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Echocardiography (Mount Kisco, N.Y.) Jul 2024
Topics: Humans; Echocardiography; Ultrasonography, Prenatal; Fetal Heart; Heart Defects, Congenital; Female; Pregnancy; Image Interpretation, Computer-Assisted
PubMed: 38958593
DOI: 10.1111/echo.15867 -
The Contribution of Shame to Eating Disorder Treatment Outcomes in a Community Mental Health Clinic.The International Journal of Eating... Jul 2024Shame is a powerful self-conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is...
OBJECTIVE
Shame is a powerful self-conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is well-established, there is limited research investigating the contribution of pre-treatment shame to clinical outcomes.
METHOD
Participants (N = 273) received outpatient cognitive-behavioral therapy for eating disorders (CBT-ED). We investigated pre-treatment shame as a predictor of dropout and as a moderator of change in ED psychopathology and clinical impairment from pre-treatment to post-treatment. We also explored the potentially moderating roles of body mass index, ED diagnostic category, and co-occurring anxiety and depression diagnoses.
RESULTS
Shame improved substantially (d = 1.28) despite not being explicitly targeted in treatment. Pre-treatment shame did not predict treatment dropout. Individuals high in shame started and ended treatment with higher ED symptoms and impairment than those with low shame. The contribution of pre-treatment shame on the degree of change in symptoms/impairment depended critically on whether analyses controlled for pre-treatment symptoms/impairment. When those were controlled, high pre-treatment shame was associated with substantially less improvement in ED symptoms and impairment. There was some evidence that ED diagnosis and co-occurring depressive diagnoses may moderate the relationship between shame and treatment outcome. Changes in shame were positively associated with changes in ED symptoms and clinical impairment.
DISCUSSION
A high level of shame at pre-treatment is not a contraindication for CBT-ED as good therapeutic outcomes can be achieved. However, outcomes may be enhanced among individuals high in shame by offering adjunctive interventions that explicitly target shame.
PubMed: 38958544
DOI: 10.1002/eat.24248 -
Clinical and Investigative Medicine.... Jun 2024The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership...
PURPOSE
The COVID-19 pandemic has resulted in a significant diagnostic, screening, and procedure backlog in Ontario. Engagement of key stakeholders in healthcare leadership positions is urgently needed to inform a comprehensive provincial recovery strategy.
METHODS
A list of 20 policy recommendations addressing the diagnostic, screening and procedure backlog in Ontario were transformed into a national online survey. Policy recommendations were rated on a 7-point Likert scale (strongly agree to strongly disagree) and organized into those retained (≥75% strongly agree to somewhat agree), discarded (≥80% somewhat disagree to strongly disagree), and no consensus reached. Survey participants included a diverse sample of healthcare leaders with the potential to impact policy reform.
RESULTS
Of 56 healthcare leaders invited to participate, there were 34 unique responses (61% response rate). Participants were from diverse clinical backgrounds, including surgical subspecialties, medicine, nursing, and healthcare administration and held institutional or provincial leadership positions. A total of 11 of 20 policy recommendations reached the threshold for consensus agreement with the remaining 9 having no consensus reached.
CONCLUSION
Consensus agreement was reached among Canadian healthcare leaders on 11 policy recommendations to address the diagnostic, screening, and procedure backlog in Ontario. Recommendations included strategies to address patient information needs on expected wait times, expand health and human resource capacity, and streamline efficiencies to increase operating room output. No consensus was reached on the optimal funding strategy within the public system in Ontario or the appropriateness of implementing private funding models.
Topics: Humans; COVID-19; Ontario; Surveys and Questionnaires; Pandemics; SARS-CoV-2; Leadership; Mass Screening; Delivery of Health Care; Male; Female; Health Personnel
PubMed: 38958478
DOI: 10.3138/cim-2024-2655 -
Health Services Research Jul 2024To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania.
OBJECTIVE
To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania.
DATA SOURCES AND STUDY SETTING
We analyzed data from the Pennsylvania cancer registry (2010-2018) for adult Medicaid beneficiaries aged 21-64 newly diagnosed with a solid tumor. To ascertain Medicaid and managed care status around diagnosis, we linked the cancer registry to statewide hospital-based facility records collected by an independent state agency (Pennsylvania Health Care Cost Containment Council).
STUDY DESIGN
We leveraged a natural experiment arising from county-level variation in mandatory MMC in Pennsylvania. Using a stacked difference-in-differences design, we compared changes in the probability of late-stage cancer diagnosis among those residing in counties that newly transitioned to mandatory managed care to contemporaneous changes among those in counties with mature MMC programs.
DATA COLLECTION/EXTRACTION METHODS
N/A.
PRINCIPAL FINDINGS
Mandatory MMC was associated with a reduced probability of late-stage cancer diagnosis (-3.9 percentage points; 95% CI: -7.2, -0.5; p = 0.02), particularly for screening-amenable cancers (-5.5 percentage points; 95% CI: -10.4, -0.6; p = 0.03). We found no significant changes in late-stage diagnosis among non-screening amenable cancers.
