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1.
Artigo em Inglês | MEDLINE | ID: mdl-34279628

RESUMO

BACKGROUND: Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. METHODS: Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems' hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. RESULTS: Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit-level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. CONCLUSION: Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.

3.
Oral Oncol ; 119: 105328, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34077813

RESUMO

OBJECTIVE: Alcohol use among survivors of head and neck cancer (HNC) negatively impacts patient outcomes and is an important risk factor for recurrent and second primary tumors. Despite recommendations from several cancer societies, alcohol consumption remains a common problem in this population. METHODS: A cross-sectional study was performed with the Alcohol Use Disorders Identification Test (AUDIT) Self-Report questionnaire. Patients with HNC completed surveys at pre-treatment and follow-up appointments every 3-6 months for at least 2-years after treatment. RESULTS: 796 surveys were available for analysis. Most participants were male (75.7%) and had either oropharyngeal (34.5%) or laryngeal (16.7%) cancer. The percentage of alcohol drinkers decreased from 56.1% at pre-treatment to 40.4% at 0-3 months post-treatment, but then increased and surpassed baseline levels by 24 + months post-treatment (64.4%, p = 0.0079). Concurrently, moderate drinkers (AUDIT = 1 - 3) decreased from 34.2% at pre-treatment to 25.2% at 0-3 months post-treatment, but then increased and surpassed baseline levels at 24 + months post-treatment (39.7%, p = 0.0129). Trends among heavy (AUDIT > 3), and heaviest (AUDIT > 6) drinkers were similar, but not statistically significant. At 24 + months post-therapy, we observed a statistically significant increase in female users (39.1% to 63.2%, p = 0.0213) and moderate drinkers < 55 years old (43.4% to 61.9%, p = 0.0184). CONCLUSION: Alcohol consumption in survivors of HNC transiently decreases in the immediate months after treatment, but then increases and remains largely stable by 24 months. This pattern is particularly concerning and highlights the need for timely interventions.

4.
Per Med ; 18(4): 347-359, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34047197

RESUMO

Aim: Patients from racial and ethnic minority backgrounds in the USA have historically been under-represented in research trials. Understanding their viewpoints regarding participation in N-of-1 trials is imperative as we design and implement these studies. Materials & methods: We conducted six focus groups of racial and ethnic minority patients (n = 25) and providers (n = 9). We used content analysis to identify themes. Results: Our results noted the importance of considering family members in N-of-1 trial recruitment and participation, patients' desire for education as a design feature, for 'lifestyle' changes as a treatment option and for use of nonevidence-based treatments in the design of future N-of-1 trials. Conclusion: Personalized trials have the potential to change the way we deliver primary care and improve disparities for minorities.

5.
Psychooncology ; 30(9): 1466-1475, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33855796

RESUMO

OBJECTIVES: Prostate cancer (PCa) survivors report poor physical functioning alongside negative psychological outcomes as they cope with treatment side effects and practical concerns after treatment completion. This study evaluated PROGRESS, a web-based intervention designed to improve adaptive coping among PCa survivors. METHODS: Localized PCa patients (N = 431) within one year of treatment completion were randomized to receive educational booklets or PROGRESS + educational booklets. Surveys completed at baseline, 1-, 3-, and 6-months assessed patient characteristics; functional quality of life and coping (primary outcomes); and psychosocial outcomes (e.g., self-efficacy, marital communication; secondary outcomes). Intent-to-treat and as-treated analyses were completed to assess change in outcomes from baseline to 6 months using linear mixed effects regression models. RESULTS: In the intent-to-treat analyses, participants randomized to the intervention group had improved diversion coping (i.e., healthy redirection of worrying thoughts about their cancer), but more difficulties in marital communication (ps < 0.05). However, PROGRESS usage was low among those randomized to the intervention group (38.7%). The as-treated analyses found PROGRESS users reported fewer practical concerns but had worse positive coping compared to PROGRESS non-users (ps < 0.05). CONCLUSIONS: The findings suggest PROGRESS may improve certain aspects of adaptive coping among PCa survivors that use the website, but does not adequately address the remaining coping and psychosocial domains. Additional research is needed to better understand the gaps in intervention delivery contributing to low engagement and poor improvement across all domains of functional quality of life and adaptive coping.

