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INTRODUCTION: Contrary to popular belief, immigrant enclaves produce less crime than other areas of the United States, yet that does not mean immigrants avoid violent crime altogether. The purpose of this project is to better characterize the victims of homicide in this population. Specifically, we sought to compare differences in victim demographics, injury patterns, and circumstances of violent death between the immigrant population and native-born victims of homicide. METHODS: We queried the National Violent Death Reporting System (NVDRS) from the years 2003-2019 for deaths in victims who were born outside of the United States. We extracted demographic information including age, race or ethnicity, means of homicide, and circumstances surrounding the event to compare immigrant to nonimmigrant deaths. RESULTS: Immigrant victims were less likely to be killed by a firearm and to have substance use or alcohol implicated. Immigrant victims were twice as likely to be killed during multiple homicide events that involved suicide of the perpetrator (2.1% to 1%, P ≤ 0.001) and to be killed by a stranger (12.9% to 6.2%, P ≤ 0.001). Immigrant victims were also more likely to be killed during the perpetration of another crime (19.1% to 15%, P ≤ 0.001), and more likely to be killed in a commercial setting such as a grocery store or retail outlet (7.6% to 2.4%, P ≤ 0.001). CONCLUSIONS: Injury prevention measures for the immigrant population require different techniques, focusing on distinct features of victimization centered on random acts in contrast to native-born citizens who tend to be victims of people they know.
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Emigrantes e Imigrantes , Homicídio , Humanos , Estados Unidos/epidemiologia , Causas de Morte , Vigilância da População , Povos IndígenasRESUMO
INTRODUCTION: This project aims to characterize trauma-associated deaths of the American incarcerated population through legal intervention (LI) or death by law enforcement officials while in custody before and during incarceration. We determined the preceding events leading to violent death, including initiation of medical care, use of restraints and force, and demographics of the victims. METHODS: We used National Violent Death Reporting System data from the years 2003-2019 to identify deaths that occurred while in custody or incarcerated, including discriminate and narrative data. Event information included weapon type, location of death, incident type, incarceration status, use of restraints, and prone positioning. RESULTS: There were 86 victims who died from LI included in the analysis. Most events occurred after incarceration. All victims in our cohort were male, and race was an associated factor for death by LI. Only 16% of victims had an education level above high school/general educational development. Death by firearm compared to other weapons was significantly more common in the in-custody but not yet incarcerated group (83% versus 42%, P ≤ 0.0001). Other associated factors included a history of mental health, physical confrontations, the belief that the victim had a weapon, and being restrained in prone positioning. CONCLUSIONS: Our study shows that racial minority victims are disproportionately affected by LI deaths. Firearms and restraint type were important factors in LI deaths. Our findings suggest that violence prevention in the justice system should focus on prevention and de-escalation across setting with specific attention to use of force and inmate access to the weapons of police, guards, and other law and justice system workers. More transparent quality data is sorely needed to adequately define and address this problem.
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Homicídio , Suicídio , Humanos , Masculino , Estados Unidos/epidemiologia , Feminino , Causas de Morte , Vigilância da População , ViolênciaRESUMO
INTRODUCTION: This study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury pattern, and perpetrator. METHODS: The data used are from the National Violent Death Reporting System database from 2003 to 2019. All victims were either in custody, in the process of custody, or in prison. Sex was coded as female or male and as assigned at birth. All analyses were conducted using SAS 9.4 software using chi-square tests, with an alpha of 0.05 to test significant differences in the circumstances of mortality and demographic characteristics for each group. RESULTS: Our findings show that suicide was the most common cause of death during incarceration for both females and males (89.8% versus 77.4%; P < 0.001). Homicide was less common in females (1.6% versus 14.8%; P < 0.001) and legal intervention only occurred in males (2.2%; P < 0.001). Male victims were more likely to be of non-White race/ethnicity compared to females, while females were more likely to be experiencing homelessness, have documented mental illness, and comorbid substance abuse. CONCLUSIONS: Victim sex is significantly associated with circumstances of violent death among the incarcerated and highlights the need for appropriate mental health and substance abuse treatment.
