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JAMA Network Open Jun 2024Insurance barriers to cancer care can cause significant patient and clinician burden.
IMPORTANCE
Insurance barriers to cancer care can cause significant patient and clinician burden.
OBJECTIVE
To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.
DESIGN, SETTING, AND PARTICIPANTS
In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023.
EXPOSURE
Insurance denial for RT.
MAIN OUTCOMES AND MEASURES
Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
RESULTS
A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.
Topics: Humans; Female; Middle Aged; Male; Aged; Adult; Aged, 80 and over; Radiation Oncology; United States; Insurance, Health; Neoplasms; Academic Medical Centers; Cohort Studies
PubMed: 38865128
DOI: 10.1001/jamanetworkopen.2024.16359 -
Frontiers in Psychiatry 2024The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of...
OBJECTIVE
The concept of caring stress and its specific management has received less attention than other dimensions of stress in nurses. Therefore, to clarify the concept of caring stress, a scoping review study was designed. This scoping review aimed to investigate the concept of caring stress among clinical nurses and examine the strategies used for its management.
METHODS
This review employed a scoping review methodology to comprehensively map the essential concepts and attributes of the phenomenon by drawing on a wide range of sources. International databases including PubMed, Scopus, Web of Science, Google Scholar, and Scientific Information Database (SID) were searched to gather relevant studies published until October 1, 2023. MESH terms included "caring stress", "care", "stress", "nurse", and "stress management" were used. Two reviewers independently collected data from full-text papers, ensuring that each paper underwent assessment by at least two reviewers.
RESULTS
Out of 104,094 articles initially searched, 22 articles were included in this study. High workloads, transmitting the infection, stressful thoughts, stressful emotions, and stressful communications were the significant concepts and factors of caring stress among nurses. Also, rest breaks during patient care shifts, playing music in the ward, and denial of critical situations were examples of positive and negative coping and management ways to reduce caring stress.
CONCLUSION
Effective stress management strategies can lead to better patient care and safety. Stressed nurses are more likely to make errors or become less vigilant in their duties, impacting patient outcomes. By addressing caring stress, clinical practice can prioritize patient well-being. Further research is required to delve deeper into this critical issue concerning nurses in the future.
PubMed: 38863606
DOI: 10.3389/fpsyt.2024.1337938 -
Public Understanding of Science... Jun 2024Today, the dominant climate change discourses affirm its anthropogenic nature and the urgency for policies. However, minority discourses remain active in the worldwide...
Today, the dominant climate change discourses affirm its anthropogenic nature and the urgency for policies. However, minority discourses remain active in the worldwide debate, refining arguments beyond simple denial-as shown regarding formal/official discourses of the United States and European far-right parties. This makes it necessary to examine the public understanding of climate change in everyday, informal minority discourses, looking at how they work for broadening societal space for "quarantining" the transformative potential of climate change meanings/policies. For this, we analyze readers' comments on climate change articles from two Portuguese newspapers, drawing from the frameworks of neutralization techniques and meaning barriers. Findings show that although denial of anthropogenic climate change remains, discursive efforts concentrate on person-stigmatizing depictions of climate change actors, delegitimized as "elites" in populist vocabularies, reflecting a consistent alignment between everyday discourses and those of the United States and European official far-right. We discuss the functions this pattern may have for the growth of climate change minority positions.
PubMed: 38863437
DOI: 10.1177/09636625241254505 -
PloS One 2024Violence against women and girls (VAWG) is a significant global public health problem and a violation of human rights experienced by one in three women worldwide. This...
BACKGROUND
Violence against women and girls (VAWG) is a significant global public health problem and a violation of human rights experienced by one in three women worldwide. This study explores community perceptions of and responses to VAWG and challenges in accessing support services among female violence survivors in Arbaminch City.
METHODS
We adopted a phenomenological explorative qualitative study design. A total of 62 participants including female violence survivors, religious leaders, service providers, police, women, and men in participated in interviews, focus group discussions, and observations in August 2022. Participants were selected purposively, and the findings were analyzed thematically. We applied data source and respondent triangulation to increase the findings' trustworthiness.
