Syncope and Unresponsiveness in an Adolescent With Comorbid Cardiac Disease: An Illustrative Case Report and Literature Review of Functional Neurologic Symptom Disorder.

BACKGROUND: This case report with an associated literature review explores the challenges, opportunities, and current evidence in creating a thoughtful diagnostic and management plan for an adolescent with functional neurologic symptom disorder and comorbid cardiac disease. METHODS: We performed a literature review utilizing PubMed to identify the current evidence base related to pediatric functional neurologic symptom disorder in the setting of comorbid cardiac disease. Ultimately, 25 manuscripts were identified for inclusion in this study. RESULTS: We reported the recent epidemiology, screening, diagnostic, and treatment measures utilized in pediatric syncope with a focus on differentiating psychogenic causes from serious cardiac and benign etiologies. We further described how psychiatric and psychological factors influence assessment, management, and outcomes. CONCLUSIONS: This study provides current, evidence-based suggestions for the assessment, diagnosis, and management of pediatric syncope, with an emphasis on recognizing psychogenic causes of syncope. It includes a description of a novel case of functional neurologic symptom disorder in a pediatric patient with structural cardiac disease. The study highlights how the absence of standardized guidelines, heterogeneity in care delivery, and lack of concurrent mental health management led to worse outcomes.

Delayed urologic cancer care in the COVID-19 pandemic: Patients' experiences.

OBJECTIVE: To understand experiences of patients with genitourinary cancer who experienced delayed cancer care due to the COVID-19 pandemic. METHODS: We conducted a mixed methods study with an explanatory sequential design. Qualitative findings are reported here. Patients with muscle invasive bladder, advanced prostate or kidney cancer were eligible. Participants were selected for interviews if they self-reported low (0-3/10) or high (6-10/10) levels of distress on a previous survey. Participants were interviewed about their experiences. Interviews were transcribed, coded and categorised using thematic data analysis methodology. RESULTS: Eighteen patients were interviewed. Seven had prostate cancer, six bladder cancer and five kidney cancer. Six themes were derived from the interviews: (1) arriving at cancer diagnosis was hard enough, (2) response to treatment delay, (3) labelling cancer surgery as elective, (4) fear of COVID-19 infection, (5) quality of patient-provider relationship and communication and (6) what could have been done differently. CONCLUSION: These findings offer insight into the concerns of patients with genitourinary cancers who experienced treatment delays due to COVID-19. This information can be applied to support patients with cancers more broadly, should treatment delays occur in the future.