6.
BMJ Open ; 11(2): e042298, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33593776

RESUMO

INTRODUCTION: Patient education is a crucial component in the management of chronic kidney disease (CKD); however, many education programmes do not tailor to patients' disease-related belief and emotional reactions. According to Leventhal's self-regulation model, such beliefs and reactions, known as illness perceptions, are a part of patients' understanding of their disease and treatment-related actions. The existing research of illness perception in the field of nephrology has been heterogenous in terms of study outcomes and in study population; and the evidence of how illness perceptions affect behavioural and decisional outcomes is limited. This scoping review aims to map and summarise the evidence of published literature on illness perception among patients with CKD not yet treated by dialysis and kidney failure. METHODS AND ANALYSIS: This study bases its approach on Joanna Brigg's Institute Guidelines on scoping review methods. The search strategy was developed together with a medical information specialist. Searches will be performed on acceptance of publication in the following databases: PubMed, EMBASE, PsycINFO via Ovid, Scopus and the Cumulative Index to Nursing and Allied Health Literature. Searches will be run without incorporating a date restriction in order to capture content from the databases' inception to present day. Search terms including 'illness perception', 'kidney disease' and 'kidney failure' will be screened in titles and abstracts. Two independent researchers will screen the abstracts and full text for full eligibility. We will include studies focusing on illness perception of patients with CKD with estimated glomerular filtration rate <60 mL/min/1.73 m2, kidney failure or recipients of kidney transplant. We will exclude patients <18 years of age, patients with acute kidney injury and non-English articles. All demographic data, study design and study findings will be collected and analysed using a data abstraction tool. ETHICS AND DISSEMINATION: This study does not require internal review board approval. We will present the findings of this scoping review in a peer-reviewed journal.


Assuntos
Nefrologia , Insuficiência Renal Crônica , Taxa de Filtração Glomerular , Humanos , Percepção , Diálise Renal , Insuficiência Renal Crônica/terapia , Projetos de Pesquisa , Literatura de Revisão como Assunto
8.
J Cancer Surviv ; 15(1): 110-118, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32681305

RESUMO

PURPOSE: Individuals who completed treatment for prostate cancer (PCa) often report poor coping and practical concerns when adapting to new roles in their lives-and strong patient-provider communication is critical for this period. However, there is limited research identifying factors associated with supportive needs after the completion of PCa treatment. This study aimed to identify the social and medical risk factors associated with supportive needs for adapting among individuals who completed treatment for localized PCa. METHODS: Using baseline data from a study evaluating a web-based support system for patients in the first year following treatment for localized PCa, self-efficacy for re-entry (e.g., maintaining relationships, symptom management), medical interactions, and practical concerns (e.g., insurance, exercise) were assessed. Multivariable regression analyses were completed to identify risk factors for low readiness. RESULTS: Participants (N = 431) with lower health literacy or income or with depressive symptoms had lower self-efficacy for re-entry, more negative interactions with medical providers, and more practical concerns (ps < .05). Lastly, non-Hispanic White participants reported greater readiness compared with all other races (ps < .05). CONCLUSIONS: Multiple social and medical risk factors are associated with greater supportive needs when adapting to new roles after PCa treatment. Understanding the risk factors for supportive needs in this period is critical. Future research is needed to help providers identify and support individuals at risk for poorer coping and greater practical concerns after treatment completion. IMPLICATIONS FOR CANCER SURVIVORS: Identifying individuals with greater supportive needs following treatment for localized PCa treatment will help ensure successful adaptation to new roles.

9.
Urology ; 151: 19-23, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32653567

RESUMO

OBJECTIVE: To apply the American Urogynecological Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) recommendations of foregoing workup in patients under 50 years of age with less than 25 red cells per high-powered field, to a cohort of asymptomatic microscopic hematuria (AMH) patients, and assess diagnostic accuracy, sensitivity, specificity, positive, and negative predictive value compared to the American Urologic Association (AUA) guidelines. METHODS: Retrospective review of female patients who underwent AMH evaluation from 2012 to 2015. The number of patients who would have avoided workup following the AUGS/ACOG recommendations was determined. Sensitivity, specificity, positive- and negative-predictive value and accuracy of the AUGS/ACOG recommendations compared to AUA guidelines were determined. RESULTS: Six hundred twenty women underwent AMH workup with 265 women undergoing full workup as per the AUA guidelines. Applying the AUGS/ACOG recommendations to this cohort would not have resulted in missed malignant diagnoses. Two tumors were found, both in patients who had undergone complete workup, and for whom AUGS/ACOG recommends workup. Following the AUGS/ACOG recommendations would have avoided workup in 126/620 of all women and 44/265 women who underwent the full AUA workup. In looking at findings of malignancy, the AUGS/ACOG workup had a sensitivity of 100% and a negative predictive value of 100% as compared to the AUA guidelines. CONCLUSION: AUA guidelines may over screen female low risk AMH patients. Extensive workup in a low risk group of female patients does not result in increased cancer diagnoses. Perhaps a more nuanced approach could result in fewer workups without compromising cancer detection.

