Cognitive Function in Patients With Chronic Kidney Disease: Challenges in Neuropsychological Assessments.

Cognitive dysfunction is a common symptom in patients with chronic kidney disease (CKD). In this review, we highlight the clinical relevance of cognitive impairment in patients with CKD. After a summary of the different pathophysiological components of this frequently overlooked clinical condition, we summarize and evaluate the available neurocognitive tests and reflect on their utility in everyday clinical practice. Finally, we identify future areas of research and allude to the fact that inclusion of cognitive function testing in routine clinical care of patients with CKD could be cost effective by reducing nonadherence to medication and improving quality of life, and even survival.

Anti-NMDA-receptor encephalitis: A neuropsychiatric syndrome associated with ovarian teratoma.

•Anti-NMDA-receptor encephalitis is a paraneoplastic syndrome caused by teratomas.•The syndrome includes psychiatric symptoms followed by autonomic dysregulation.•Rapid diagnosis and removal of the tumor is essential for optimizing outcomes.•Following recovery, counsel on contraceptive options, particularly LARC methods.•If no tumor is identified initially, monitor for development of ovarian teratoma.

Assessment of the sunk-cost effect in clinical decision-making.

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment.

Family structure differences in health care utilization among U.S. children.

This study explores the relationship between family structure and children's access to health care using data from the 2001-2003 waves of the child sample files from the U.S. National Health Interview Survey. Specifically, we investigate the extent to which family structure types predict children's utilization of preventive health care, and barriers to care. We then explore whether observed differences across family structures can be attributed to differences in demographic characteristics, socioeconomic status (SES), and child health status. Using logistic regression models, we document substantial variation in health care usage and barriers to health care across a variety of family structures. Of note is the finding that the children of single mothers demonstrate extremely different patterns of health care access than do the children of single fathers, and the importance of SES as a risk factor for diminished levels of access to health care varies by family type. SES plays a major role in mediating the relationship between access to care for children in single mother and cohabiting families (when contrasted against children in two married parent families), but less of a role for children living with stepparents, a single father, or with parents and other relatives.