RESUMO
All medical students at the University of South Dakota Sanford School of Medicine (SSOM) have rural healthcare rotations. Because SSOM has adopted kindness as a focal point in its new five year strategic plan, we designed a qualitative study to assess students' perception of kindness in the rural setting.
Assuntos
Educação de Graduação em Medicina , Educação Médica , Serviços de Saúde Rural , Estudantes de Medicina , Escolaridade , Humanos , População Rural , South DakotaRESUMO
Erdheim-Chester disease (ECD) is a very rare form of non-Langerhans histiocytic disorder which affects multiple systems and can present in a variety of different ways. We present two patients diagnosed with ECD whose symptoms, progression and treatment differ dramatically.
Assuntos
Doença de Erdheim-Chester , Doença de Erdheim-Chester/complicações , Doença de Erdheim-Chester/diagnóstico , Humanos , SíndromeRESUMO
We describe two patients with prominent hand deformities attributable to Parkinson's disease. This uncommon condition, which mimics inflammatory arthritis, can be hard to diagnose and is disabling. As these two cases illustrate, hand deformities attributable to Parkinson's can be a late complication of the disease or present in the early stage as initial symptomatology.
Assuntos
Deformidades da Mão , Doença de Parkinson , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Deformidades da Mão/complicaçõesRESUMO
BACKGROUND: While disease-modifying therapies (DMTs) for multiple sclerosis (MS) treatments are costly, patient valuation of DMTs has not been examined. The objective of this study was to examine patients' preferences and willingness-to-pay (WTP) for DMTs. METHODS: Six attributes (i.e., number of relapses, percentage of disability progression, percentage of severe adverse events, route of administration, frequency of administration, and out-of-pocket cost) and their levels were used to develop a discrete choice experiment questionnaire. Each questionnaire comprised seven choice sets and each choice set contained two hypothetical DMTs and an opt-out alternative. A total of 1,200â¯U.S. patients with MS were asked to choose a DMT option or opt-out in each choice set. Multinomial logit model was used to determine relative preferences of each attribute. WTPs for all attributes and DMTs were calculated. RESULTS: A total of 508 patients were analyzed. Patients preferred DMTs with lower relapse rate, lower disability progression, lower severe adverse event, lower frequency of administration, and lower cost. In addition, they preferred oral DMTs. They were willing to pay $2,768, $289, $292, and $76 a month in exchange for every 1-time decrease in the number of relapses in two years, every 1% decrease in disability progression in two years, every 1% decrease in severe adverse events, and every 1-time decrease in the frequency of administration per month, respectively. The patients were willing to pay, in relation to market prices, between $7,020 and $134,934 per year for all DMTs, but interferon beta-1a SC. CONCLUSIONS: Patients with MS considered relapse rate, disability progression, severe adverse events, route of administration, frequency of administration, and out-of-pocket cost, when they chose DMTs. Their WTPs for DMTs varied widely.
Assuntos
Fatores Imunológicos , Esclerose Múltipla , Preferência do Paciente/estatística & dados numéricos , Adulto , Idoso , Progressão da Doença , Feminino , Gastos em Saúde , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/economia , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/economia , Esclerose Múltipla/fisiopatologia , Psicometria/instrumentação , RecidivaAssuntos
Atenção à Saúde , Ética , Indígenas Norte-Americanos , Atenção à Saúde/ética , Humanos , Fatores de Risco , South Dakota , População BrancaRESUMO
In this report, we describe two cases of sporadic meningioangiomatosis (MA) - a rare condition of the central nervous system known to cause headaches, seizures and other focal neurologic deficits. Both patients presented with headache and vision change, somewhat suggestive of migraine. The combination of magnetic resonance imaging (MRI) and computerized tomography (CT) can establish the diagnosis of MA.