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Labor Dystocia in Nulliparous Women.

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Labor Dystocia in Nulliparous Women.

Am Fam Physician. 2021 Jan 15;103(2):90-96

Authors: LeFevre NM, Krumm E, Cobb WJ

Abstract
Dystocia (abnormally slow or protracted labor) accounts for 25% to 55% of primary cesarean deliveries. The latent phase of labor begins with onset of regular, painful contractions and continues until 6 cm of cervical dilation. Current recommendations are to avoid admission to labor and delivery during the latent phase, assuming maternal/fetal status is reassuring. The active phase begins at 6 cm. An arrested active phase is defined as more than four hours without cervical change despite rupture of membranes and adequate contractions and more than six hours of no cervical change without adequate contractions. Managing a protracted active phase includes oxytocin augmentation with or without amniotomy. The second stage of labor begins at complete cervical dilation and continues to delivery. This stage is considered protracted if it lasts three hours or more in nulliparous patients without an epidural or four hours or more in nulliparous patients with an epidural. Primary interventions for a protracted second stage include use of oxytocin and manual rotation if the fetus is in the occiput posterior position. When contractions or pushing is inadequate, vacuum or forceps delivery may be needed. Effective measures for preventing dystocia and subsequent cesarean delivery include avoiding admission during latent labor, providing cervical ripening agents for induction in patients with an unfavorable cervix, encouraging the use of continuous labor support (e.g., a doula), walking or upright positioning in the first stage, and not diagnosing failed induction during the latent phase until oxytocin has been given for 12 to 18 hours after membrane rupture. Elective induction at 39 weeks' gestation in low-risk nulliparous patients may reduce the risk of cesarean delivery.

PMID: 33448772 [PubMed - as supplied by publisher]

Dear White People.

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Dear White People.

Ann Fam Med. 2021 Jan-Feb;19(1):66-69

Authors: Foster KE, Johnson CN, Carvajal DN, Piggott C, Reavis K, Edgoose JYC, Elliott TC, Gold M, Rodríguez JE, Washington JC

Abstract
We are living in unprecedented times. While the world is grappling with COVID-19, we find the horrors of racism looming equally large as we, yet again, confront lurid deaths in the center of the news cycle of Black and brown people from police bias and brutality. Those of us who have been championing antiracism and justice work and bearing the burden of the "minority tax" have been overwhelmed by sudden asks from our well-intentioned White colleagues of how to best respond. In the tone of the Netflix series, "Dear White People," we further emphasize that we are not alone in trying to reach out to you, our White colleagues and leaders. Please hear our story and heed our call to action.

PMID: 33431395 [PubMed - in process]

Current Practices in Tranexamic Acid Administration for Pediatric Trauma Patients in the United States.

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Current Practices in Tranexamic Acid Administration for Pediatric Trauma Patients in the United States.

J Trauma Nurs. 2021 Jan-Mar 01;28(1):21-25

Authors: Cornelius B, Cummings Q, Assercq M, Rizzo E, Gennuso S, Cornelius A

Abstract
BACKGROUND: Although controversial, early administration of tranexamic acid (TXA) has been shown to reduce mortality in adult patients with major trauma. Tranexamic acid has also been successfully used in elective pediatric surgery, with significant reduction in blood loss and transfusion requirements. There are limited data to guide its use in pediatric trauma patients. We sought to determine the current practices for TXA administration in pediatric trauma patients in the United States.
METHODS: A survey was conducted of all the American College of Surgeons-verified Level I and II trauma centers in the United States. The survey data underwent quantitative analysis.
RESULTS: Of the 363 Level I and II qualifying centers, we received responses from 220 for an overall response rate of 61%. Eighty of 99 verified pediatric trauma centers responded for a pediatric trauma center response rate of 81%. Of all responding centers, 148 (67%) reported they care for pediatric trauma patients, with an average of 513 pediatric trauma patients annually. The pediatric trauma centers report caring for an average of 650 pediatric trauma patients annually. Of all centers caring for pediatric trauma, 52 (35%) report using TXA, with the most common initial dosing being 15 mg/kg (68%). A follow-up infusion was utilized by 45 (87%) of the programs, most commonly dosed at 2 mg/kg/hr × 8 hr utilized by 24 centers (54%).
CONCLUSION: Although the clinical evidence for TXA in pediatric trauma patients is limited, we believe that consideration should be given for use in major trauma with hemodynamic instability or significant risk for ongoing hemorrhage. If available, resuscitation should be guided by thromboelastography to identify candidates who would most benefit from antithrombolytic administration. This represents a low-cost/low-risk and high-yield therapy for pediatric trauma patients.

