The Utility of Assessing Alexithymia, in Addition to Coping, in the Context of Posttraumatic Stress.

ABSTRACT: The distinction between alexithymia and coping in relation to posttraumatic stress has not been fully explored. The present study examined the extent to which alexithymia explained unique variance in posttraumatic stress, beyond the variance explained by coping, in a sample of trauma-exposed adults ( N = 706; M age = 19.41 years, SD = 1.5; 77.1% female). Then, we explored the effect of race on these associations, comparing participants who identified as Black ( n = 275) to those who identified as White ( n = 337). Avoidant-emotional coping showed stronger correlations (compared with problem-focused and active-emotional coping) with total alexithymia, difficulty identifying feelings, and difficulty describing feelings. In regression analyses, we found alexithymia explained unique variance in posttraumatic stress severity beyond the effect of coping. Results did not differ by racial identity. These findings suggest that despite some overlap between alexithymia and coping, each shows unique relations with posttraumatic stress.

Conversion of PROMIS global health to EQ-5D health state values in patients undergoing lumbar spine surgery: A psychometric evaluation.

This study seeks to validate the conversion of PROMIS-GH scores to EQ-5D Health Utility Index (HUI) values. Patients undergoing lumbar spine surgery were prospectively surveyed using EQ-5D-3L and PROMIS-GH short form instruments. EQ-5D-HUI scores, and PROMIS scores converted to HUI were calculated. Neither instrument demonstrated any floor effects. The EQ-5D-HUI demonstrated significantly higher ceiling effects. Patients reported a significantly higher mean HUI score using the EQ-5D compared to PROMIS-GH. Strong positive correlation and agreement were observed. Conversion of the PROMIS-GH to the EQ-5D-HUI appears to be viable for evaluating the health status of patients undergoing lumbar spine surgery.

Bundled Payments for Appendectomy: a Model of Financial Implications to Institutions.

BACKGROUND: Bundled payments are increasingly becoming common in surgery, yet little is known regarding their potential impact on reimbursements for patients presenting with acute appendicitis. This study examines the financial impact of bundled payments for acute appendicitis. METHODS: This was a retrospective review of all open or laparoscopic appendectomies between July 2014 and June 2017. Patients that were not candidates for surgery were not included in this review. RESULTS: Of the total 741 patients, 42.1% were diagnosed with complicated acute appendicitis. The median length of stay was 1 day (range, 0 to 21 days). The median hospital cost was $4183 (range, $2075 to $71,023). The 90-day readmission rate was 3.2%, with a mean cost of $5025 per readmission (range, $1595 to $10,795). Length of stay, hospital costs, and 90-day readmissions were significantly higher for complicated versus uncomplicated acute appendicitis. In our current fee-for-service model, hospital reimbursements resulted in margins of - 4.0% to 24.6% depending on the severity of disease. If we assume that bundled payments do not reimburse for readmissions, we estimate that our hospital would incur losses of - 5.7% for patients with acute appendicitis with localized peritonitis and - 20.2% for patients with acute appendicitis with generalized peritonitis. CONCLUSIONS: As bundled payments become more common, hospitals may incur significant losses for acute appendicitis under a model that does not reflect the heterogeneous nature of patients requiring appendectomies. These losses can range up to - 20.2% for complicated cases. Improving clinical outcomes by reducing readmissions may mitigate some of these anticipated losses.

Simultaneous Confidence Bands for Abbott-Adjusted Quantal Response Models.

We study use of a Scheffé-style simultaneous confidence band as applied to low-dose risk estimation with quantal response data. We consider two formulations for the dose-response risk function, an Abbott-adjusted Weibull model and an Abbott-adjusted log-logistic model. Using the simultaneous construction, we derive methods for estimating upper confidence limits on predicted extra risk and, by inverting the upper bands on risk, lower bounds on the benchmark dose, or BMD, at which a specific level of 'benchmark risk' is attained. Monte Carlo evaluations explore the operating characteristics of the simultaneous limits.

Swallowing disorders in trauma patients: impact of tracheostomy.