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Homicídio , Prisioneiros , Prisões , Feminino , Humanos , Recém-Nascido , Masculino , Causas de Morte , Vigilância da População , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos/epidemiologia , Violência/legislação & jurisprudência , Violência/estatística & dados numéricos , Fatores Sexuais , Prisões/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Homicídio/estatística & dados numéricosRESUMO
Objective: To compare PCR and culture results for the detection of Streptococcus equi subspecies equi (S. equi). Animals: Respiratory tract samples (N = 158) from horses being tested for S. equi. Procedure: Bacterial culture was carried out on samples from which S. equi was detected by quantitative real-time PCR. Results: S. equi was isolated from 12 (7.6%) samples: 4/9 (44%) samples when the PCR cycle threshold (CT) was ≤ 30, 7/30 (23%) when the CT was 30.1 to 35, and 1/119 (0.8%) when the CT was 35.1 to 40. The highest CT sample from a sample that yielded a positive culture was 36.9. The optimal Youden's J value was at a CT of 34.2, the same value as determined by number needed to misdiagnose when the cost of a false negative is deemed to be either 5 or 10 × that of a false positive. Conclusions: Viable S. equi was only detected in a minority of quantitative PCR (qPCR) positive samples. A qPCR CT of 34.2 was a reasonable breakpoint for likelihood of the presence of culturable S. equi. Clinical relevance: Evaluation of CT values may be useful as a proxy to indicate the likelihood of cultivable S. equi being present and could be useful as part of risk assessments.
Relation entre le seuil du cycle de PCR quantitatif en temps réel et la culture pour la détection de Streptococcus equi sous-espèce equi. Objectif: Comparer les résultats de PCR et de culture pour la détection de Streptococcus equi sous-espèce equi (S. equi). Animaux: Échantillons des voies respiratoires (N = 158) de chevaux testés pour S. equi. Procédure: La culture bactérienne a été réalisée sur des échantillons à partir desquels S. equi a été détecté par PCR quantitatif en temps réel. Résultats: S. equi a été isolé à partir de 12 échantillons (7,6 %) : 4/9 (44 %) échantillons lorsque le seuil du cycle de PCR (CT) était ≤ 30, 7/30 (23 %) lorsque le CT était de 30,1 à 35 et 1/119 (0,8 %) lorsque le CT était de 35,1 à 40. L'échantillon CT le plus élevé d'un échantillon ayant donné une culture positive était de 36,9. La valeur J optimale de Youden était à un CT de 34,2, la même valeur que celle déterminée par le nombre nécessaire pour un mauvais diagnostic lorsque le coût d'un faux négatif est estimé à 5 ou 10 × celui d'un faux positif. Conclusion: Du S. equi viable n'a été détecté que dans une minorité d'échantillons positifs pour le PCR quantitatif (qPCR). Un CT qPCR de 34,2 était un seuil raisonnable pour la probabilité de la présence de S. equi cultivable. Pertinence clinique: L'évaluation des valeurs CT peut être utile comme approximation pour indiquer la probabilité de présence de S. equi cultivable et pourrait être utile dans le cadre d'une évaluation des risques.(Traduit par Dr Serge Messier).
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Doenças dos Cavalos , Infecções Estreptocócicas , Streptococcus equi , Animais , Cavalos , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Streptococcus equi/genética , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/microbiologiaRESUMO
BACKGROUND: This study aims to characterize trauma-associated deaths in the United States prison system. We hypothesize that incarcerated victims are less likely to receive appropriate medical care compared to the non-incarcerated. METHODS: We utilized 2015-2017 National Violent Death Reporting System data. Victims were classified by whether they were seen by emergency medical services, in the emergency room, or hospitalized prior to death, with the latter considered higher levels of care. Propensity score matching was used to compare highest level of care received by incarcerated versus non-incarcerated victims with similar age, sex, race/ethnicity, weapon type, and state where the incident occurred. RESULTS: Of 101,054 victims, 1229 (1.2%) were incarcerated at the time of fatal injury; 64.4% died by suicide. For suicide, the proportion of minority victims was higher in the incarcerated compared to the non-incarcerated population, but the opposite was true of homicide. Firearms were more commonly used in the non-incarcerated population. After Propensity score matching, we found that incarcerated victims received higher levels of medical care following suicide (P < 0.001) while there was no difference for homicide (P = 0.28). However, when only victims injured in public settings were included, we found that incarcerated homicide victims were less likely to receive hospital-based medical care. CONCLUSIONS: Contrary to our hypothesis, overall, incarcerated victims received similar levels of medical care as compared to non-incarcerated victims following lethal injury. However, this fails to account for the highly supervised setting of prisons. Our findings reinforce that violence prevention methods should be tailored to specific populations.