PMID: 33417398 [PubMed - as supplied by publisher]

Object Relations Assessment Predicts Outpatients' Attrition, Early Working Alliance, and Psychotherapy Process.

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Object Relations Assessment Predicts Outpatients' Attrition, Early Working Alliance, and Psychotherapy Process.

Clin Psychol Psychother. 2021 Jan 08;:

Authors: Vaughn KN, Jenkins SR, Weber KM

Abstract
This study investigated the predictive utility of assessing clients' object relations functioning to prognosticate therapy dropout, quality of the early working alliance, and psychotherapy process events reported by clients after their first five sessions. Clients accepting a recruitment invitation were administered the Thematic Apperception Test (TAT) shortly after intake, and those still in treatment three to four sessions later rated the working alliance and psychotherapy process events. Participants were 47 clients beginning psychotherapy with advanced doctoral practicum students at a university-based community-serving training clinic. The Social Cognition and Object Relations Scales (SCORS), an object relations scoring system for TAT stories, was used to assess object relations functioning. The California Psychotherapy Alliance Scales-Patient form measured four dimensions of the alliance. The Therapy Orientation Process Scales, created from the Psychotherapy Process Q-set, measured clients' perceptions of therapy process events as involving relatively more psychodynamic or cognitive behavioral techniques. The SCORS significantly predicted remaining in therapy, client ratings of stronger working alliance, and typical therapy process as more psychodynamic than cognitive behavioral. SCORS Complexity of Representations and Capacity for Emotional Investment in Relationships scales were the strongest predictors, especially of the Patient Commitment facet of the alliance. The findings suggest that 1) beginning psychotherapy with object relations assessment can be useful for treatment planning, and 2) the relationship between clients' object relations functioning, working alliance, and greater sensitivity to psychodynamic than to cognitive behavioral interventions depends on the aspect of object relations that is being assessed.

PMID: 33416195 [PubMed - as supplied by publisher]

Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores.

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Cone of economy classification: evolution, concept of stability, severity level, and correlation to patient-reported outcome scores.

Eur Spine J. 2021 Jan 03;:

Authors: Haddas R, Sambhariya V, Kosztowski T, Block A, Lieberman I

Abstract
STUDY DESIGN: A prospective cohort study OBJECTIVE: To determine a classification system for cone of economy (CoE) measurements that defines clinically significant changes in altered balance and to assess if the CoE measurements directly impacts patients reported outcome measures (PROMs). Preoperative functional data is a crucial component of determining patient disability and prognosis. The CoE has been theorized to be the foundation of biomechanical changes that leads to increased energy expenditure and disability in spine patients. PROMs have been developed to quantify the level of debilitation in spine patients but have various limitations.
METHODS: A total of 423 symptomatic adult patients with spine pathology completed a series of PROMs preoperatively including VAS, ODI, Tampa Scale for Kinesiophobia (TSK), Fear and Avoidance Beliefs Questionnaire (FABQ), and Demoralization (DS). Functional balance was tested in this group using a full-body reflective marker set to measure head and center of mass (CoM) sway.
RESULTS: PROMs scores were correlated with the magnitude of the CoE measurements. Patients were separated by the following proposed classification: CoM coronal sway > 1.5 cm, CoM sagittal sway > 3.0 cm, CoM total sway > 30.0 cm, head coronal sway > 3.0 cm, head sagittal sway > 6.0 cm, and head total sway > 60.0 cm. Significant differences were noted in the ODI (< 0.001), FABQ physical activity (< 0.001-0.009), DS (< 0.001-0.023), and TSK (< 0.001-0.032) across almost all planes of motion for both CoM and head sway. The ODI was most sensitive to the difference between groups across CoM and head sway planes with a mean ODI of 47.5-49.5 (p < 0.001) in the severe group versus 36.6-39.3 (p < 0.001) in the moderate group.
CONCLUSIONS: By classifying CoE measurements by the cutoffs proposed, clinically significant alterations in balance can be quantified. Furthermore, this study demonstrates that across spinal pathology, higher magnitude CoE and range of sway measurements correlate with worsening PROMs. The Haddas' CoE classification system in this study helps to identify patients that may benefit from surgery and guide their postoperative prognosis.

