Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity ...concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (
= 9) reported clinically significant FT. Income (
= .001), place of birth (
= .048) and employment status (
= .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
Human papillomavirus (HPV) is associated with the genesis of cervical carcinoma. The co-infection among HPV genotypes is frequent, but the clinical significance is controversial; in Mexico, the ...prevalence and pattern of co-infection differ depending on the geographic area of study. We analyzed the mono- and co-infection prevalence of multiple HPV genotypes, as well as preferential interactions among them in a Mexico City sample population.
This study was designed as a retrospective cohort study. Cervical cytology samples from 1163 women and 166 urethral scraping samples of men were analyzed between 2010 and 2012. The detection of HPV infection was performed using the hybrid capture and the genotyping was by PCR (HPV 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52).
36% of women were HPV-positive and the most prevalent genotypes were HPV 51, 52, 16, and 33 (42, 38, 37, and 34%, respectively). The prevalence of co-infection was higher (75.37%) than mono-infection in women HPV positives. All genotypes were co-infected with HPV 16, but the co-infection with 51-52 genotypes was the most frequent combination in all cases.
The co-infection was very common; each HPV genotype showed different preferences for co-infection with other genotypes, HPV 51-52 co-infection was the most frequent. The HPV 16, 33, 51 and 52 were the most prevalent and are a public health concern to the Mexican population.
We evaluated the acceptability of a patient activation toolkit for hepatitis C virus (HCV) testing amidst universal adult guidelines. We developed a patient-facing toolkit that included a letter to ...the patient from their healthcare provider, HCV factsheet, and question prompt list, which contained questions for their provider about HCV infection and testing. We conducted qualitative interviews with patients ages 18–78 (
n
= 17), using a semi-structured interview guide based on learner verification. We assessed attraction, comprehension, cultural-linguistic acceptability, self-efficacy, and persuasiveness of toolkit materials using direct content analysis. Participants reported materials were attractive, offering suggestions to improve readability. They reported some understanding of materials but requested use of less medical jargon, particularly for the factsheet. Participants discussed cultural acceptability and suggested ways to improve language inclusiveness and comfort with content, given stigma surrounding HCV risk factors. Participants reported that including a letter, factsheet, and QPL improved the persuasiveness of materials, and they conveyed their motivation to be tested for HCV. Results indicate preliminary acceptability for use of the patient activation toolkit, which will be refined based on participants’ recommendations. Overall, this patient activation toolkit holds promise for increasing HCV testing rates.
Knee osteoarthritis (OA) involves peri-articular sarcopenia. The infrapatellar articularis genu (AG) links to the quadriceps femoris (QF) and can be sampled from discarded tissue during arthroplasty. ...We predict disuse-mediated changes in AG myofiber type ratio and atrophy similar to reports on the QF during OA. OA AGs (n = 40) were preserved and grouped by poor (≤ 85°; n = 11), fair (90°-110°; n = 19), and good (≥ 115°; n = 10) range of motion (ROM). Immunolabeling of slow and fast myosin heavy chains in AG sections allowed comparing distribution and cross-sectional area (CSA) of type-I (T1) and type-II (T2) myofibers between groups and associating to ROM. T1/T2 ratios in fair and poor ROM groups was consistent with those published in OA QF. Increasing mean ± SD T2 percentages from good (43.31 ± 11.76), to fair (50.96 ± 5.85), and poor (60.02 ± 8.29) ROM groups was significant between poor versus fair (p = 0.018) and good (p < 0.0001) in association with ROM deficits (r = - 0.729; p < 0.0001). T1 and T2 CSA decreased with worsening ROM, which associates with lower symptom scores (r = 0.3198; p = 0.0472). In-depth evaluation of the OA AG as a surrogate for the OA QF relative to serum and/or synovial fluid biomarkers of sarcopenia could refine diagnostics of peri-articular muscle health to guide individualized strength rehabilitation after surgery.
Crotalinae (pit viper) envenomations are frequently encountered in North American emergency departments. Cases can be complicated by ambiguity in initial species identification as well as timing and ...duration of current antivenin treatment. Recently, thromboelastography (TEG) has emerged as an enhanced real-time monitoring parameter for snake envenomations that may aid in management of venom-induced consumptive coagulopathy.
A 61-year-old snake handler presented with severe coagulopathy and hypofibrinogenemia following envenomation from her pet eastern diamondback rattlesnake (
). Her coagulopathy transiently improved with Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) but would repeatedly rebound following cessation of antivenin over the next 10 days. Serial TEGs were successfully utilized to identify and corroborate fibrinolysis while predicting clot formation prior to routine coagulation studies.
Traditional coagulation parameters have not always been ideal when treating severe coagulopathy from pit viper envenomations and may not identify active fibrinolysis for several hours. In this case of
envenomation, TEG proved to be useful in demonstrating improvements in clotting function prior to standard laboratory measures, which further guided antivenin therapy.