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Vigilância da População , Prisioneiros , Causas de Morte , Homicídio , Humanos , Estados Unidos/epidemiologia , ViolênciaRESUMO
BACKGROUND: Several composite measures of neighborhood social vulnerability exist and are used in the health disparity literature. This study assesses the performance of the Social Vulnerability Index (SVI) compared with three similar measures used in the surgical literature: Area Deprivation Index (ADI), Community Needs Index (CNI), and Distressed Communities Index (DCI). There are advantages of the SVI over these other scales, and we hypothesize that it performs equivalently. METHODS: We identified all cholecystectomies at a single, urban, academic hospital over a 9-month period. Cases were considered emergency if the patient presented and underwent surgery during that admission. We geocoded patient's addresses and assigned estimated SVI, ADI, CNI, and DCI. Cutoffs for high versus low social vulnerability were generated using Youden's index, and the scales were compared using multivariable modeling. RESULTS: Overall, 366 patients met inclusion criteria, and the majority (n = 266, 73%) had surgery in the emergency setting. On multivariable modeling, patients with high social vulnerability were more likely to undergo emergency surgery compared with those with low social vulnerability in accordance with all four scales: SVI (OR 3.24, P < 0.001), ADI (OR 3.2, P < 0.001), CNI (OR 1.90, P = 0.04), and DCI (OR 2.01, P = 0.03). The scales all had comparable predictive value. CONCLUSIONS: The SVI performs similarly to other indices of neighborhood vulnerability in demonstrating disparities between emergency and elective surgery and is readily available and updated. Because the SVI has multiple subcategories in addition to the overall measure, it can be used to stratify by modifiable factors such as housing or transportation to inform interventions.
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Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Colecistectomia/economia , Colecistectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/economia , Tratamento de Emergência/economia , Feminino , Disparidades em Assistência à Saúde/economia , Hospitais Urbanos/economia , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: The burden of emergency general surgery leads to higher cost and less compensation to institutions; cholecystectomy accounts for >150,000 cases/y, the highest number of emergency general surgery cases that have a potentially elective course. We hypothesize that our cholecystectomy patient pool has unique characteristics informing health care access in our area. METHODS: We retrospectively identified cholecystectomy patients at our academic hospital over a 6-mo period from January to June of 2018 and classified them as emergent or elective. We excluded pregnant patients, patients aged <18 y, and patients who had undergone another major procedure concurrently. Patient demographics and clinical course were abstracted from the medical record. RESULTS: Two hundred and sixty-seven patients were included in the study, with most patients (n = 196, 73.4%) presenting emergently. We found no differences in age, sex, or BMI between the two groups. Emergent patients were more likely to be minorities, less likely to have insurance or a primary care physician, and 25% required an interpreter. Although a greater percentage of patients in the elective setting had chronic symptoms, most emergent patients also had duration of symptoms of months to years. After multivariable analysis, insurance status, lack of a primary care provider, and chronic duration of symptoms remained significant predictors of emergent presentation. CONCLUSIONS: Our findings indicate several targets for increasing access to elective surgical care. Most patients in the emergent group experienced chronic symptoms, indicating an opportunity to prevent emergency surgical treatment. This study provides local population characterization for improvements in access to care, which could lead to decreases in emergency gallbladder surgery.
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Colecistectomia , Emergências , Acessibilidade aos Serviços de Saúde , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária , Estudos RetrospectivosRESUMO
BACKGROUND: The Social Vulnerability Index (SVI) is a composite scale formulated by the Centers for Disease Control and is geocoded as a percentile ranking at the census tract level. SVI is potentially applicable to assess risk and target populations that are likely to present emergently for disease that could have been treated electively and target local disparities. We applied the SVI to compare cholecystectomy patients presenting emergently versus electively. METHODS: We identified patients who had undergone cholecystectomy at our academic medical center over a 6-month period. We abstracted patient demographics, chronic symptom duration, and diagnosis from the medical record. Patient addresses were geocoded to identify their census tract of residence and estimated SVI. RESULTS: Two hundred and fifty five patients met inclusion criteria. Most patients (n = 185, 72.5%) had surgery in the emergent setting. Emergent patients lived in areas of greater social vulnerability compared with elective patients (median SVI 75th versus 64th percentile, P < 0.001). On multivariable analysis adjusting for chronicity of symptoms and patient proximity to the hospital, having high SVI (>70th percentile) was associated with higher odds of undergoing an emergent versus an elective procedure (OR 2.05, P = 0.04). CONCLUSIONS: The SVI has potential utility for examining health care disparities, performing comparably with a more complex model including individual risk factors. Because it is a composite measure geocoded at the census tract level for all communities in the United States, it has potential for targeting relatively discrete geographic areas for intervention. Being a geocoded measure also offers opportunity for linking with other data sets using geographic information systems.