PMID: 33389136 [PubMed - as supplied by publisher]

Characterization of Device-Related Malfunction, Injury, and Death Associated with Using Elastomeric Pumps for Delivery of Local Anesthetics in the US Food and Drug Administration MAUDE Database.

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Characterization of Device-Related Malfunction, Injury, and Death Associated with Using Elastomeric Pumps for Delivery of Local Anesthetics in the US Food and Drug Administration MAUDE Database.

Drug Healthc Patient Saf. 2020;12:293-299

Authors: Teames R, Joyce A, Scranton R, Vick C, Nagaraj N

Abstract
Purpose: To characterize medical device reports about elastomeric pumps delivering local anesthesia made to the US Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database.
Patients and Methods: We conducted a retrospective review of medical device reports submitted to MAUDE from January 2010 to July 2018. A systematic, computerized algorithm was used to identify records pertaining to elastomeric pumps using local anesthesia. Included records indicated the use of local anesthesia or were determined to involve the use of local anesthetics (if they did not contain specific information on drug use). Reports were analyzed within the MAUDE event type categories of malfunction, injury, death, other, and missing. Possible cases of liver injury or surgical site infection were also identified. Manual review of narratives provided in MAUDE was performed by 2 reviewers to identify possible or probable cases of local anesthetic system toxicity (LAST).
Results: From a pool of 384,285 reports about elastomeric pumps from the MAUDE database, 4093 met inclusion criteria for involving elastomeric pumps to deliver local anesthetics, with the peak number of reports occurring in 2014. Of these identified reports, 3624 (88.5%) were categorized as malfunctions, 292 (7.1%) as injuries, and 8 (0.2%) as involving death. We identified 13 cases (0.3%) of possible liver injury and 51 cases (1.2%) of possible surgical site infection; 139 reports (3.4%) were determined to be probably (n=53) or possibly (n=86) associated with LAST.
Conclusion: Malfunction of elastomeric pumps delivering local anesthetics leaves patients vulnerable to injury or death. Our study indicates that reports of malfunction, injury, and death have been reported to the MAUDE database. These reports likely reflect an underrepresentation of cases in the real-world population, emphasizing the need for more comprehensive medical device reporting.

PMID: 33380842 [PubMed]

Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial.

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Predictors of retained hemothorax in trauma: Results of an Eastern Association for the Surgery of Trauma multi-institutional trial.

J Trauma Acute Care Surg. 2020 10;89(4):679-685

Authors: Prakash PS, Moore SA, Rezende-Neto JB, Trpcic S, Dunn JA, Smoot B, Jenkins DH, Cardenas T, Mukherjee K, Farnsworth J, Wild J, Young K, Schroeppel TJ, Coimbra R, Lee J, Skarupa DJ, Sabra MJ, Carrick MM, Moore FO, Ward J, Geng T, Lapham D, Piccinini A, Inaba K, Dodgion C, Gooley B, Schwartz T, Shraga S, Haan JM, Lightwine K, Burris J, Agrawal V, Seamon MJ, Cannon JW

Abstract
BACKGROUND: The natural history of traumatic hemothorax (HTX) remains unclear. We aimed to describe outcomes of HTX following tube thoracostomy drainage and to delineate factors that predict progression to a retained hemothorax (RH). We hypothesized that initial large-volume HTX predicts the development of an RH.
METHODS: We conducted a prospective, observational, multi-institutional study of adult trauma patients diagnosed with an HTX identified on computed tomography (CT) scan with volumes calculated at time of diagnosis. All patients were managed with tube thoracostomy drainage within 24 hours of presentation. Retained hemothorax was defined as blood-density fluid identified on follow-up CT scan or need for additional intervention after initial tube thoracostomy placement for HTX.
RESULTS: A total of 369 patients who presented with an HTX initially managed with tube thoracostomy drainage were enrolled from 17 trauma centers. Retained hemothorax was identified in 106 patients (28.7%). Patients with RH had a larger median (interquartile range) HTX volume on initial CT compared with no RH (191 [48-431] mL vs. 88 [35-245] mL, p = 0.013) and were more likely to be older with a higher burden of thoracic injury. After controlling for significant differences between groups, RH was independently associated with a larger HTX on presentation, with a 15% increase in risk of RH for each additional 100 mL of HTX on initial CT imaging (odds ratio, 1.15; 95% confidence interval, 1.08-1.21; p < 0.001). Patients with an RH also had higher rates of pneumonia and longer hospital length of stay than those with successful initial management. Retained hemothorax was also associated with worse functional outcomes at discharge and first outpatient follow-up.
CONCLUSION: Larger initial HTX volumes are independently associated with RH, and unsuccessful initial management with tube thoracostomy is associated with worse patient outcomes. Future studies should use this experience to assess a range of options for reducing the risk of unsuccessful initial management.
LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

