RESUMO
The ability to retrieve specific, single-incident autobiographical memories has been consistently posited as a predictor of recurrent depression. Elucidating the role of autobiographical memory specificity in patient-response to depressive treatments may improve treatment efficacy and facilitate use of science-driven interventions. We used recent methodological advances in individual patient data meta-analysis to determine a) whether memory specificity is improved following mindfulness-based cognitive therapy (MBCT), relative to control interventions, and b) whether pre-treatment memory specificity moderates treatment response. All bar one study evaluated MBCT for relapse prevention for depression. Our initial analysis therefore focussed on MBCT datasets only(n = 708), then were repeated including the additional dataset(n = 880). Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions. There was no evidence that baseline memory specificity predicted treatment response in terms of symptom-levels, or risk of relapse. Findings raise important questions regarding the role of memory specificity in depressive treatments.
Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Memória Episódica , Atenção Plena , Transtorno Depressivo Maior/psicologia , Humanos , Resultado do TratamentoRESUMO
Five years ago, the Melanoma Research Foundation (MRF) conducted an assessment of the challenges and opportunities facing the melanoma research community and patients with melanoma. Since then, remarkable progress has been made on both the basic and clinical research fronts. However, the incidence, recurrence, and death rates for melanoma remain unacceptably high and significant challenges remain. Hence, the MRF Scientific Advisory Council and Breakthrough Consortium, a group that includes clinicians and scientists, reconvened to facilitate intensive discussions on thematic areas essential to melanoma researchers and patients alike, prevention, detection, diagnosis, metastatic dormancy and progression, response and resistance to targeted and immune-based therapy, and the clinical consequences of COVID-19 for patients with melanoma and providers. These extensive discussions helped to crystalize our understanding of the challenges and opportunities facing the broader melanoma community today. In this report, we discuss the progress made since the last MRF assessment, comment on what remains to be overcome, and offer recommendations for the best path forward.
Assuntos
COVID-19/prevenção & controle , Oncologia/métodos , Melanoma/terapia , Guias de Prática Clínica como Assunto , SARS-CoV-2/isolamento & purificação , Neoplasias Cutâneas/terapia , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Oncologia/organização & administração , Oncologia/tendências , Melanoma/diagnóstico , SARS-CoV-2/fisiologia , Neoplasias Cutâneas/diagnósticoRESUMO
Proboscis lateralis is a rare spontaneous congenital anomaly that results from a failure of normal embryological nasal development. The ensuing deformity consists of imbrication of the nasal soft tissues into a tubelike proboscis and can be associated with ipsilateral heminasal aplasia, choanal atresia, and multiple other abnormalities. A case report of a patient with proboscis lateralis is presented, with a 27-year follow-up detailing the complexities of long-term surgical management. After 15 major surgical interventions, there is relatively normal facial symmetry, but abnormalities remain with the underlying craniofacial skeleton and nasopharyngeal airway. Proboscis lateralis is not an isolated soft tissue abnormality but is a craniofacial defect that requires a long-term multidisciplinary approach to the surgical timing and treatment with lifelong follow-up.
Assuntos
Anormalidades Craniofaciais/cirurgia , Assimetria Facial/cirurgia , Nariz/anormalidades , Procedimentos de Cirurgia Plástica/métodos , Coloboma/complicações , Coloboma/cirurgia , Anormalidades Craniofaciais/complicações , Dacriocistorinostomia , Pálpebras/anormalidades , Pálpebras/cirurgia , Assimetria Facial/congênito , Assimetria Facial/etiologia , Feminino , Humanos , Recém-Nascido , Aparelho Lacrimal/anormalidades , Aparelho Lacrimal/cirurgia , Cavidade Nasal/anormalidades , Cavidade Nasal/cirurgia , Nariz/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Cleft palate repair is a challenging procedure to learn because of the delicate tissue handling required and the small confines of the infant oral cavity. As a result, cleft palate simulators have previously been described to augment cleft palate repair training. Although valuable, they lack the fidelity for this complex procedure. METHODS: A high-fidelity cleft palate simulator was evaluated by staff and fellows in pediatric plastic surgery who provided feedback on its realism, anatomical accuracy, and effectiveness as a training tool. The simulator was implemented within a training workshop following a didactic session on cleft palate repair and anatomy. A test was administered to each participant before and immediately after the workshop to assess knowledge transfer. Perceived confidence of performing a repair following the workshop was also assessed, as was the workshop's effectiveness. RESULTS: Overall, participants agreed that the simulator is anatomically accurate and realistic and strongly agreed that the simulator is a valuable training tool. The average test score increased from 25 percent before the workshop to 77.27 percent after the workshop. Overall, participants of the workshop felt more confident performing a repair and strongly agreed that the workshop was valuable and effective. CONCLUSIONS: A high-fidelity cleft palate simulator has been evaluated as realistic, anatomically accurate, and valuable as a training tool. The simulator was successfully integrated into a training workshop, which resulted in significant knowledge increase on anatomy and the procedure and perceived confidence and comfort in performing a cleft palate repair.