The Army Physical Evaluation Board results for wounded warriors from a previously described cohort were reviewed to identify permanently disabling conditions and whether the conditions were ...preexisting or caused by battlefield injury. Arthritis was the most common unfitting condition in this cohort, with 94.4% of cases attributed to combat injury and only 5.6% attributed to preexisting conditions or documented in the health records prior to battle injury. The most common causes of injury that resulted in arthritis were intra-articular fractures secondary to explosions, traumatic arthrotomies resulting from fragment projectiles, and gunshot wounds. Arthritis was recognized as a disabling condition an average of 19 ± 10 months after injury. Research is needed to enhance prevention and management of joint injuries in order to minimize the disabling effects of joint degeneration in this young patient population.
To explore factors associated with communication and information-seeking after receipt of skin cancer prevention information among Hispanic individuals.
Multivariable logistic regression was used to ...analyze existing data on demographics, personal experience, salience, and beliefs variables collected from Hispanic individuals to determine independent associations with sharing and seeking information about skin cancer prevention.
Of 578 participants, 53% reported any communication about skin cancer prevention behaviors or skin cancer genetic risk; and 31% and 21% sought additional information about preventive behaviors or genetic risk, respectively. Female sex, greater perceived severity, higher comparative chance of getting skin cancer, and lower health literacy were associated with greater communication, while having no idea of one's own skin cancer risk was related to less communication. Greater health numeracy and higher cancer worry were associated with information-seeking about prevention behaviors and genetic risk.
Up to half of participants reported communication or information-seeking, although factors associated with specific activities differed. Future studies should evaluate how to promote communication behaviors in the Hispanic community and how sharing and seeking information influence an individual's network prevention practices.
Several factors related to communication behaviors among Hispanic people after obtaining skin cancer prevention information were identified.
Trial registration: This trial was registered on clinicaltrials.gov (NCT03509467).
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•Hispanic people reported modest communication about skin cancer.•Perceived severity was consistently related to sharing information about skin cancer.•Health numeracy and cancer worry were related to skin cancer information seeking.
Opioid-associated complications are compounded by other concomitant drugs that affect the central nervous system (CNS). This analysis aims to describe opioid and CNS polypharmacy from a ...representative sample of emergency department (ED) encounters to identify patient- and facility-level characteristics associated with these prescription outcomes.
Generalized linear regression multivariable modeling was used to test for associations between the prescrip-tion outcomes and individual and group level predictors.
Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED encounters from 2006-2015 were analyzed.
Survey entrants who received ED care within the above timeframe were analyzed.
The primary outcomes were dichotomous variables of an opioid or CNS polypharmacy prescription.
Twenty-five percent of encounters resulted in an opioid prescription plus another CNS medication prescription. Diagnoses of a blood disorder, musculoskeletal disorder or gastrointestinal disorder were associated with opioid prescription. Fifty-five percent of the presenting pain level treated with an opioid was reported as severe while 11 percent of opioid prescriptions were given to patients reporting no pain or mild pain. Non-Hispanic blacks had the lowest odds of receiving an opioid or CNS polypharmacy prescription compared to Non-Hispanic whites. Hospitals located within areas of increasing levels of poverty had decreasing odds of dispensing opioids following an ED encounter.
Opioid prescriptions resulted from one-quarter of ED encounters despite the acute care setting of the ED and included 11 percent frequency of prescription for patients reporting no pain or mild pain.
Introduction
Surgical training using simulation can fill gaps in traditional surgical residency learning. We hypothesize that arthroscopy training conducted on a virtual reality simulator will be ...preferred by orthopaedic surgery residents over a traditional dry lab simulation model.
Methods
38 orthopaedic surgery residents at a single U.S. residency program were randomized to train for a shoulder arthroscopy procedure using either a virtual reality simulator or a table-top dry lab simulator. Training and learning preferences were then asked of the resident participants.
Results
Junior residents were likely to report training preference for the virtual reality simulator compared to senior residents 15/24 (62.5%) v. 8/14 (57.1%); P = .043. Simulator preference was not influenced by subspecialty interest, prior arthroscopy experience, or simulator experience. Virtual reality simulation was associated with positive attitude towards arthroscopy and high chance of reporting learning gains on general arthroscopic understanding. Senior residents were 4.7 times more likely than juniors to report learning gains via staff discussion pre- and post-operatively. A majority of residents 34/38 (89.5%) reported, however, wanting more simulation for training surgical skills.
Conclusion
Simulation is a desired and potentially valuable adjunct to training orthopaedic residents in arthroscopy. Training needs do evolve; and junior arthroscopists may benefit more from virtual reality platforms for general skills. Senior residents preferred dry lab simulation, possibly because it allowed for handling of actual instruments and implants.
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