RESUMO
Solid mass tumors are not as common as leukemia in individuals with Down syndrome. In this report, we describe the rare case of an adult Hispanic male with Down syndrome who developed advanced subungual melanoma in the hallux. We also describe the course of treatment, which involved hallux amputation along with metastatic work-up and sentinel lymph node biopsy with eventual resection.
Assuntos
Síndrome de Down/complicações , Hallux/cirurgia , Melanoma/diagnóstico , Dedos do Pé , Amputação Cirúrgica , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Masculino , Melanoma/complicações , Melanoma/cirurgia , Pessoa de Meia-Idade , Cintilografia , Biópsia de Linfonodo SentinelaRESUMO
The opioid epidemic has resulted in significant morbidity and mortality in the U.S. Health systems, policymakers, payers, and public health have enacted numerous strategies to reduce the harms of opioids, including opioid use disorder (OUD). Much of this implementation has occurred before the development of OUDârelated comparative effectiveness evidence, which would enable an understanding of the benefits and harms of different approaches. This article from the American College of Preventive Medicine (ACPM) uses a prevention framework to identify the current approaches and make recommendations for addressing the opioid epidemic, encompassing strategies across a primordial, primary, secondary, and tertiary prevention approach. Key primordial prevention strategies include addressing social determinants of health and reducing adverse childhood events. Key primary prevention strategies include supporting the implementation of evidence-based prescribing guidelines, expanding school-based prevention programs, and improving access to behavioral health supports. Key secondary prevention strategies include expanding access to evidence-based medications for opioid use disorder, especially for high-risk populations, including pregnant women, hospitalized patients, and people transitioning out of carceral settings. Key tertiary prevention strategies include the expansion of harm reduction services, including expanding naloxone availability and syringe exchange programs. The ACPM Opioid Workgroup also identifies opportunities for de-implementation, in which historical and current practices may be ineffective or causing harm. De-implementation strategies include reducing inappropriate opioid prescribing; avoiding mandatory one-size-fits-all policies; eliminating barriers to medications for OUD, debunking the myth of detoxification as a primary solo treatment for opioid use disorder; and destigmatizing care practices and policies to better treat people with OUD.
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Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/efeitos adversos , Criança , Feminino , Humanos , Naloxona , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica , Gravidez , Estados Unidos/epidemiologiaRESUMO
Improving the timeliness and quality of your guidance on work disability lessens the impact of health problems on patients' lives and livelihoods.
Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Medicina de Família e Comunidade/normas , Guias de Prática Clínica como Assunto , Retorno ao Trabalho/psicologia , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.
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Transtornos de Estresse por Calor , Doenças Profissionais , Exposição Ocupacional , Medicina do Trabalho , Transtornos de Estresse por Calor/epidemiologia , Transtornos de Estresse por Calor/prevenção & controle , Temperatura Alta , Humanos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Estados UnidosRESUMO
Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.
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Medicina Ambiental , Medicina do Trabalho , Aclimatação , Adaptação Fisiológica , Mudança Climática , Humanos , Estados UnidosRESUMO
UNLABELLED: Clear cell sarcoma (CCS) is a subset of soft tissue sarcoma that occurs mainly in young Caucasians. Although on initial presentation these growths might not appear to be malignant, CCS has a tendency to disseminate to regional lymph nodes and ultimately develop distant metastasis. We report a case of CCS from our institution, discussing the radiological and pathological findings, surgical treatments, and survival prognoses. To our knowledge, this is the first reported case of using a Chopart's amputation technique in the resection of CCS of the foot. LEVEL OF CLINICAL EVIDENCE: 4.
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Amputação Cirúrgica/métodos , Articulação do Tornozelo/cirurgia , Doenças do Pé/cirurgia , Sarcoma de Células Claras/cirurgia , Adulto , Biópsia , Diagnóstico Diferencial , Seguimentos , Doenças do Pé/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Sarcoma de Células Claras/diagnósticoRESUMO
OBJECTIVE: To describe the relationship between the length of short-term disability (STD) and health care spending. METHODS: Medical claims for insured US employees on STD were evaluated to describe the distribution of disability durations and health expenditures across major diagnostic categories and common medical conditions. Correlations between health expenditures and disability durations were examined. RESULTS: The most expensive 10% of cases accounted for more than half of total health spending. The longest 10% of cases accounted for more than one-third of total disability time. Only one-third of the most expensive cases were also among the longest in duration. Disability durations were moderately correlated with medical spending and this relationship was modified by comorbid conditions and age. CONCLUSION: Psychosocial barriers, in addition to biomedical factors, should be considered to achieve optimal functional outcomes and well-being of patients.