Assuntos
Fissura Palatina/cirurgia , Treinamento por Simulação/métodos , Educação , Retroalimentação , Humanos , Resultado do TratamentoRESUMO
Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.
RESUMO
The authors report a case of a 16-year-old girl who presented with a 1-week history of progressive low-back pain, buttock paresthesias, and bilateral lower extremity pain and weakness. Magnetic resonance (MR) imaging and MR venography studies of her lumbar spine revealed engorgement of the epidural venous plexus and mild compression of the cauda equina. A lower extremity and pelvic venogram revealed occlusive thrombosis of the femoral and iliac veins as well as of the inferior vena cava (IVC). The patient required an IVC thrombectomy due to progressive symptoms, after which she improved and returned to baseline status in 1 week. Imaging studies afterwards showed resolution of the venous engorgement and decompression of the cauda equina. This is the second published report of an association between IVC thrombosis and cauda equina syndrome.
Assuntos
Polirradiculopatia/etiologia , Trombose Venosa/complicações , Doença Aguda , Adolescente , Feminino , Humanos , Imageamento por Ressonância Magnética , Polirradiculopatia/patologia , Resultado do Tratamento , Veia Cava Inferior/patologia , Trombose Venosa/cirurgiaRESUMO
Kaiser Permanente, an integrated health care delivery system in the USA, takes a "whole systems" approach to the chronic disease of obesity that begins with efforts to prevent it by modifying the environment in communities and schools. Aggressive case-finding and substantial investment in intensive lifestyle modification programs target individuals at high risk of diabetes and other weight-related conditions. Kaiser Permanente regions are increasingly standardizing their approach when patients with obesity require treatment intensification using medically supervised diets, prescription medication to treat obesity, or weight loss surgery.
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Doença Crônica/prevenção & controle , Serviços de Saúde Comunitária , Prestação Integrada de Cuidados de Saúde/organização & administração , Sistemas Pré-Pagos de Saúde/organização & administração , Promoção da Saúde , Obesidade/prevenção & controle , Doença Crônica/terapia , Promoção da Saúde/métodos , Humanos , Investimentos em Saúde , Obesidade/terapia , Formulação de Políticas , Estados UnidosAssuntos
Fenda Labial , Rinoplastia , Fenda Labial/cirurgia , Humanos , Nariz/cirurgia , Resultado do TratamentoRESUMO
Arthrogryposis multiplex congenita (AMC) is a complex disorder that leads to joint stiffness and deformities in 2 or more joints in afflicted children. Late manifestations of this disorder can include secondary degeneration of the abnormal joints with arthritic symptoms of pain and loss of function. There are few reports in the orthopedic literature on the use of total joint arthroplasty to improve the pain and function in patients with arthrogryposis. This case report presents one patient who underwent bilateral total hip and total knee arthroplasties for deteriorating function and pain in her hips and knees secondary to the congenital deformities created by arthrogryposis multiplex congenita. We discuss the intraoperative difficulties and techniques used to reconstruct her hips and knees, as well as the potential indications for joint arthroplasty in this challenging group of patients.