10.
Transl Behav Med ; 11(2): 495-503, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32320039

RESUMO

Digital health promises to increase intervention reach and effectiveness for a range of behavioral health outcomes. Behavioral scientists have a unique opportunity to infuse their expertise in all phases of a digital health intervention, from design to implementation. The aim of this study was to assess behavioral scientists' interests and needs with respect to digital health endeavors, as well as gather expert insight into the role of behavioral science in the evolution of digital health. The study used a two-phased approach: (a) a survey of behavioral scientists' current needs and interests with respect to digital health endeavors (n = 346); (b) a series of interviews with digital health stakeholders for their expert insight on the evolution of the health field (n = 15). In terms of current needs and interests, the large majority of surveyed behavioral scientists (77%) already participate in digital health projects, and from those who have not done so yet, the majority (65%) reported intending to do so in the future. In terms of the expected evolution of the digital health field, interviewed stakeholders anticipated a number of changes, from overall landscape changes through evolving models of reimbursement to more significant oversight and regulations. These findings provide a timely insight into behavioral scientists' current needs, barriers, and attitudes toward the use of technology in health care and public health. Results might also highlight the areas where behavioral scientists can leverage their expertise to both enhance digital health's potential to improve health, as well as to prevent the potential unintended consequences that can emerge from scaling the use of technology in health care.

11.
Adv Radiat Oncol ; 5(5): 897-904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33083651

RESUMO

Purpose: A genetic test predicting susceptibility for the development of toxicities after prostate cancer radiation therapy is in development. This test intends to help physicians with treatment decision making. Methods and Materials: Radiation oncologists were surveyed using a web-based questionnaire to gauge their interest in using a genetic test predictive of increased risk of radiation therapy toxicities as an aid in determining therapy for men with prostate cancer. Responses were summarized using frequencies, and a χ2 test compared responses among participants. Multivariable ordinal regression identified factors associated with anticipated adoption or nonadoption of such a genetic test by radiation oncologists. Results: Among 204 radiation oncologists (64% from the United States, 36% from other countries), 86.3% would order a genetic test and 80.2% said the test would be useful for treatment discussions. There was wide acceptance (76.7%) to offer a genetic test to all patients considering radiation therapy for prostate cancer. Additionally, 98.1% indicated that patients would be receptive to the test information. There were no significant differences in the likelihood of ordering a genetic test based on practice setting, familiarity with scientific literature, time spent on research, or geographic location (all P > .05). Conclusions: Radiation oncologists who treat prostate cancer are interested in and willing to order a genetic test predictive of susceptibility to radiation therapy toxicity to aid their treatment decision making.

14.
Urology ; 141: 27.e1-27.e6, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32305550

RESUMO

OBJECTIVE: To determine if use of the hematuria risk index can reduce testing and cost, while maintaining equivalent lesion detection in patients with asymptomatic microscopic hematuria. MATERIALS AND METHODS: Retrospective cohort study of 1049 patients at single institution. Hematuria risk index score was calculated based on clinical factors including age, sex, smoking history, and degree of hematuria for each patient along with evaluation studies performed and total number of tumors discovered. Cost benefit analysis was performed based on published Medicare averages. RESULTS: Tumor detection rate in overall, low-risk, and moderate-risk groups were 1.2%, 0%, and 2.96% at a total cost of $408,376. When low-risk group is not screened cost decreases to $166,252 with no lesions missed. The cost to discover one lesion/cancer in the overall group was $34,031.3, the cost to find one high-grade clinically significant lesion/cancer was $136,125.3 for the overall group. When the low-risk group was removed, the cost to find a high-grade clinically significant lesion/cancer decreased to $55,417.3 without missing any significant lesions. Ultrasound may be utilized instead of computed tomography with minimal loss of lesion detection in select moderate risk patients. CONCLUSION: None of the low-risk hematuria risk patients were diagnosed with any lesions, as such these patients may not need an evaluation. Furthermore, by utilizing a risk-stratified approach to the assessment of asymptomatic microscopic hematuria health care costs can be significantly decreased with limited negative consequences in terms of lesion detection.

