Care of Cancer Survivors: Distress and Mental Health.

In 2022, it was estimated that 18.1 million US adults were cancer survivors. By 2032, this number is projected to increase to 22.5 million. All patients with cancer experience some degree of psychological distress associated with the diagnosis. This can include mental health conditions, most commonly anxiety and depression. Management of such conditions in cancer survivors begins with detection via screening. Commonly used screening tools include the National Comprehensive Cancer Network (NCCN) Distress Thermometer, the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9). Initial management involves patient education and psychotherapy. If needed, pharmacotherapy is similar to that for patients in the general population. Of note, several commonly prescribed antidepressants have been shown to decrease the effects of tamoxifen, which breast cancer survivors may be taking as adjuvant endocrine therapy. Integrative medicine therapies, such as music interventions, yoga, mindfulness meditation, and exercise, have shown benefit. Patients undergoing treatment should have outcomes assessed. Thoughts of self-harm or suicidal ideation are common among cancer survivors with mental health conditions. Clinicians should regularly ask patients about suicidal ideation. If present, this indicates the need for more intensive or altered treatment.

The Prevalence of Periodontitis Among US Adults with Multimorbidity Using NHANES Data 2011-2014.

INTRODUCTION: Often misperceived as solely a dental disease, periodontitis is a chronic condition characterized by inflammation of the support structures of the tooth and associated with chronic systemic inflammation and endothelial dysfunction. Despite affecting almost 40% of US adults 30 years of age or older, periodontitis is rarely considered when quantifying the multimorbidity (the presence of 2 or more chronic conditions in an individual) burden for our patients. Multimorbidity represents a major challenge for primary care and is associated with increasing health care expenditure and increased hospitalizations. We hypothesized that periodontitis was associated with multimorbidity. METHODS: To interrogate our hypothesis, we performed a secondary data analysis of a population-based cross-sectional survey, the NHANES 2011 to 2014 dataset. The study population included US adults aged 30 years or older who underwent a periodontal examination. Prevalence of periodontitis in individuals with and without multimorbidity was calculated using likelihood estimates and adjusting for confounding variables with logistic regression models. RESULTS: Individuals with multimorbidity were more likely than the general population and individuals without multimorbidity to have periodontitis. However, in adjusted analyses, there was no independent association between periodontitis and multimorbidity. Given the absence of an association, we included periodontitis as a qualifying condition for the diagnosis of multimorbidity. As a result, the prevalence of multimorbidity in US adults 30 years and older increased from 54.1% to 65.8%. DISCUSSION: Periodontitis is a highly prevalent, preventable chronic inflammatory condition. It shares many common risk factors with multimorbidity but was not independently associated with multimorbidity in our study. Further research is required to understand these observations and whether treating periodontitis in patients with multimorbidity may improve health care outcomes.

Current State of Point-of-Care Ultrasound Use Within Family Medicine.

BACKGROUND AND OBJECTIVES: Following the publication of Point-of-Care-Ultrasound (POCUS) curriculum guidelines from the American Academy of Family Physicians in 2016, there has been a rapid expansion in POCUS curricula across family medicine departments in the US. There is growing appreciation for the potential role of POCUS in enhancing the clinical care family physicians provide to patients. The primary aim of our study was to evaluate the utilization of POCUS in outpatient clinic care across Family Medicine departments nationwide and to identify perceived or realized barriers in integrating POCUS use for clinic care. METHODS: The questions were part of a larger omnibus survey of US Department of Family Medicine chairs, conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) between August 6 to August 31, 2021. RESULTS: 81% of departments have at least 1 POCUS-trained faculty, with 44% of departments using POCUS in some ambulatory clinical care. Currently, only 6% have established billing for the POCUS they perform. Faculty time, as well as funding, for POCUS training were seen as 2 primary barriers. The purchasing of equipment and billing for POCUS were described by FMCs as difficult. CONCLUSIONS: As POCUS use continues to rise in Family Medicine, it is imperative to create a more efficient and less hindered road to growth. Collaboration across departments to share best practices in training, purchasing equipment and billing for POCUS will be important to facilitate high-quality POCUS access for our patients.

Patient-centered home cancer screening attitudes during SARS-CoV-2 pandemic.

COVID-19 has caused disruptions in health care, in particular cancer screenings. The primary aim of our work was to evaluate the degree to which populations were accepting of home-based screenings for colorectal cancer (CRC) and cervical cancer (primary HPV testing). Three groups of adults having distinct health burdens which may affect acceptance of home-based cancer screening were identified through outpatient electronic medical records as follows as either having survived a COVID hospitalization, having been positive for non-COVID respiratory illness or having type 2 diabetes. 132 respondents (58% female) completed an online survey with hypothetical cases about their acceptance of home-based CRC or cervical cancer screening. Among females, urine and vaginal screening for primary HPV testing was acceptable to 64% and 59%, respectively. Among both males and females, CRC home screening with fecal immunochemical test (FIT) or Cologuard was acceptable to 60% of the respondents. When adjusting for education, women with a positive attitude toward home-based urine /vaginal screening were 49 times and 23 times more likely to have a positive attitude toward CRC screening (aOR=48.7 (95% CI: 7.1, 337) and aOR=23.2 (95% CI: 3.8, 142), respectively). This report indicates that home-based cancer screens for CRC and primary HPV testing are acceptable to men and women and may allow for greater compliance with screening in the future.

