and recall scores after training than did children with lower elaborative mothers. These findings highlight linkages between parents' elaborative style and children's uptake and successful use of strategic organizational training, underscoring the role that parent - child reminiscing conversations play in the socialization of cognition.
Current research suggests COVID-19 in pregnancy is associated with poor maternal and fetal outcomes, although the exact mechanisms remain unclear, and the approach to the management of affected ...patients presents a distinct challenge to clinicians. We present a case of gestational hypertension, eclampsia, and postpartum depression in a 39-year-old gravida 4, para 0030 (G4P0) pregnant patient following multiple prenatal severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infections. After a case of coronavirus disease-19 (COVID-19) during her first trimester, the patient received a two-dose mRNA vaccine against SARS-CoV-2. Despite vaccination, she again contracted COVID-19 during her third trimester of pregnancy. She subsequently developed gestational hypertension at 38 weeks necessitating a cesarean section at 38+4 weeks. The patient delivered a healthy neonate, however, her postpartum course was complicated by eclampsia and postpartum depression. This case bolsters current literature and emphasizes the necessity of continued research into the effects of COVID-19 in pregnant and postpartum women.
The stress state-dependent fracture behavior of binder jetted 316L stainless steel infiltrated with bronze (SS316 + bronze) with varying porosity and secondary phases was investigated. Notched ...tension specimens were fabricated to probe mechanical behavior under stress triaxialities ranging from approximately 0.5 to 0.8. Variations in porosity and secondary phases were studied by performing bronze infiltration in different N
2
- and Ar-based atmospheres. All samples infiltrated in N
2
-based atmospheres had (Cr, Mo)
2
N precipitates whereas samples infiltrated in the Ar-based atmosphere had (Cr, Mo)
7
C
3
precipitates. Internal porosity was assessed using x-ray computed tomography (XCT) and ultrasonic attenuation and wave speed measurements. Finite element simulations were performed to determine the stress state-dependent strains to failure of samples, which were linked to nondestructive evaluation signals. Ultrasonic signals were found to correlate to pore volume fraction from XCT and mechanical properties, with attenuation being inversely correlated, and wave speed being positively correlated, with strength and ductility. The ductility of the samples was inversely correlated to stress triaxiality and porosity. In samples with similar porosities but infiltrated in different environments, the higher fraction of (Cr, Mo)
2
N in samples infiltrated in N
2
-based atmospheres led to increased strength and reduced ductility compared to those infiltrated in the Ar-based atmosphere.
For studies that aim to assess biological ankle function, calculating ankle joint complex (AJC) power between the calcaneus and shank is recommended over conventional inverse dynamics estimates ...between a rigid-body foot and shank. However, when designing a new experiment, it remains unclear whether holes should be cut in footwear to permit motion tracking via skin-mounted markers, or whether marker placement locations should be tightly controlled across conditions. Here we provide data to assist researchers in answering these questions. We performed a gait analysis study of walking (0.8, 1.2, 1.6 m·s−1) and running (2.6, 2.8, 3.0 m·s−1) while subjects (N = 10) wore custom-modified footwear, which allowed markers to be placed either on the shoe, or on the skin via cut-out windows in the shoes. First, we compared foot markers affixed to the skin vs. on the same locations on the shoe. Using statistical non-parametric mapping techniques, we discovered that skin vs. shoe markers had no statistically significant effect on net AJC power estimates throughout stance phase, for all walking and running speeds. Second, we compared calcaneal markers in the nominal shoe configuration vs. markers in a nearby location (∼27 mm below) on the shoe. We observed significant differences when marker placement on the shoe was varied, which may be relevant to repeated-measures study designs. The results suggest that when computing AJC power for walking and running, you may want to put down the scissors (i.e., forego cutting holes in your footwear), and instead pick up a Sharpie® (pen) or use a template, to maintain consistent marker placement across trials and conditions.
Abstract
Background
Western guidelines recommend an international normalized ratio (INR) range of 2 to 3 when using warfarin for stroke prevention in atrial fibrillation (AF), but lower INR ranges ...are frequently used in East Asia. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) in AF patients comparing the effect of lower versus standard INR targets on thromboembolism, major bleeding, and mortality.