PMID: 32649619 [PubMed - indexed for MEDLINE]

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

James d'Etienne, MD - Wed, 12/30/2020 - 18:30
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The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

High Blood Press Cardiovasc Prev. 2020 Dec 28;:

Authors: Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H

Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.

PMID: 33369723 [PubMed - as supplied by publisher]

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

Hao Wang, MD - Wed, 12/30/2020 - 18:30
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The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

High Blood Press Cardiovasc Prev. 2020 Dec 28;:

Authors: Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H

Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.

PMID: 33369723 [PubMed - as supplied by publisher]

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

Chet Schrader, MD - Wed, 12/30/2020 - 18:30
Related Articles

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

High Blood Press Cardiovasc Prev. 2020 Dec 28;:

Authors: Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H

Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.

PMID: 33369723 [PubMed - as supplied by publisher]

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

Related Articles

The Role of Using HEART Score to Risk Stratify Chest Pain Among Emergency Department High Utilizers.

High Blood Press Cardiovasc Prev. 2020 Dec 28;:

Authors: Schrader CD, Meyering SH, Kumar D, Alanis N, D'Etienne JP, Shaikh S, Vo V, Kamaria AR, Huettner N, Wang H

Abstract
The HEART score is used to effectively risk stratify undifferentiated chest pain patients in the Emergency Department (ED). It is unclear whether such risk stratification can be applied among ED high utilizers. We aim to determine the efficacy and safety of using the HEART score to predict 30-day short-term major adverse cardiac events (MACE) in ED high utilizers. We conducted a retrospective, observational study in which ED high utilizers were defined as patients who had four or more ED visits within the past 12 months. ED high utilizers presenting at the study ED with chest pain were enrolled. Patients in which the HEART score was utilized were placed in the HEART group and patients with no HEART scores documented were placed to the usual care group. Hospital admissions and cardiac stress tests performed during the index hospitalizations, and 30-day MACE rates were analyzed and compared between the HEART and usual care groups. From January 1, 2017 to December 31, 2019, a total of 8,315 patient visits from ED high utilizers were enrolled. In the HEART group, 49% of ED visits were admitted with 20% receiving stress tests. A 30-day MACE outcome occurred among 1.4% of visits. In the usual care group, 44% of ED visits were admitted, with only 9% receiving index stress tests and a 1.5% of 30-day MACE occurrence (p=0.727). The study showed that similar short-term MACE outcomes occurred between patients using HEART scores and usual care to risk stratify chest pain among ED high utilizers.

PMID: 33369723 [PubMed - as supplied by publisher]

Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system.

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Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system.

Prev Med Rep. 2020 Dec;20:101266

Authors: Agovi AM, Anikpo I, Cvitanovich MJ, Craten KJ, Asuelime EO, Ojha RP

Abstract
Safety-net health systems are a primary source of care for socioeconomically disadvantaged individuals who may be eligible for HIV pre-exposure prophylaxis (PrEP) and are priority groups under the Ending the HIV Epidemic (EHE) initiative. Nevertheless, little evidence is available about barriers to PrEP implementation in safety-net settings. We aimed to assess the association between PrEP knowledge and prescribing practices, and to ascertain unmet knowledge needs to implement PrEP. In 2019, we surveyed primary care providers (PCPs) in a safety-net health system that serves an EHE priority jurisdiction located in North Texas. Our questionnaire ascertained self-reported prescribing practices, knowledge, and training needs related to PrEP. We used penalized logistic regression to estimate odds ratio (OR) and 95% posterior limits (PL) for the association between provider self-rated knowledge of PrEP and PrEP prescribing. Our study population comprised 62 primary care providers, of whom 61% were female, 60% were non-Hispanic White, 76% were physicians (76%), 57% had ≥ 10 years of practice experience, 45% reported low self-rated PrEP knowledge, and 35% prescribed PrEP in the past year. Providers with low PrEP knowledge had 69% lower odds of prescribing PrEP within the past year (OR = 0.31, 95% PL: 0.12, 0.82). Eligibility for PrEP, side effects and adherence concerns were key unmet knowledge needs. Our findings suggest that low provider PrEP knowledge may be a barrier to PrEP prescribing among safety-net PCPs. Our results provide insight about specific educational needs of PCPs in a safety-net health system, which are amenable to educational intervention.