CONCLUSIONS
In Pennsylvania, the implementation of mandatory MMC for adult Medicaid beneficiaries was associated with earlier stage of diagnosis among newly diagnosed cancer patients with Medicaid, especially those diagnosed with screening-amenable cancers. Considering that over half of the sample was diagnosed with late-stage cancer even after the transition to mandatory MMC, Medicaid programs and managed care organizations should continue to carefully monitor receipt of cancer screening and design strategies to reduce barriers to guideline-concordant screening or diagnostic procedures.
PubMed: 38958003
DOI: 10.1111/1475-6773.14348 -
Cureus Apr 2024Unilateral hypertrophy of the Tensor Fasciae Latae (TFL) muscle is a rare condition often characterized by a palpable mass in the lower limbs or hip pain. Despite its...
Unilateral hypertrophy of the Tensor Fasciae Latae (TFL) muscle is a rare condition often characterized by a palpable mass in the lower limbs or hip pain. Despite its rarity, several causative factors have been identified, necessitating accurate diagnosis and appropriate management. Here, we present the case of a 53-year-old patient who sought outpatient consultation for a mass in the anterolateral aspect of the right thigh. Through this case study, we aim to contribute to the limited literature on this condition by discussing our diagnostic approach, management plan, and outcomes. Upon presentation, the patient underwent a thorough physical examination, revealing a non-tender, sessile mass seemingly originating in the deep connective tissue of the thigh. A magnetic resonance image (MRI) was performed to confirm the diagnosis and assess the extent of muscle involvement. This noninvasive modality provided valuable insights into the nature and localization of the mass, providing the diagnosis and guiding subsequent management decisions. Given the benign nature of the condition and absence of associated symptoms, conservative management was favored. Physical therapy focusing on stretching and strengthening exercises was initiated to address the underlying probable causes and improve functional capacity. Close monitoring through regular follow-up appointments was also recommended to track the progression of the hypertrophy and ensure symptomatic relief. Unilateral hypertrophy of the TFL muscle is a rare entity that presents diagnostic and management challenges. Through our case study, we have highlighted the importance of a comprehensive diagnostic workup, including imaging studies, in confirming the diagnosis and guiding management decisions. Conservative approaches, such as physical therapy, can effectively manage symptoms and improve quality of life in affected individuals. Continued research and documentation of cases are essential to expand our understanding of this condition and refine treatment strategies.
PubMed: 38957828
DOI: 10.7759/cureus.58547 -
Cureus Apr 2024Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes...
Metastatic cervical carcinoma from an unknown primary source poses a diagnostic and therapeutic challenge, as it involves the spread of cancer to the neck lymph nodes without a discernible primary tumor despite thorough investigation. While the diagnosis and treatment of this uncommon condition lack definitive evidence, a review of existing literature offers some clinical guidance. A comprehensive diagnostic evaluation, which includes multiple imaging and endoscopic studies, is essential. Surgery is preferred whenever feasible due to its ability to offer more precise staging. This treatment entails an excisional biopsy, neck dissection, and tonsillectomy, but advanced cases necessitate a combination of treatments. This case report underscores this complexity, where, despite radical neck dissection on the affected side, recurrence manifested after two months with no discernible primary site. We emphasize the urgency for continued research and innovative approaches to enhance the diagnosis and management of metastatic cervical carcinoma from an unknown primary source.
PubMed: 38957817
DOI: 10.7759/cureus.58537 -
Cureus Apr 2024Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of cervical vertebrae, limiting neck mobility, and often presenting with clinical...
Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of cervical vertebrae, limiting neck mobility, and often presenting with clinical manifestations such as neck pain, stiffness, and neurological deficits. While the classical presentation of KFS includes a "clinical triad" comprising a shortened neck, a low posterior hairline, and limited cervical motion, not all patients exhibit all three features. This case report presents an 81-year-old male with the complete KFS triad and underscores the diagnostic challenges and management strategies associated with this condition. Despite the rarity of KFS, understanding it is crucial for clinicians due to its profound implications on patient management and quality of life. This case emphasizes the importance of clinical suspicion in Internal Medicine, showcasing how an isolated presentation may often be a manifestation of an underlying congenital condition.
PubMed: 38957816
DOI: 10.7759/cureus.58538 -
Sleep Advances : a Journal of the Sleep... 2024The Sleep Program at the VA San Diego Healthcare System (VASDHS) started a patient database over twenty years ago for its home sleep apnea testing (HSAT) program. An...
STUDY OBJECTIVES
The Sleep Program at the VA San Diego Healthcare System (VASDHS) started a patient database over twenty years ago for its home sleep apnea testing (HSAT) program. An analysis of ten years of diagnostic HSAT data was reported on over 12 500 patients in 2014. Over this time period, severe obstructive sleep apnea (OSA) decreased in frequency. In contrast, mild OSA increased in frequency and was the most frequently reported severity in our analysis. In more recent times, the 2021 continuous positive airway pressure (CPAP) crisis created difficulties in dispersing CPAP therapies to individuals including Veterans with OSA, prompting our group to reexamine the HSAT database.
