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Journal of Pediatric Gastroenterology... Oct 2022Increasingly, in the United States, the prescribing of high-cost drugs has become a challenge for physicians and other practitioners. Such drugs are highly regulated by... (Review)
Review
Increasingly, in the United States, the prescribing of high-cost drugs has become a challenge for physicians and other practitioners. Such drugs are highly regulated by third-party payers (aka insurance), as well as pharmacy benefit managers. Not infrequently, a clinician prescribing a medication will have the payment for the prescription denied by the third-party payer, with the end result being a delay in getting a medically necessary medication to a patient. This article highlights the challenges involved in the prior authorization and denial process, with a focus on pediatric inflammatory bowel disease. The article reviews the role of pharmacy benefits managers in restricting access to drugs, and the reasons why denials of medically necessary medications may occur. The article also provides information on how to appeal denials, how to write a letters of medical necessity, and how to conduct a proper peer-to-peer review. Advocacy from patients and clinicians will be important, as we want to reform the process in the future.
Topics: Child; Humans; Inflammatory Bowel Diseases; Insurance, Health, Reimbursement; United States
PubMed: 35836325
DOI: 10.1097/MPG.0000000000003564 -
Archives of Public Health = Archives... Jan 2022Coronavirus disease 2019 (COVID-19) emerged in late 2019, with the first case identified in Wuhan City, Hubei Province, China, on 12 December 2019. In order to perceive...
Coronavirus disease 2019 (COVID-19) emerged in late 2019, with the first case identified in Wuhan City, Hubei Province, China, on 12 December 2019. In order to perceive the comprehensive impact of this pandemic, we have to know that misinformation and denials about COVID-19 have surely exacerbated its diffusion and hindered the response against it. Turkmenistan remains one of the very few countries in the world that lacks reports about emerging cases of the novel coronavirus. Turkmen authorities claim that they have adopted all attainable measures required in order to combat the virus, asserting that COVID-19 has yet to reach their country. Despite the government's reported absence of COVID-19 in the country, rumors, media reports and independent sources suggest the spread of the pandemic in Turkmenistan. By mid-June 2020, the outbreak was referred to as being serious with patients suffering extreme health risks, and following its state of disrepair and unethical practices, many of those anticipated to be COVID-19 infected tend to suffer at home, discouraging any interaction with the healthcare system. The civil society in Turkmenistan, for the time being, takes full part of the government's duty in the process of informing and educating the public regarding the COVID-19 pandemic, and endeavors to keep the government and WHO accountable for behaving in such repressive ways that could lead to rather preventable loss of human life in Turkmenistan. Yet, efforts hang fire before unveiling the real situation, and Turkmenistan's government owning up to the negations and roaming speculations, not only regarding the coronavirus crisis, but every public-related issue itself.
PubMed: 34983658
DOI: 10.1186/s13690-021-00779-x -
BMC Palliative Care Nov 2022Cancer is one of the leading causes of death worldwide and a cancer death is a major risk factor for pathological bereavement. This systematic review of the literature...
BACKGROUND
Cancer is one of the leading causes of death worldwide and a cancer death is a major risk factor for pathological bereavement. This systematic review of the literature aimed to identify biopsychosocial and existential determinants specific to the palliative phase of cancer that influence the grieving experience of the caregiving relative.
METHOD
A systematic review of the literature was conducted without language or time restrictions. The Cairn, Cochrane Library, PubMed, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection databases were explored. All studies assessing pre- and post-death measures and focusing on friends and relatives caring for adults with cancer in palliative care services were included in the review.
RESULTS
Out of 645 articles identified, 18 full text studies were finally included in our systematic review of the literature. Many factors specific to the cancer palliative phase were identified as influencing the bereavement experience of caregivers, with factors relating to: 1) the caregiver (e.g. social support, psychological burden, preparation for loss, action and discussion related to death); 2) the patient (e.g. denial or acceptance); 3) the interactions between patient and their caregivers (e.g. tensions, communication difficulties, and presence at the time of death); and 4) the end-of-life context. The caregiver's grief experience can be described by the following terms: typical and pathological grief, anxiety, depression, guilt, psychological distress, post-traumatic stress disorder and post-traumatic growth, and life satisfaction.
CONCLUSIONS
Many contextual, sociodemographic, dispositional and transactional factors specific to the palliative cancer phase are involved in the caregiver's grieving experience. Avenues for reflection and recommendations are proposed including supporting communication and patient-relative relationships, evaluating the nature and degree of functionality of coping strategies, strengthening the robustness of methodologies, considering impact of COVID-19, and new lines of enquiry for research.
Topics: Adult; Humans; Palliative Care; COVID-19; Bereavement; Grief; Neoplasms
PubMed: 36451118
DOI: 10.1186/s12904-022-01096-y -
Iranian Journal of Nursing and... 2022As the 2019 coronavirus spreads rapidly around the world, it has caused widespread fear and anxiety in various populations. This study aimed to explore the psychological...