Patient-Centered Home Cancer Screening Attitudes During COVID-19 Pandemic.

The COVID-19 pandemic disrupted health care delivery of cancer screenings. The primary aim of our work was to evaluate the degree to which populations were accepting of home-based screenings for colorectal cancer (CRC) and cervical cancer (ie, primary human papillomavirus [HPV] testing). Three groups of adults having distinct health burdens that may affect acceptance of home-based cancer screening were identified through outpatient electronic medical records: those having survived a COVID-19 hospitalization; those having been positive for a non-COVID-19 respiratory illness; or those having type 2 diabetes. A total of 132 respondents (58% female) completed an online survey with hypothetical cases about their acceptance of home-based CRC or cervical cancer screening. Among women respondents, urine and vaginal screening for primary HPV testing was acceptable to 64% and 59%, respectively. Among both men and women, at-home CRC screening with fecal immunochemical test or Cologuard® was acceptable to 60% of the respondents. When adjusting for education, women with a positive attitude toward home-based urine and vaginal screening were 49 times and 23 times more likely, respectively, to have a positive attitude toward CRC screening. These findings indicate that home-based cancer screens for CRC and primary HPV testing are acceptable to men and women and may allow for greater compliance with screening in the future.

Health-Related Quality of Life for People With Acute and Chronic Illnesses During the COVID-19 Pandemic.

BACKGROUND: Health-related quality of life (HRQoL) for adults with chronic and acute illnesses informs health and economic policy for pandemic recovery. Our primary aim was to compare HRQoL of 3 illness groups of outpatient adults: those with diabetes, those who survived a hospitalization for COVID-19, and those who had a respiratory virus not COVID-19. The secondary aim was to compare the group domain summary scores to the referent general population. METHODS: We identified the 3 groups from the electronic medical record and invited them to complete the SF-36 survey. Analysis of variance and post hoc testing was used for univariate analyses followed by linear regression. RESULTS: One hundred thirty-two adults completed the survey. The groups differed least for physical functioning and most for emotional/mental health. The hospitalized group had the greatest limitation in role due to emotional issues. All groups had significantly lower social functioning scores than the general population. Linear regression showed lower HRQoL domain score in role limitations due to emotional issues adjusted for age, race, and gender for the hospitalized group. CONCLUSION: SF-36 scores show the decrease in HRQoL that outpatient adults have suffered, mostly in the emotional domain, regardless of illness group during the COVID-19 pandemic.

The evidence for switching dibenzazepines in people with epilepsy.

The dibenzazepines particularly carbamazepine are associated with known adverse effects (AEs) and drug to drug interactions. Eslicarbazepine acetate (ESL) is structurally distinct from other members of the dibenzazepine family and has the advantage of once daily dosing. Observational and trial data report successful switching from older dibenzazepines to ESL. The evidence base for doing so is unclear and not standardized. This is a literature review following the PRISMA scoping guidelines identifying the evidence of switching dibenzazepines. Transition methods, ratios, tolerance to change, adverse effects and retention post-change were evaluated. Study quality was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. Seven studies investigated the outcome of transition between carbamazepine and or oxcarbazepine to ESL, with specific data on the transition dose ratio and scheduling. The available data suggest that the overnight transition between oxcarbazepine and ESL in a 1:1 ratio (most common) is generally well tolerated with high retention rates. The transition showed improvement in adverse events associated with oxcarbazepine across a variety of domains. Almost 60% transitioned because of adverse events experienced no further symptoms at 12 months. There is less data on the transition from carbamazepine to ESL. The evidence available suggests an overnight transition in the ratio of 1:1.3-1.5. The retention rate following transition from carbamazepine to ESL was 69% (follow-up of 4 months) with almost half of those transitioned because of adverse events experiencing no further symptoms. There is Grade C evidence available to help guide clinicians in the transition.

Epidemiology of epilepsy in older adults with an intellectual disability in Ireland: associations and service implications.

There are limited studies on the prevalence of epilepsy and co-morbid conditions in older adults with an ID. To begin to address this prevalence of epilepsy was estimated for participants in the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing. Associations with demographic variables and co morbid health conditions were examined. It was found that prevalence was high (30.7%); but declined as people aged. Those with epilepsy were less likely to live with family, independently or in community settings, rates of refractory epilepsy were high and, despite medication over half of those with epilepsy still reported experiencing seizures. Given these findings, people with ID and their careers have considerable needs for information about epilepsy management, and for support from specialist ID and epilepsy services.