Tracheostomy is associated with increased aspiration rates, and swallowing disorders have not been well-studied in trauma patients with tracheostomy. Swallowing evaluations were conducted in 224 patients (102 trauma and 122 nontrauma patients). Half of the patients in each group had tracheostomies. Bedside swallow studies were conducted in 40 patients, videofluoroscopy swallow studies in 100 patients, and both studies in 84 patients. chi2, Fisher's exact test, Cramer's V, and descriptive statistics were used for data analysis. Aspiration occurred in 35 per cent (36 of 102) of trauma patients with or without tracheostomy and in 36 per cent (22 of 61) of nontrauma patients with tracheostomy. Aspiration with and without penetration was observed in 54 per cent of trauma patients (55% with tracheostomy) compared with 67 per cent of all nontrauma patients (61% with tracheostomy). Trauma patients with head injuries exhibited 41 per cent (26 of 63) aspiration and 68 per cent (43 of 63) dysphagia compared with 26 per cent (10 of 39) and 59 per cent (23 of 39) in trauma patients with other injuries. There was a lower incidence of dysphagia in trauma patients (65% versus 81% in nontrauma) and in patients with tracheostomy (71% versus 77% without tracheostomy). Tracheostomy was not associated with increased dysphagia or aspiration.

New anatomic repair of midline abdominal wall incisions extending to suprapubic region.

This article describes a new technique to close infraumbilical midline abdominal wall incisions extending to the suprapubic region. This repair is technically easy to perform, saves time, reduces the risk of bowel and bladder injury and takes into consideration the anatomical landmarks of the peritoneum, the rectus sheath and the arcuate line. Abdominal wall closure with this repair is especially useful in obese patients. Furthermore, with this repair the pelvic cavity is lined with smooth peritoneum, which may reduce postoperative adhesions in the pelvis. Technically easy to perform and saves time Very useful technique for obese patients Reduced risk of bowel and bladder injury Anatomical in nature Potentially minimizes postoperative adhesions.

Role of the physician versus the patient in the detection of recurrent disease following treatment for head and neck cancer.

OBJECTIVES/HYPOTHESIS: Objective evidence supporting current National Comprehensive Cancer Network guidelines regarding surveillance of patients treated for head and neck cancer is presently lacking. The study examines the relative role of current surveillance methods on disease detection in this patient population. STUDY DESIGN: Prospective nonrandomized study. METHODS: Clinical information was prospectively collected in a standardized format during 3645 encounters with patients with head and neck cancer over an 18-month period. Data pertaining to visit history, symptom history, patient findings, physician findings, and disease status for each encounter were reviewed. RESULTS: Of 3645 visits, disease recurrence or new primary tumor was documented in 180 encounters (5%). Salvage therapy was thought to be feasible in at least 65% of cases. Of these 180 recurrences or new primaries, there were 142 patients (79%) who had identified new symptoms or physical findings, or both, before the physician's examination. Most commonly reported was the presence of a neck mass (38%), progressive pain (27%), or other visible lesion or ulcer (14%). Patients with recurrence represented nearly 40% of all patients reporting new symptoms or findings (142 of 367). Conversely, recurrence was rare in the absence of reported symptoms or findings (1.2%). Surprisingly, despite patients reporting new symptoms or findings, physician evaluation most commonly occurred at the patient's routine surveillance visit rather than an earlier time point (104 of 142 [73%]). CONCLUSION: Self-diagnosis of recurrent or new primary disease is extremely common by virtue of symptoms or findings noted by patients before interaction with the clinician. However, presence of symptoms or findings did not motivate the patients to seek earlier medical attention. In the absence of such symptoms, physician diagnosis of recurrence is uncommon. Given the significant social and economic impact involved in surveillance of patients with head and neck cancer, further prospective study to optimize the method and frequency of this type of clinical activity is warranted and planned.

Confidence limits on one-stage model parameters in benchmark risk assessment.

In modern environmental risk analysis, inferences are often desired on those low dose levels at which a fixed benchmark risk is achieved. In this paper, we study the use of confidence limits on parameters from a simple one-stage model of risk historically popular in benchmark analysis with quantal data. Based on these confidence bounds, we present methods for deriving upper confidence limits on extra risk and lower bounds on the benchmark dose. The methods are seen to extend automatically to the case where simultaneous inferences are desired at multiple doses. Monte Carlo evaluations explore characteristics of the parameter estimates and the confidence limits under this setting.