PMID: 33364148 [PubMed]

Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease?

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Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease?

J Parkinsons Dis. 2020 Dec 23;:

Authors: Salvatore MF, Soto I, Alphonso H, Cunningham R, James R, Nejtek VA

Abstract
Up to 23% of newly diagnosed, non-demented, Parkinson's disease (PD) patients experience deficits in executive functioning (EF). In fact, EF deficits may occur up to 39-months prior to the onset of motor decline. Optimal EF requires working memory, attention, cognitive flexibility, and response inhibition underlying appropriate decision-making. The capacity for making strategic decisions requires inhibiting imprudent decisions and are associated with noradrenergic and dopaminergic signaling in prefrontal and orbitofrontal cortex. Catecholaminergic dysfunction and the loss of noradrenergic and dopaminergic cell bodies early in PD progression in the aforementioned cortical areas likely contribute to EF deficits resulting in non-strategic decision-making. Thus, detecting these deficits early in the disease process could help identify a significant portion of individuals with PD pathology (14-60%) before frank motor impairment. A task to evaluate EF in the domain of non-strategic decision-making might be useful to indicate the moderate loss of catecholamines that occurs early in PD pathology prior to motor decline and cognitive impairment. In this review, we focus on the potential utility of the Iowa Gambling Task (IGT) for this purpose, given significant overlap between in loss of dopaminergic and noradrenergic cells bodies in early PD and the deficits in catecholamine function associated with decreased EF. As such, given the loss of catecholamines already well-underway after PD diagnosis, we evaluate the potential utility of the IGT to identify the risk of therapeutic non-compliance and a potential companion approach to detect PD in premotor stages.

PMID: 33361612 [PubMed - as supplied by publisher]

Simple Nephrectomy in a Tertiary Care Safety Net Hospital - Patient Characteristics, Causes, Cost, and Renal Function Implications.

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Simple Nephrectomy in a Tertiary Care Safety Net Hospital - Patient Characteristics, Causes, Cost, and Renal Function Implications.

Urology. 2020 Dec 23;:

Authors: Ames KS, Baky F, Blair S, Sanchez J, Franklin W, Barefoot A, Mears J, Magness P, Johnson B, Bakare T, Hudak S, Antonelli J, Hutchinson R, Lotan Y, Woldu SL

Abstract
OBJECTIVE: To evaluate factors associated with simple nephrectomy at a safety net hospital with a diverse patient population and large catchment area. Simple nephrectomy is an underreported surgery. Performance of simple nephrectomy may represent a failure of management of underlying causes.
METHODS: We performed a retrospective review of simple nephrectomies performed at a major urban safety net hospital from 2014-2019. Detailed demographic, surgical, and renal functional outcomes were abstracted. We assessed the medical and social factors leading to performance of simple nephrectomy and report contemporaneous perception of preventability of the simple nephrectomy by the surgeon.
RESULTS: 85 patients underwent simple nephrectomy during the study period; 55% were non-white, 77% were women, and the median age at time of surgery was 46 years. The most common medical factors contributing to simple nephrectomy were stone disease in 55.3%, followed by retained ureteral stent (30.6%) and stricture (30.6%). The most common social factors were lack of insurance (58.5%), substance abuse issues (32.3%), mental health issues (24.6%), and immigration status (18.5%). In 38.8% of cases, the provider felt the surgery was preventable if medical factors leading to simple nephrectomy were properly addressed.
CONCLUSIONS: Simple nephrectomy is a common surgery in the safety net hospital setting. Both medical and sociologic factors can lead to simple nephrectomy, and awareness of these factors can lead efforts to mitigate them. This review has led to the implementation of strategies to minimize occurrences of retained stents in our patients.