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Colecistectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
We prove an equivariant version of the Cosmetic Surgery Conjecture for strongly invertible knots. Our proof combines a recent result of Hanselman with the Khovanov multicurve invariants Kh~ and BN~. We apply the same techniques to reprove a result of Wang about the Cosmetic Crossing Conjecture and split links. Along the way, we show that Kh~ and BN~ detect if a Conway tangle is split.
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Aloe has a long history of topical and systemic use with testimonials of countless health benefits and is one of the most popular botanical medicines in the world for the management of a wide variety both of benign and serious ailments including irritable bowel syndromes, osteoarthritis, Type II diabetes mellitus, and viral respiratory illness. The human consumption of Aloe vera extract in beverage form has substantially grown over the last several decades, in no small part, due to the increased consumer interest in alternative approaches to health benefits. The principal aim of the present paper is to characterize the research to date that has explored the genotoxic potential of Aloe vera inner leaf gel extract and decolorized whole leaf extract used in commercially available food-grade drinkable products which contain no more than 10 ppm aloin. Despite prevailing public health opinion, especially in Europe, the consensus of the reviewed studies retrieved from the peer-reviewed literature together with a mutagenic evaluation of an Aloe vera whole leaf decolorized spray-dried powder is that these products are not genotoxic.
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Aloe , Diabetes Mellitus Tipo 2 , Humanos , Extratos Vegetais/toxicidade , Aloe/toxicidade , Mutagênicos , BebidasRESUMO
Objectives: The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions (appendicitis and acute cholecystitis), hypothesizing that necessity of testing for COVID-19 significantly delayed operative intervention. Methods: We performed a prepost study to examine a 2-month timeframe, or historical control, prior to COVID-19 testing (January 1, 2020-March 1, 2020) as well as a 2-month timeframe during the COVID-19 era (January 1, 2021-March 1, 2021). We chose conditions that are frequently treated surgically as outpatient or observation status. We examined time for COVID-19 test to result, and associated time to operative intervention (operating room (OR)) and need for admission. Results: Median time to COVID-19 test results was 7.4 hours (IQR 5.8-13.1). For appendectomy, time to surgical consultation or case request did not differ between cohorts. Time to OR after case request was significantly longer (12.5 vs 1.9 hours, p<0.001) and patients more frequently required admission prior to operative intervention if receiving treatment in the COVID-19 timeframe. Similarly, for cholecystectomy there were no differences in time to surgical consultation or case request, but time to OR after case request was longer in the COVID-19 era (21.1 vs 9.0 hours, p<0.001). Conclusion: While COVID-19 positivity rates have declined, the purpose of this study was to reflect on one element of our hospital system's response to the COVID-19 pandemic. Based on our institutional experience, waiting for COVID-19 test results directly impacts time to surgery, as well as the need for admission for a historically outpatient procedure. In the future, if the healthcare system is asked to respond to another pandemic or similar situation, expediting time to OR to eliminate unnecessary time in the hospital and non-critical admissions should be paramount. Level of evidence: Level III, prognostic/epidemiological.
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Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.