METHODS
A retrospective review was performed of the local clinical database of HSAT diagnostic testing of 8,928 sleep studies from 2018 to 2022.
RESULTS
The overall mean apnea-hypopnea index (AHI) decreased from 40.4/hour (2004) to 24.3/hour (2022) ( < .001). The two time periods were examined separately. For 2004-2013, it was found that the mean AHI in 2004 was not significantly different from the mean AHI in 2005, 2006, or 2007 but was significantly different from the mean AHI in each year from 2008 (mean AHI = 30.7/h) to 2013 (mean AHI = 26.1/hour). For 2019-2022, the mean AHI did not significantly differ between the 4 years.
CONCLUSIONS
These findings have implications for OSA therapies. Additionally, the high prevalence of mild sleep apnea, which is typically associated with lesser adherence to PAP therapy, further highlights the importance of non-PAP alternatives to improve treatment effectiveness.
PubMed: 38957728
DOI: 10.1093/sleepadvances/zpae036 -
Ghana Medical Journal Sep 2023To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not.
OBJECTIVE
To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not.
DESIGN
A cross-sectional questionnaire survey based on the Health Belief Model was used to collect data from 356 men aged 40 years and above. Data were collected between February and March 2021.
SETTING
The study was conducted in the Accra metropolitan area of the Greater Accra region of Ghana.
PARTICIPANTS
Convenience sampling was used to recruit participants for the study.
RESULTS
Although 86% of the respondents had heard about prostate cancer, only 23% had ever screened for it. Logistic regression analysis suggested that knowledge of the disease (OR = 1.19, CI 95% = 1.03 -1.38) and barriers to screening (OR = .87, CI 95% = .83 -.91) were statistically significant predictors of screening behaviour.
CONCLUSION
HBM has limited predictive power as far as our study is concerned. We suggest increasing public education on prostate cancer and its screening methods. The cost of screening should also be made more affordable so as not to become a barrier.
FUNDING
None declared.
Topics: Humans; Male; Prostatic Neoplasms; Ghana; Middle Aged; Cross-Sectional Studies; Early Detection of Cancer; Adult; Health Belief Model; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Aged; Mass Screening; Logistic Models; Patient Acceptance of Health Care
PubMed: 38957671
DOI: 10.4314/gmj.v57i3.10 -
Cureus May 2024Background The clinical diagnosis of acute appendicitis (AA) can be challenging. This study aimed to evaluate the significance of this diagnosis amidst technological...
Background The clinical diagnosis of acute appendicitis (AA) can be challenging. This study aimed to evaluate the significance of this diagnosis amidst technological progress. It compared clinical diagnosis to radiology-aided diagnostic outcomes and negative appendicectomy rates (NAR). Methodology This study conducted a single-center retrospective and prospective cohort observational study on all adult patients presenting with suspected AA in 2018 at a major tertiary teaching hospital in Perth, Western Australia. Key demographics, clinicopathological, radiology, and operative reports were reviewed. Data were analyzed using SPSS v.27. Results Of 418 patients with suspected AA, 234 (56%) were in the retrospective group. The median age was 35 (IQR=26), and 224 (54%) were female. The overall NAR was 18.6% (95% CI (14.8-22.4)) and 20.8% for clinical diagnosis. Notably, the NAR for ultrasound (USS)-reported AA (false positive) was 17.6% (95% CI (10.6-27.4)). Three-quarters of the patients, 298 (71.3%), had radiological imaging. The most common modality was CT 176 (59.1%), and 33 (7.9%) had both CT and USS imaging performed. Compared with final histopathology, no significant difference was found in the accuracy of clinically diagnosed and USS-diagnosed cases, with rates of 83.5% and 82.5%, respectively (p=0.230). CT had the best positive predictive value at 82.1%. Single-modality imaging did not cause a significant surgical delay (p=0.914), but multi-modal imaging showed a non-significant trend toward delay (p=0.065). When surgeons assessed an appendix as normal, 54 (12.9%), the histopathological assessment revealed pathology in 28 (51.9%). The inter-observer agreement was only fair to moderate, Kappa=0.46 (95% CI (0.33-0.58); p<0.001). The intraoperative identification of a normal appendix inversely correlated to the grade of the primary surgeon, which was likely related to the number of surgical personnel in the theater (p<0.001). Conclusion This study showed that clinical diagnosis matches the diagnostic accuracy of imaging technologies. Utilizing diagnostic imaging methods promptly and appropriately did not lead to considerable delays in surgery. Surgeons' capability to diagnose appendicitis during surgery is moderately accurate. Most patients underwent imaging, with CT scans being the most common. Moving forward, practitioners must minimize excessive reliance on imaging techniques as this can be resource-intensive, especially in developing countries. Future clinical practice should balance embracing technological advancements and preserving essential clinical diagnostic expertise, for medicine is both a science and an art.
PubMed: 38957595
DOI: 10.7759/cureus.60555