PMID: 33359487 [PubMed - as supplied by publisher]

A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain.

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A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain.

Int J Yoga. 2020 Sep-Dec;13(3):177-182

Authors: Smith SL, Langen WH

Abstract
Background: Chronic pain is a serious public health problem that affects people of all ages and backgrounds. Mindfulness-based stress reduction (MBSR) techniques offer an accessible treatment modality for chronic pain patients that may complement or replace pharmacological treatment. This article reviews the literature on the efficacy of MBSR training in patients with back chronic pain syndromes for the outcomes of pain measures, quality of life (QOL), mental health, and mindfulness.
Methods: A systemized search was conducted in September of 2018 for studies published between 2008 and 2018 on mindfulness and chronic low back pain. Out of 50 articles on mindfulness and chronic pain, 12 empirical studies were selected for the inclusion in this review.
Results: Subjective pain scores and QOL improved for chronic pain patients after mindfulness interventions, compared to control groups, in most of the studies reviewed. Limitations of the studies reviewed included the varied pain measurement instruments, the small sample sizes, and the inability to blind participants to MBSR intervention.
Conclusions: MBSR interventions show significant improvements in chronic pain patients for pain measures, QOL, and mental health.

PMID: 33343146 [PubMed]

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

James d'Etienne, MD - Wed, 12/02/2020 - 12:47
Related Articles

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Emerg Med J. 2020 Nov 25;:

Authors: Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H

Abstract
BACKGROUND: Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors.
METHOD: A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis.
RESULTS: A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined.
CONCLUSION: Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.

PMID: 33239313 [PubMed - as supplied by publisher]

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Hao Wang, MD - Wed, 12/02/2020 - 12:47
Related Articles

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Emerg Med J. 2020 Nov 25;:

Authors: Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H

Abstract
BACKGROUND: Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors.
METHOD: A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis.
RESULTS: A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined.
CONCLUSION: Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.

PMID: 33239313 [PubMed - as supplied by publisher]

Beta Blockers for Suspected or Diagnosed Acute Myocardial Infarction.

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Beta Blockers for Suspected or Diagnosed Acute Myocardial Infarction.

Am Fam Physician. 2020 Dec 01;102(11):666-667

Authors: LeFevre NM, Mischel N

PMID: 33252901 [PubMed - as supplied by publisher]

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

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Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Emerg Med J. 2020 Nov 25;:

Authors: Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H

Abstract
BACKGROUND: Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors.
METHOD: A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis.
RESULTS: A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined.
CONCLUSION: Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.

PMID: 33239313 [PubMed - as supplied by publisher]

Providing Ancillary Care in Clinical Research: A Case of Diffuse Large B-Cell Lymphoma during a Malaria Vaccine Trial in Equatorial Guinea.

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Providing Ancillary Care in Clinical Research: A Case of Diffuse Large B-Cell Lymphoma during a Malaria Vaccine Trial in Equatorial Guinea.

Am J Trop Med Hyg. 2020 Nov 23;:

Authors: Manock SR, Mtoro A, Urbano Nsue Ndong V, Olotu A, Chemba M, Sama Roca AE, Eburi E, García GA, Cortes Falla C, Niemczura de Carvalho J, Contreras J, Saturno B, Riocalo JD, Nze Mba JL, Koka R, Lee ST, Menon H, Church LWP, Ayekaba MO, Billingsley PF, Abdulla S, Richie TL, Hoffman SL

Abstract
Providing medical care for participants in clinical trials in resource-limited settings can be challenging and costly. Evaluation and treatment of a young man who developed cervical lymphadenopathy during a malaria vaccine trial in Equatorial Guinea required concerted efforts of a multinational, multidisciplinary team. Once a diagnosis of diffuse large B-cell lymphoma was made, the patient was taken to India to receive immunochemotherapy. This case demonstrates how high-quality medical care was provided for a serious illness that occurred during a trial that was conducted in a setting in which positron emission tomography for diagnostic staging, an oncologist for supervision of treatment, and an optimal therapeutic intervention were not available. Clinical researchers should anticipate the occurrence of medical conditions among study subjects, clearly delineate the extent to which health care will be provided, and set aside funds commensurate with those commitments.

PMID: 33236704 [PubMed - as supplied by publisher]

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