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Artrogripose/cirurgia , Artroplastia de Quadril , Artroplastia do Joelho , Articulação do Quadril/cirurgia , Articulação do Joelho/cirurgia , Adulto , Artrogripose/diagnóstico por imagem , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Radiografia , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
In October 2011, California became the first US state to ban indoor tanning for minors under age 18 years. Vermont followed in May 2012. Increasingly, scientific evidence shows that artificial tanning raises the risk of skin cancer, including melanoma, a common cancer in adolescents and young adults and the type most likely to result in death. The World Health Organization, the American Academy of Pediatrics, the American Academy of Dermatology, the American Medical Association, and other organizations strongly recommend legislation to ban minors under age 18 from indoor tanning. Several nations have banned teen tanning. Yet, tanning in salons is still a prevalent practice in the United States, especially among teen girls, where rates for the oldest teens approach 40%. There is no federal legislation to restrict minors from salon tanning. More than 60% of states have some kind of legislation regarding minors' use of tanning salons, but only California and Vermont have passed complete bans of indoor tanning for minors. The Indoor Tanning Association, an industry advocacy group, has vigorously opposed legislative efforts. Pediatricians can play key roles in counseling families and with legislative efforts. In this update, we review the prevalence of salon tanning, association with skin cancer risk, tanning addiction, the roles of the federal and state governments in regulation and legislation, and responses to arguments created by industry to oppose legislation. Preventing exposure to artificial tanning may save lives, including young lives, and is a key cancer prevention opportunity for pediatricians.
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Técnicas Cosméticas/efeitos adversos , Regulamentação Governamental , Papel do Médico , Neoplasias Cutâneas/prevenção & controle , Banho de Sol/legislação & jurisprudência , Bronzeado , Raios Ultravioleta/efeitos adversos , Adolescente , Comportamento do Adolescente , Técnicas Cosméticas/psicologia , Humanos , Indústrias/legislação & jurisprudência , Aplicação da Lei , Pediatria , Relações Médico-Paciente , Pele/efeitos da radiação , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Banho de Sol/psicologia , Estados Unidos/epidemiologiaRESUMO
There are several surgical management options for medial knee arthritis, and it is often difficult to decide whether a unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) is appropriate. Few studies have compared UKAs and TKAs in the same patient. We identified 23 patients with osteoarthritis who had a TKA on one side and a UKA on the other. The preoperative values of the 2 knees were not statistically different. Strict criteria were used to determine whether a UKA could be performed (functional anterior cruciate ligament, minimal deformity, and minimum changes in other compartments). Preoperative radiographs were reviewed to confirm that the knee undergoing TKA had medial compartment disease only. Knee Society scores, radiographic analysis, and patient preferences were recorded for all patients. Average follow-up was 46 months (range, 7.2-148 months) and 42 months (range, 11.5-59.8 months) for TKA and UKA, respectively. We found little or no difference in outcomes between the 2 procedures, except for an improved range of motion with the UKA compared with the TKA (123 degrees +/-9 degrees vs 119.8 degrees +/-7 degrees, respectively). Knee Society scores improved from 45.9 to 89.7 in UKA and from 42.4 to 90.3 in TKA. Of the 23 patients, 11 expressed no preference between either knee and 12 preferred the unicompartmental knee; no patient preferred the total knee. With appropriate patient selection, UKAs are a successful option for patients with osteoarthritis.
Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
To assess the association between infant size or growth and subsequent obesity and to determine if any association has been stable over time...
Assuntos
Masculino , Feminino , Humanos , Criança , Nutrição da Criança , Obesidade , Sobrepeso , Saúde da CriançaRESUMO
BACKGROUND: Gemcitabine is an effective treatment for recurrent Hodgkin disease (HD), with relatively minimal associated toxicity. The authors conducted a trial substituting this drug for dacarbazine in the standard regimen to form ABVG (doxorubicin, bleomycin, vinblastine, gemcitabine) for patients with newly diagnosed, high-risk HD. METHODS: Twelve patients (median age, 34 years) with advanced-stage de novo HD were enrolled. Standard doses of doxorubicin, bleomycin, and vinblastine were given for six cycles. Cohorts of three patients were enrolled and the dose of gemcitabine was escalated to identify the maximally tolerated dose in this combination. RESULTS: The maximally tolerated dose of gemcitabine was determined to be 800 mg/m(2) in this combination. Five patients developed clinically significant pulmonary toxicity. Three required hospitalization during the final two cycles of treatment. Pneumonitis could not be predicted with serial diffusion capacity for carbon monoxide (DECO) evaluations, and reversed after discontinuation of bleomycin in three patients and steroid therapy in two patients. All 12 patients are alive to date, and 4 patients have experienced disease progression. CONCLUSIONS: The bleomycin/gemcitabine combination should not be pursued for de novo HD due to significant pulmonary toxicity.