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Cannabis , Doença de Charcot-Marie-Tooth , Dor Crônica , Maconha Medicinal , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Doença de Charcot-Marie-Tooth/complicações , Doença de Charcot-Marie-Tooth/epidemiologia , Maconha Medicinal/uso terapêutico , Manejo da Dor , Estudos Prospectivos , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Medidas de Resultados Relatados pelo PacienteRESUMO
Cancer cells exhibit elevated lipid synthesis. In breast and other cancer types, genes involved in lipid production are highly upregulated, but the mechanisms that control their expression remain poorly understood. Using integrated transcriptomic, lipidomic, and molecular studies, here we report that DAXX is a regulator of oncogenic lipogenesis. DAXX depletion attenuates, while its overexpression enhances, lipogenic gene expression, lipogenesis, and tumor growth. Mechanistically, DAXX interacts with SREBP1 and SREBP2 and activates SREBP-mediated transcription. DAXX associates with lipogenic gene promoters through SREBPs. Underscoring the critical roles for the DAXX-SREBP interaction for lipogenesis, SREBP2 knockdown attenuates tumor growth in cells with DAXX overexpression, and DAXX mutants unable to bind SREBP1/2 have weakened activity in promoting lipogenesis and tumor growth. Remarkably, a DAXX mutant deficient of SUMO-binding fails to activate SREBP1/2 and lipogenesis due to impaired SREBP binding and chromatin recruitment and is defective of stimulating tumorigenesis. Hence, DAXX's SUMO-binding activity is critical to oncogenic lipogenesis. Notably, a peptide corresponding to DAXX's C-terminal SUMO-interacting motif (SIM2) is cell-membrane permeable, disrupts the DAXX-SREBP1/2 interactions, and inhibits lipogenesis and tumor growth. These results establish DAXX as a regulator of lipogenesis and a potential therapeutic target for cancer therapy.
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Lipogênese , Neoplasias , Carcinogênese/genética , Transformação Celular Neoplásica , Proteínas Correpressoras/genética , Proteínas Correpressoras/metabolismo , Lipídeos , Lipogênese/genética , Chaperonas Moleculares/genética , Chaperonas Moleculares/metabolismo , Proteína de Ligação a Elemento Regulador de Esterol 1/genética , Proteína de Ligação a Elemento Regulador de Esterol 1/metabolismo , Animais , CamundongosRESUMO
OBJECTIVES: This study aims to explore the impact of Charcot-Marie-Tooth disease type 1A (CMT1A) and its treatment on patients in European (France, Germany, Italy, Spain, and the United Kingdom) and US real-world practice. METHODS: Adults with CMT1A (n = 937) were recruited to an ongoing observational study exploring the impact of CMT. Data were collected via CMT&Me, an app through which participants completed patient-reported outcome measures. RESULTS: Symptoms ranked with highest importance were weakness in the extremities, difficulty in walking, and fatigue. Almost half of participants experienced a worsening of symptom severity since diagnosis. Anxiety and depression were each reported by over one-third of participants. Use of rehabilitative interventions, medications, and orthotics/walking aids was high. CONCLUSIONS: Patient-reported burden of CMT1A is high, influenced by difficulties in using limbs, fatigue, pain, and impaired quality of life. Burden severity appears to differ across the population, possibly driven by differences in rehabilitative and prescription-based interventions, and country-specific health care variability.
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Doença de Charcot-Marie-Tooth , Adulto , Doença de Charcot-Marie-Tooth/diagnóstico , Doença de Charcot-Marie-Tooth/epidemiologia , Fadiga/etiologia , Humanos , Estilo de Vida , Medidas de Resultados Relatados pelo Paciente , Qualidade de VidaRESUMO
BACKGROUND: Fatigue is common in people with Charcot-Marie-Tooth (pwCMT) disease. However, no studies have characterized performance fatigability during gait in this population. Characterizing performance fatigability during gait, and assessing its relation to life satisfaction could improve understanding and treatment of mobility challenges in pwCMT. RESEARCH QUESTIONS: How do gait outcomes change with fatigue in pwCMT? Do these changes relate to life satisfaction? METHODS: 31 pwCMT completed a 6-minute, fast-as-possible walk while gait outcomes were captured via inertial sensors. Gait outcomes were separated into six sequential bins of equal size. The mean value, variability, and asymmetry (step time only) of outcomes were calculated for each bin. Perceived fatigue and general life satisfaction were assessed via questionnaire. RESULTS: Of the five mean gait outcomes measured, four showed statistically significant changes over the 6-minute fast-as-possible walk: velocity (reduced; p = 0.008); cadence (reduced; p < 0.001), step time (increased; p < 0.001), and trunk ROM (increased; p = 0.032). Of the four variability and one asymmetry outcomes, only stride length variability changed during the walking task (p = 0.015), decreasing from bins 1-2, and remaining stable for bins 2-6. Changes in velocity, cadence, step time were related to general life satisfaction (0.038 < ps<0.04), but not perceived fatigue (ps>0.343). SIGNIFICANCE: pwCMT exhibit statistically significant changes in mean gait outcomes, but not variability outcomes, across a 6-minute, fast-as-possible walking bout. Changes correlated to life satisfaction, suggesting performance fatigability during gait could be a target for rehabilitation for pwCMT. Perceived fatigue did not correlate to gait fatigue, underscoring the differentiation between perceived fatigue and performance fatigability.