Methods
We searched Western databases including Cochrane CENTRAL, Medline, and Embase as well as Chinese databases including SinoMed, CNKI, and Wanfang Data. We pooled risk ratios (RRs) using random-effects model. We grouped INR targets in two ways: (1) any study-specific lower versus standard targets and (2) INR ranges of approximately 1.5 to 2 versus 2 to 3.
Results
Seventy-nine RCTs (
n
= 12,928) met eligibility criteria: 74 (
n
= 11,322) from East Asia and 5 (
n
= 1,606) from Western countries. Compared with standard targets, lower INR ranges were associated with higher rates of thromboembolism (76 RCTs,
n
= 12,577: 7.1% vs. 4.4%, RR 1.50, 95% confidence interval CI 1.29–1.74,
I
2
= 0%), lower rates of major bleeding (61 RCTs,
n
= 10,815: 2.2% vs. 4.4%, RR 0.54, 95% CI 0.44–0.67,
I
2
= 0%), and similar mortality (32 RCTs,
n
= 7,327: 4.8% vs. 5.2%, RR 1.00, 95% CI 0.85–1.19,
I
2
= 0%). Results were similar when comparing target ranges of approximately 1.5 to 2 versus 2 to 3.
Conclusion
Moderate quality evidence suggests lower INR targets reduce bleeding but increase thromboembolism in AF. The data are dominated by East-Asian studies, limiting generalizability to Western populations. Until higher quality data demonstrate otherwise, an INR range of 2 to 3 should remain standard for thromboembolic prophylaxis in AF.
Highly frequent users (HFU) of the emergency department (ED) are a poorly defined population. This study describes patient and visit characteristics for Canadian ED HFU and patient subgroups with ...mental illness, substance misuse, or ≥ 30 yearly ED visits.
We reviewed health records from a random selection of adult patients whose visit frequency comprised the 99th percentile of yearly ED visits to The Ottawa Hospital. We excluded scheduled repeat ED assessments. We collected the following: 1) patient characteristics - age, sex, and comorbidities; and 2) ED visit characteristics - diagnosis category, length of stay, presentation time, consultation services, and final disposition. Two reviewers collected data, and we performed an inter-rater review to measure agreement.
We analyzed 3,164 ED visits for 261 patients in all subgroups overall. Within the HFU random selection, mean age was 53.4 ± 1.3, and 55.6% were female. Most patients had a fixed address (88.9%), and family physician (87.2%). Top ED diagnoses included musculoskeletal pain (9.6%), alcohol intoxication (8.5%), and abdominal pain (8.4%). Allied health (social work, geriatric emergency medicine, or community care access centre) was consulted for 5.9% of visits. In 52.7% of these cases, allied health services were not available at the time of presentation.
HFU are a complex population who represent a marked proportion of annual ED visits. Our data indicate that there are opportunities to improve the current approaches to care. Future work examining ED-based screening and multi-disciplinary approaches for HFU may help reduce frequent ED presentations, and better serve this vulnerable population.
This review aims to identify process–structure–property relationships in metals fabricated using binder jet additive manufacturing. Binder jet differs from fusion-based additive manufacturing ...methods, such as powder bed fusion or directed energy deposition, in that the metallic component is processed without melting. The three primary stages in the binder jet process are: green body fabrication, de-binding, and post-processing, all of which have numerous variables that impact the microstructure and mechanical properties. The effects of powder characteristics, processing parameters, and post-processing conditions on porosity and mechanical properties are discussed based on data compiled from literature. Results indicate that sintering temperature and environment are more impactful for density and mechanical properties than sintering time. Binder jetting presents opportunities to rapidly fabricate components out of a wide range of materials; however, the large number of variables with intertwined impacts on structure and properties requires additional modeling and characterization efforts toward the development of optimized protocols for binder jetting. Additionally, efforts toward reliable part certification methods, particularly with nondestructive evaluation techniques, are needed for the improvement and adoption of binder jetted metals in a broader range of critical applications.
PDF