BACKGROUND
As the 2019 coronavirus spreads rapidly around the world, it has caused widespread fear and anxiety in various populations. This study aimed to explore the psychological effects of COVID-19 on patients with this disease.
MATERIALS AND METHODS
A qualitative study was conducted with a phenomenological approach. A purposive sample of 11 patients with COVID-19 was recruited. Data were collected from the beginning of March to the beginning of June 2020 using semi-structured interviews and they were analyzed according to Van Manen's method. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis.
RESULTS
Initially, 315 codes were extracted. During data analysis and comparisons, the codes were reduced to 108. Ultimately, 10 categories, 38 subcategories, and 3 themes emerged. The theme of "behavioral responses" including 5 categories (Remorse, Fear and despair, Death anxiety, Growth, Support), "disease-caused helplessness" including two categories (Failure, Denial), and "decline of social networks" including three categories (Rejection, Stigma, Feeling guilty).
CONCLUSIONS
After understanding the findings of this research, nurses working in the wards of patients with COVID-19 can better consider the importance of assessing and analyzing the psychological challenges and experiences of these patients during the course of illness and quarantine. Findings also enhance the identification and organization of training needs during such a pandemic and the design of nursing programs to meet them.
PubMed: 35419267
DOI: 10.4103/ijnmr.ijnmr_382_20 -
Journal of Geriatric Psychiatry and... Nov 2022Caregivers of patients diagnosed with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) often experience distressing symptoms related to their... (Review)
Review
Caregivers of patients diagnosed with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) often experience distressing symptoms related to their caregiving role. This review evaluates the existing literature on coping and their relationship to ALS and FTD caregiver psychological wellbeing. Published articles were identified via a systematic search of four databases (Cinahl Complete, Medline, Embase and PsycINFO). Overall, problem-focused coping strategies such as active coping and planning was used most often by ALS and FTD caregivers. Positive emotion-focused coping strategies such as acceptance were also frequently used by FTD caregivers. In contrast, dysfunctional coping strategies such as self-oriented reactions including self-blame, denial and self-preoccupation appeared to be the most salient coping strategy negatively impacting on caregiver psychological wellbeing. Six different coping measures were used and their psychometric properties were typically under-reported or satisfactory at best when reported. While coping is as an important aspect of caregivers' experience, it remains unclear how the temporal dimensions of the coping process as well as stressor specificity influences psychological adaptation, and consequently, development of targeted caregiver intervention. The need for future studies to define the coping process more clearly in order to capture the unique stressors encountered by ALS and FTD caregivers throughout the different disease stages is emphasised.
Topics: Humans; Caregivers; Frontotemporal Dementia; Amyotrophic Lateral Sclerosis; Adaptation, Psychological; Emotions
PubMed: 34937437
DOI: 10.1177/08919887211060016 -
Archives of Psychiatric Nursing Jun 2022Depressive disorder is the most prevalent mental illness and is characterised by the presence of mental and somatic symptoms, with the latter affecting 65.0% to 98.2% of...
BACKGROUND
Depressive disorder is the most prevalent mental illness and is characterised by the presence of mental and somatic symptoms, with the latter affecting 65.0% to 98.2% of patients with their general function and quality of life.
PURPOSE
The purpose of this study aimed to explore the experiences and coping strategies of somatic symptoms in Chinese patients with depressive disorder, and to gain new insight into the illness and the health care provided to patients.
METHODS
Semi-structured, in-depth interviews were conducted with 15 patients diagnosed with depressive disorder according to international classification of diseases 10th revision. The interviews were transcribed verbatim and the thematic analysis was adapted to the data. MAXQDA10 software was used to organise, encode, classify, induce, and extract themes.
RESULTS
Four major themes were extracted from the interviews: (1) descriptions of symptoms; (2) perceptions of the symptoms; (3) symptom disturbance; and (4) coping strategies of symptoms. Within the first theme, patients identified the following sub-themes: complex experiences of somatic symptoms, which were mainly in the neuromuscular system, circulatory respiratory system, gastrointestinal system and some symptoms without obvious systemic classification; difficulty in locating symptoms accurately; and being not consistent with examination results. The second theme included patient's inadequate understanding of somatic symptoms; and denial of the link between physical discomfort and depression. Disturbance of somatic symptoms embraced three sub-themes: (1) Uncertainty about somatic symptoms; (2) Struggling with daily life; (3) Impact on social activities; (4) feeling a decrease in family support. Lastly, coping strategies taken by patients in the face of various symptoms mainly included relying on drug treatment, avoiding stressors, diverting attention, and compromise or acceptance.