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Doença de Charcot-Marie-Tooth/fisiopatologia , Fadiga/fisiopatologia , Marcha/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida , Teste de Caminhada , CaminhadaRESUMO
PURPOSE: To assess patient satisfaction with the use of portable video media (PVM) for the purpose of taking informed consent for common urological outpatient procedures performed under local anaesthesia. METHODS: Patients undergoing the following procedures were approached for recruitment: flexible cystoscopy with or without biopsy, transrectal ultrasound-guided prostate biopsy or flexible cystoscopy with insertion or removal of a ureteric stent. Audio-visual media were developed for each procedure, with each script translated from English into isiXhosa and Afrikaans. The study involved a cross-over for each patient between standard verbal consent (SVC) and PVM consent, with each patient randomised to start with SVC or PVM consent. Each of these consent arms was assessed via a questionnaire. RESULTS: Sixty patients completed participation, with PVM as the first exposure for 28 patients and 32 patients receiving SVC as their first arm of the study. When comparing the overall satisfaction between SVC and PVM consent (the total scores out of 18 for the questionnaire), patients scored significantly higher for PVM consent (M = 16.3 ± 2.4) compared to SVC (M = 15.4 ± 2.9) (p = 0.002). 92% of the total patient sample preferred PVM consent. CONCLUSION: Portable video media proved superior to SVC in improving satisfaction in the consent process for common outpatient urological procedures performed under local anaesthesia.
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Anestesia Local , Consentimento Livre e Esclarecido , Satisfação do Paciente , Procedimentos Cirúrgicos Urológicos , Gravação em Vídeo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Charcot-Marie-Tooth disease (CMT) is a rare, chronic, progressive motor and sensory neuropathy affecting the peripheral nervous system. This study will explore the real-world impact of CMT. The trial is a digital study of approximately 2000 people in 6 countries with CMT ≥18 years. Participants will use a smartphone application to check eligibility, provide consent and contribute data. The dataset will include a personal profile, covering demographics, lifestyle, diagnosis and treatment and a selection of validated generic and disease-specific instruments. Participants will provide data for up to 2 years. Data analysis will be conducted upon registration of the 1000th participant and at 12-month intervals from launch. This study is designed to help researchers and clinicians understand the real-world impact of CMT and the unmet needs of patients. ClinicalTrials.gov identifier: NCT03782883.
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Doença de Charcot-Marie-Tooth/psicologia , Estilo de Vida , Medidas de Resultados Relatados pelo Paciente , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. METHODS: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. RESULTS: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the 'second wave' from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3-5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2-4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1-1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3-9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2-14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8-36.7, P = 0.006). CONCLUSIONS: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.
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COVID-19 , Adulto , Austrália/epidemiologia , Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Humanos , SARS-CoV-2RESUMO
Ending the HIV epidemic will require dedicated efforts to engage the highest need persons living with HIV (PLWH) in treatment. We assessed patient perceptions of a clinic in Seattle, Washington, that is designed for PLWH who do not engage in conventional HIV care. The Max Clinic provides walk-in access to care, incentives for blood draws and achieving viral suppression, and intensive case management. We conducted semistructured individual interviews with 25 patients purposively recruited to obtain diverse viewpoints. Interviews were audio-recorded and transcribed. Analysis used a constant comparative approach to identify major themes related to the components of the program. For many participants, engagement in the Max Clinic was the first time they had success with HIV treatment. Relationships with clinic staff and the ability to receive care on a walk-in basis had the strongest influences on engagement. Participants felt that Max Clinic staff attended to their social circumstances in ways that were distinct from prior care experiences. Walk-in visits removed perceived stigma associated with failure to keep appointments and provided immediate attention to acute concerns. Financial incentives initially motivated participants to attend clinic and take medications, but were less important for supporting ongoing engagement in care. Food incentives motivated patients to seek care and helped them focus on health issues. In summary, patients identified walk-in access to care, monetary and food incentives, and relationships with clinic staff, particularly case managers, as the key elements of an HIV clinic model for high-need PLWH.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por HIV/psicologia , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Instituições de Assistência Ambulatorial , Administração de Caso , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias/psicologia , Populações Vulneráveis , Washington/epidemiologiaRESUMO
Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen's kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as "hazardous on the CARET only" consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.