RESULTS
Community perceptions of VAWG, specifically of intimate partner violence (IPV) and non-partner sexual violence (NPSV), varied depending on gender, age, and social position. IPV and NPSV were normalized through tolerance and denial by young and married men, while resistance to all forms of violence was common among women. Survivors of violence responded to the act of violence by leaving their homes, separating from their husbands, or taking harsh actions against their husbands, such as murder. Support for VAWG survivors was available through health care, free legal services, and a temporary shelter. Yet factors ranging from individual to societal levels, such as fear, lack of knowledge, lack of family and community support, and social and legal injustice, were barriers to accessing existing services. Nonetheless, violence survivors desired to speak about their experiences and seek psychosocial support.
CONCLUSIONS
Our qualitative evidence gathered here can inform tailored VAWG prevention and response services such as interventions to shift social norms and the perception towards VAWG among different population group through raising awareness in schools, health care settings, faith-based venues, and using social media.
Topics: Humans; Female; Adult; Ethiopia; Male; Intimate Partner Violence; Adolescent; Young Adult; Qualitative Research; Middle Aged; Focus Groups; Sex Offenses; Survivors
PubMed: 38861511
DOI: 10.1371/journal.pone.0304459 -
Chinese Clinical Oncology May 2024Patients with surgically resectable BRAF-mutated colorectal liver metastases (CRLM) or limited extrahepatic disease constitute a highly selective subgroup among...
BACKGROUND
Patients with surgically resectable BRAF-mutated colorectal liver metastases (CRLM) or limited extrahepatic disease constitute a highly selective subgroup among BRAF-mutated patients, characterized by a more indolent disease biology. This is evident in their suitability for surgical resection. However, initial studies from a decade ago presented a discouraging outlook for these patients, citing early, frequent, multifocal recurrences and a very limited median overall survival (OS) of less than two years. Our objective was to provide an updated, comprehensive, and critically assessed review of the current literature on the prognostic impact of BRAF variants in CRLM, as well as to explore optimal treatment strategies for these patients through a systematic search.
METHODS
A systematic literature search of the Medline, Scopus, and CENTRAL databases for studies reporting long-term outcomes of patients with a known BRAF status was performed.
RESULTS
A total of 386 unique studies were screened during the study selection process. After applying the exclusion criteria, a total of 18 studies published between 2012 and 2023 were deemed eligible for inclusion.
CONCLUSIONS
In contrast to older studies, more recent studies, with larger sample sizes, have revealed that the rate of extrahepatic recurrence is comparable between BRAF-mutated and wild-type patients. Furthermore, they have reported significantly improved survival outcomes, with OS extending up to 52 months. Notably, patients with non-V600E BRAF mutations may even achieve outcomes comparable to those with wild-type BRAF CRLM. Additionally, a few recent studies have compared surgery and systemic therapies, indicating that surgery is associated with improved survival rates, even for patients with the V600E mutation. This challenges the previous belief that BRAF mutations are absolute contraindications to surgical treatment. Surgical denial for technically resectable patients may now be reserved for specific clinical scenarios, such as the presence of a BRAF V600E mutation and concurrent extrahepatic disease.
PubMed: 38859602
DOI: 10.21037/cco-23-128 -
Journal of Psychosomatic Research Aug 2024Stigma is a social attribute that links a person to an undesirable characteristic and leads to actions that increase the social distance from that person. This includes... (Review)
Review
INTRODUCTION
Stigma is a social attribute that links a person to an undesirable characteristic and leads to actions that increase the social distance from that person. This includes different or discriminatory treatment. Stigma is common in healthcare, particularly in people with persistent physical symptoms (PPS) and functional disorders (FD). The aim of this study is to create a new actionable framework to aid understanding of stigmatisation in consultations about PPS/FD and to improve the consultation experiences.
METHODS
This framework development used the Best Fit Framework approach to data collected for a scoping review of stigma in functional disorders. The stages included selection of an initial framework from existing conceptual models, mapping quote data from published papers to the framework and an iterative process of revision and re-mapping. The final framework was tested by re-mapping all the quote data to the framework following classification rules.
RESULTS
253 quotes were obtained from the results sections of qualitative studies from a previous scoping review. The framework comprises of prejudice, stereotypes and actions to increase social distance. Stereotype refers to the focus of stigma: this may be the condition, the patient, or their behaviour. Actions that increase social distance include: othering; denial; non-explanation; minimising, norm-breaking; and psychologising. By breaking down stigma into recognisable components, the framework provides a way to understand the difficulties that patients and clinicians face during consultations and a way to develop intervention materials.
CONCLUSIONS
This new framework for stigma in clinical consultations for PPS/FDs provides a useful tool for the study of stigma in clinical consultations.