15.
JAMA ; 323(20): 2052-2059, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32320003

RESUMO

Importance: There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19). Objective: To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system. Design, Setting, and Participants: Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. Exposures: Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. Main Outcomes and Measures: Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results: A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). Conclusions and Relevance: This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.


Assuntos
Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Complicações do Diabetes , Feminino , Hospitalização , Humanos , Hipertensão/complicações , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Fatores de Risco , SARS-CoV-2 , Resultado do Tratamento , Adulto Jovem
16.
J Health Psychol ; 25(3): 298-310, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-28810471

RESUMO

Gay men's experiences with prostate cancer and its impact on health-related quality of life are poorly understood. This qualitative study explored gay men's experience with prostate cancer with a focus on the emotional, physical, and sexual impact of cancer; support needs; and healthcare interactions. Three semi-structured focus groups of gay men with prostate cancer were conducted. A conventional content analytic approach was used to identify six primary content areas that described poignant aspects of the men's experience with prostate cancer: minority stress, intimacy and sexuality concerns, impact on life outlook, healthcare experiences, social support and the gay community, and intersectional identities.


Assuntos
Homossexualidade Masculina/psicologia , Satisfação do Paciente , Neoplasias da Próstata/psicologia , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Apoio Social , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/terapia , Pesquisa Qualitativa , Parceiros Sexuais/psicologia
17.
Head Neck ; 42(4): 732-738, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31777131

RESUMO

Alcohol drinking is a risk factor for the development of head-and-neck malignancies, including oral, pharyngeal, and laryngeal cancers, and coupled with tobacco use, accounts for 75% of oral cancers. We summarized the literature on alcohol-related head and neck cancer (HNC) and identified gaps that represent areas for future investigation. Research indicates that alcohol consumption has not only been linked to the development of primary HNCs, but also to secondary cancers with continued alcohol intake, cancer recurrences, and other poor health outcomes. Given this evidence, several organizations have called for reduction or avoidance of alcohol, particularly in HNC survivors. Despite these strong recommendations, evidence suggests that HNC survivors continue to use alcohol. There is a need to forge collaborations among clinicians, researchers, and social workers, to address this problem of alcohol consumption in the growing population of HNC survivors.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas , Neoplasias Bucais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Recidiva Local de Neoplasia , Fatores de Risco , Uso de Tabaco
19.
Ann Behav Med ; 54(12): 978-984, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416842

RESUMO

BACKGROUND: Screening for distress and referral for the provision of psychosocial care is currently the preferred approach to the management of distress in patients with cancer. To date, this approach has shown a limited effect on the reduction of distress. Recent commentaries have argued that the implementation of distress screening should be improved. On the other hand, the underlying assumption that a referral for psychosocial care is required for distressed patients can be questioned. This has led to the development of an alternative approach, called emotional support and case finding. PURPOSE: In the context of finding innovative solutions to tomorrow's health challenges, we explore ways to optimize distress management in patients with cancer. METHODS AND RESULTS: We discuss three different approaches: (i) optimization of screening and referral, (ii) provision of emotional support and case finding, and (iii) a hybrid approach with multiple assessments, using mobile technology. CONCLUSIONS: We suggest continued research on the screening and referral approach, to broaden the evidence-base on improving emotional support and case finding, and to evaluate the utility of multiple assessments of distress with new interactive mobile tools. Lessons learned from these efforts can be applied to other disease areas, such as cardiovascular disease or diabetes.


Assuntos
Gerenciamento Clínico , Neoplasias/psicologia , Reabilitação Psiquiátrica , Angústia Psicológica , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia , Telemedicina , Humanos , Ciência da Implementação , Encaminhamento e Consulta , Apoio Social
20.
Ann Behav Med ; 54(12): 915-919, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416844

RESUMO

This introduction to the special issue outlines key ways that behavioral medicine researchers can accelerate their science. The authors highlight the 2020 Society of Behavioral Medicine's annual meeting plenary sessions, that fit this theme.


Assuntos
Medicina do Comportamento , Congressos como Assunto , Sociedades Médicas , Medicina do Comportamento/tendências , Humanos
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