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Gastos em Saúde/estatística & dados numéricos , Seguro por Deficiência/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Retorno ao Trabalho/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Comorbidade , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Ocupacional , Fatores de Tempo , Estados Unidos , Adulto JovemRESUMO
CONTEXT: Advances in screening and treatment of prostate cancer have dramatically increased the number of survivors in the US population. Yet the effect of screening is controversial, and in some instances may not be beneficial. Previous studies have typically only reported outcomes of treatment and symptoms within a short time frame following treatment. The persistence of such symptoms over time necessitates an improvement of survivor care so that the medical and support needs of these patients are met. OBJECTIVE: This study aims to perform a patient-centered survey of prostate cancer survivors in the Michigan Cancer Registry to identify treatment side effect rates, evaluate survivors' access to preventive care services post-prostate cancer treatment, and assess the informational needs of these survivors regarding their prostate cancer. DESIGN, SETTING, AND PATIENTS: Linking case files of the Michigan Cancer Registry with records from the National Death Index, we identified prostate cancer patients diagnosed between 1985 and 2004 and alive on 31 December 2005. Participants were selected using a stratified cross-sectional sampling strategy to ensure adequate inclusion of survivors based upon race and ethnicity, urban versus rural location, and number of years since diagnosis of prostate cancer. A total of 2,499 surveys were completed and returned. MAIN OUTCOME MEASURES: (1) Physical symptoms--assessing bowel, sexual, urinary, and vitality symptoms by treatment modality. (2) Access to care--identifying whether diagnostic tests for prostate cancer (prostate-specific antigen (PSA) and digital rectal examination) were performed. Determining whether the survivors had knowledge of the "watchful waiting" paradigm for prostate cancer surveillance. (3) Informational needs--assessing whether the informational needs of patients were addressed by providers. Evaluating the significant predictors associated with seeking information about prostate cancer from any other source. Identifying what factors influenced a person to actively seek out information and what factors guide which primary information source a survivor would use. RESULTS: Median duration between prostate cancer diagnosis and survey response was 9 years. Of the study population, 80 % was diagnosed at an early stage. Survivors had reported significant problems in the 4 weeks prior to survey. Of the survivors, 88.1 % reported having a PSA test since diagnosis of prostate cancer, with 93 % of them having it done at least once per year. Of the survivors, 82.6 % reported that a healthcare provider gave them information on prostate cancer. Of this 82.6 %, 86.4 % had this information provided by a urologist, 45.4 % by a primary care physician, and 29.2 % by an oncologist. The primary source of information for these survivors was "healthcare provider" (59.2 %). CONCLUSION: Persistent symptoms subsequent to prostate cancer treatment suggest a gap in symptom management. Future research should support long-term studies of active surveillance versus active treatment outcomes to understand the feasibility of minimizing the burden of long-term physical symptoms arising from prostate cancer treatment. Clinicians must assess post-treatment distress long after treatment has ended to identify when supportive care is needed. More informational resources should be allocated to prostate cancer survivors to ensure that they are well-educated about their prognosis. IMPLICATIONS FOR CANCER SURVIVORS: This study is needed to ensure that the post-treatment symptoms of prostate cancer survivors are properly addressed and managed by healthcare providers over the long term.
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Adenocarcinoma/terapia , Neoplasias da Próstata/terapia , Sobreviventes/estatística & dados numéricos , Adenocarcinoma/mortalidade , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Coleta de Dados , Necessidades e Demandas de Serviços de Saúde , Nível de Saúde , Humanos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Satisfação do Paciente , Neoplasias da Próstata/mortalidade , Psicologia , Qualidade de Vida , Fatores Socioeconômicos , Avaliação de Sintomas , Resultado do TratamentoRESUMO
Gene therapy involves the safe and effective delivery of one or more genes of interest to target cells in vivo. The advantages of using nonviral delivery systems include ease of preparation, low toxicity, and weak immunogenicity. Nonviral delivery methods, when combined with a noninvasive, clinically applicable imaging assay, will greatly aid in the optimization of gene therapy approaches for cancer. We demonstrate cationic lipid-mediated noninvasive monitoring of reporter gene expression of firefly (Photinus pyralis) luciferase (fl) and a mutant herpes simplex virus type I thymidine kinase (HSV1-sr39tk, tk) in living mice using a cooled charge coupled device (CCD) camera and positron emission tomography (PET), respectively. We observe a high level of fl and tk reporter gene expression predominantly in the lungs after a single injection of the extruded DOTAP:cholesterol DNA liposome complexes by way of the tail vein, seen to be time- and dose-dependent. We observe a good correlation between the in vivo bioluminescent signal and the ex vivo firefly luciferase enzyme (FL) activity in different organs. We further demonstrate the feasibility of noninvasively imaging both optical and PET reporter gene expression in the same animal using the CCD camera and microPET, respectively.