Topics: Humans; Social Stigma; Stereotyping; Referral and Consultation; Psychological Distance
PubMed: 38852031
DOI: 10.1016/j.jpsychores.2024.111828 -
Frontiers in Public Health 2024Individuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression,...
Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals.
INTRODUCTION
Individuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience "minority stress" from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.
METHODS
The National Inpatient Sample was used to identify nationwide patients with depression ( = 378,552, weighted = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals' gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.
RESULTS
Among the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.
CONCLUSION
Differences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.
Topics: Humans; United States; Female; Male; Gender Dysphoria; Adult; Middle Aged; Depression; Hospitalization; Hospital Costs; Aged; Adolescent; Young Adult; Length of Stay
PubMed: 38846620
DOI: 10.3389/fpubh.2024.1359127 -
Frontiers in Artificial Intelligence 2024The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread... (Review)
Review
The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread adoption has also brought about significant security challenges that must be addressed to ensure the integrity and confidentiality of data transmitted and processed by IoT systems. This survey paper delves into the diverse array of security threats faced by IoT devices and networks, ranging from data breaches and unauthorized access to physical tampering and denial-of-service attacks. By examining the vulnerabilities inherent in IoT ecosystems, we highlight the importance of implementing robust security measures to safeguard sensitive information and ensure the reliable operation of connected devices. Furthermore, we explore cutting-edge technologies such as blockchain, edge computing, and machine learning as potential solutions to enhance the security posture of IoT deployments. Through a comprehensive analysis of existing security frameworks and best practices, this paper aims to provide valuable insights for researchers, practitioners, and policymakers seeking to fortify the resilience of IoT systems in an increasingly interconnected world.
PubMed: 38845684
DOI: 10.3389/frai.2024.1397480 -
Frontiers in Psychiatry 2024Causal relationships between psychopathological symptoms, personality traits, coping mechanisms, and sleep bruxism (SB) were studied in the past, giving inconsistent...
Why am I grinding and clenching? Exploration of personality traits, coping strategies, oral parafunctional behaviors, and severe sleep bruxism in a polysomnographic study.
INTRODUCTION
Causal relationships between psychopathological symptoms, personality traits, coping mechanisms, and sleep bruxism (SB) were studied in the past, giving inconsistent results mostly based on self-assessment evaluations. This polysomnography-based cross-sectional study aimed to explore the relationships between severe SB, personality traits (according to the Big Five model), and coping strategies with objective polysomnographic verification.
METHODOLOGY
The study included 66 participants divided into severe SB (SSB) (n=32) and no or mild SB (n=34) groups based on video-polysomnography performed in the sleep laboratory. Questionnaire assessment included the use of the Beck Depression Inventory, Beck Anxiety Inventory, Mini-COPE, International Personality Item Pool Big Five Markers 20-Item version, and Oral Behavior Checklist.
RESULTS
Participants with SSB presented with fewer self-reported anxiety (p=0.008) and depressive (p=0.01) symptoms than the non- or mild-SB groups. The SSB group scored significantly higher in Big Five personal traits such as extraversion (p=0.007), emotional stability (p=0.013), and intellect (p=0.004), while regarding coping strategies, the SSB group was less likely to use negative strategies: self-distraction (p=0.036), denial (p=0.006), venting (p=0.03), behavioral disengagement (p=0.046), and self-blame (p=0.003), and turning to religion (p=0.041). The intensity of oral parafunctional behaviors was comparable in both groups (p=0.054). Emotional stability was a moderate protective factor (p=0.004), and the self-blame strategy was a strong risk factor (p<0.001) for increased oral parafunctional behavior intensity. Phasic activity negatively correlated with anxiety symptom severity (p=0.005), whereas tonic (p=0.122) and mixed (p=0.053) phenotypes did not. SB intensity was a protective factor against anxiety symptoms (p=0.016).
CONCLUSION
In terms of psychopathology, severe sleep bruxers tend to present less severe anxiety and depressive symptoms, while some of their personality traits (extraversion, emotional stability, and intellect) were more strongly pronounced. SSB is possibly related to the lesser use of the "maladaptive" coping strategies and there were no specific coping strategies preferred by SSB participants, compared to the other group. These observations require further studies, as it should be determined whether SB (especially phasic activity) might be a form of a somatization/functional disorder. Further research should focus on the psychogenic background of oral parafunctional behaviors, which occur more often in less emotionally stable personalities and in people using self-blame coping strategies.
PubMed: 38840944
DOI: 10.3389/fpsyt.2024.1362429