CONCLUSIONS
Patients with depressive disorder experience a variety of somatic symptoms that have a negative impact on social function and reduce their quality of life. Patients did not have an adequate understanding of their physical discomfort and lacked effective coping strategies for these somatic symptoms. Professional staff should pay more attention to patients' somatic symptoms and focus on targeted symptom management to facilitate patient recovery.
Topics: Adaptation, Psychological; Depressive Disorder; Humans; Medically Unexplained Symptoms; Qualitative Research; Quality of Life
PubMed: 35461645
DOI: 10.1016/j.apnu.2022.01.004 -
Clinical Nursing Research Nov 2021The diagnosis of childhood cancer is one of the most serious and unexpected experiences a mother can endure. A descriptive phenomenological approach was used to explore...
The diagnosis of childhood cancer is one of the most serious and unexpected experiences a mother can endure. A descriptive phenomenological approach was used to explore the experiences of mothers of children diagnosed with cancer in Jordan. Themes that emerged include (1) Emotional response on knowing the diagnosis (feelings of shock, lack of preparedness, denial, and feelings of "paralysis"), (2) Fear of the dreaded disease (fear of suffering and fear of death), and (3) The challenges of the treatment journey (inadequate financial resources, role transition, and feeling socially isolated). This study describes the experiences of Jordanian mothers who care for their children diagnosed with cancer so that health care providers can develop strategies to provide adequate psychological support to these mothers.
Topics: Anxiety; Child; Emotions; Fear; Female; Humans; Mothers; Neoplasms; Qualitative Research
PubMed: 33736501
DOI: 10.1177/10547738211002021 -
Frontiers in Psychology 2023Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and...
INTRODUCTION
Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus.
METHODS
Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at < 0.05 (family wise error corrected for each comparison).
RESULTS
69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ = 9.02; < 0.009), demoralization (ꭓ = 8.05; < 0.018), somatization (ꭓ = 4.92; < 0.063) and functional symptoms (ꭓ = 5.21; < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls ( = -2.282; < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity.
DISCUSSION
Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.
PubMed: 38192387
DOI: 10.3389/fpsyg.2023.1256291 -
PloS One 2021Dog importation data from 2018-2020 were evaluated to ascertain whether the dog importation patterns in the United States changed during the COVID-19 pandemic,...
Dog importation data from 2018-2020 were evaluated to ascertain whether the dog importation patterns in the United States changed during the COVID-19 pandemic, specifically with regard to denial of entry. Dog denial of entry reports from January 1, 2018, to December 31, 2020, stored within the Centers for Disease Control and Prevention (CDC) Quarantine Activity Reporting System (QARS), were reviewed. Basic descriptive statistics were used to analyze the data. Reason for denial, country of origin, and month of importation were all examined to determine which countries of origin resulted in the largest number of denials, and whether there was a seasonal change in importations during the COVID-19 pandemic (2020), compared to previous years (2018 and 2019). During 2020, CDC denied entry to 458 dogs. This represents a 52% increase in dogs denied entry compared to the averages in 2018 and 2019. Dogs were primarily denied entry for falsified rabies vaccination certificates (56%). Three countries exported 74% of all dogs denied entry into the United States, suggesting that targeted interventions may be needed for certain countries. Increased attempts to import inadequately vaccinated dogs from countries with canine rabies in 2020 may have been due to the increased demand for domestic pets during the COVID-19 pandemic. Educational messaging should highlight the risk of rabies and the importance of making informed pet purchases from foreign entities to protect pet owners, their families, and the public.
Topics: Animals; COVID-19; Centers for Disease Control and Prevention, U.S.; Dog Diseases; Dogs; Humans; Pandemics; Quarantine; Rabies; Rabies Vaccines; SARS-CoV-2; United States; Vaccination
PubMed: 34492037
DOI: 10.1371/journal.pone.0254287 -
Revista Brasileira de Enfermagem 2023to know the violence spoken and felt by disabled people, living in rural areas, from the perspective of their families.
OBJECTIVES
to know the violence spoken and felt by disabled people, living in rural areas, from the perspective of their families.
METHODS
a descriptive-exploratory and qualitative study, carried out in four municipalities in Rio Grande do Sul, Brazil. Twelve family members who lived with disabled people in rural areas participated. Data were collected through semi-structured interviews and analyzed using thematic content analysis.
RESULTS
disabled people, living in rural areas, experienced physical, psychological and sexual violence, perpetrated by family members, colleagues, community members and health professionals. Adaptations were mentioned in family dynamics for the care of disabled people, social, financial and leisure impacts, and challenges in access and accessibility to education and health services.
FINAL CONSIDERATIONS
violence against this population manifests itself in a reality with socioeconomic and family particularities, marked by exclusion, disrespect and denial of rights and access to fundamental goods and services.
Topics: Humans; Violence; Health Services; Sex Offenses; Rural Population; Family; Brazil; Qualitative Research
PubMed: 37255188
DOI: 10.1590/0034-7167-2022-0404