Dismissal informs the priorities of endometriosis patients in New Zealand.

Introduction: Endometriosis is a common condition with average delays to diagnosis in New Zealand of almost 9 years. Methods: In total, 50 endometriosis patients participated in anonymous, asynchronous, online group discussions about their priorities, and their experiences with the development of symptoms, seeking a diagnosis, and receiving appropriate treatment. Results: Higher subsidy of care was the top change endometriosis patients wanted, followed by more research funding. When asked to choose whether research should be focused on improving diagnosis or improving treatment methods, the results were evenly split. Within this cohort, patients highlighted that they did not know the difference between normal menstrual discomfort and pathological endometriotic pain. If, upon seeking help, medical practitioners classified their symptoms as "normal," these dismissals could instill doubt in patients, which made it more difficult for them to continue to seek a diagnosis and effective treatments. Patients who did not express dismissal had a significantly shorter delay from symptom onset to diagnosis of 4.6 ± 3.4 years vs. 9.0 ± 5.2 years. Conclusion: Doubt is a frequent experience for endometriosis patients in New Zealand, which was reinforced by some medical practitioners who were dismissive of their pain and thus prolonged the patient's delay to diagnosis.

The experiences of endometriosis patients with diagnosis and treatment in New Zealand.

Endometriosis is a chronically painful, invasive, inflammatory disease, with limited treatment options and long delays to diagnosis, which impacts 10% of females in New Zealand. Introduction: As part of a larger group discussion study, this paper covers three themes associated with endometriosis patient experiences: intensity of pain, diagnostic tool shortcomings and perspectives of treatment options. Materials and methods: The goal of this research was the inclusion of patient voices to guide research priorities. In early 2022, 50 New Zealand endometriosis patients participated in anonymous, asynchronous, text-based group discussions on the VisionsLive platform. The patients ranged in age from 18-48. The patients answered 50 questions, 23 text-based and 27 quantitative, and then took part in online group discussions. Results and discussion: The average age of symptom onset was 15.3 years, while the average delay from symptom onset to a working or surgically confirmed diagnosis was 7.91 years. The top five reported symptoms within the cohort were pain-based, and the participants discussed the many impacts of this pain on their work and education. The four main diagnostic tools employed on this cohort were abdominal ultrasound (72%), transvaginal ultrasound (68%), laparoscopy (82%) and sharing their symptom history with a medical practitioner (88%). The most common emotions patients experienced following receiving a diagnosis of endometriosis were relief (86%), feeling overwhelmed (54%), and anger (32%). The main treatments offered to this cohort were pain relief (96%), laparoscopic surgery (84%) and the combined oral contraceptive pill (80%). Of these three treatments, only laparoscopic surgery was viewed positively by the majority of users, with 67% considering laparoscopy an effective treatment, compared to 46% of users for pain relief, and 25% of users for the combined oral contraceptive pill. Conclusions: Gathering the voice of patients revealed that long delays to diagnosis and dismissal by medical practitioners frequently manifests as a reaction of relief by patients once diagnosed. Results also showed treatment options such as pain relief and hormonal medications were often considered ineffective, but were routinely offered as the first, or only, options for patients. It is therefore important that both quicker routes to diagnosis and more effective treatment options be developed.

Understanding and Measuring the Cognitive Load of Amputees for Rehabilitation and Prosthesis Development.

Objective: To derive a definition of cognitive load that is applicable for amputation as well as analyze suitable research models for measuring cognitive load during prosthesis use. Defining cognitive load for amputation will improve rehabilitation methods and enable better prosthesis design. Data Sources: Elsevier, Springer, PLoS, IEEE Xplore, and PubMed. Study Selection: Studies on upper limb myoelectric prostheses and neuroprostheses were prioritized. For understanding measurement, lower limb amputations and studies with individuals without lower limb amputations were included. Data Extraction: Queries including "cognitive load," "neural fatigue," "brain plasticity," "neuroprosthetics," "upper limb prosthetics," and "amputation" were used with peer-reviewed journals or articles. Articles published within the last 6 years were prioritized. Articles on foundational principles were included regardless of date. A total of 69 articles were found: 12 on amputation, 15 on cognitive load, 8 on phantom limb, 22 on sensory feedback, and 12 on measurement methods. Data Synthesis: The emotional, physiological, and neurologic aspects of amputation, prosthesis use, and rehabilitation aspects of cognitive load were analyzed in conjunction with measurement methods, including resolution, invasiveness, and sensitivity to user movement and environmental noise. Conclusions: Use of "cognitive load" remains consistent with its original definition. For amputation, 2 additional elements are needed: "emotional fatigue," defined as an amputee's emotional response, including mental concentration and emotions, and "neural fatigue," defined as the physiological and neurologic effects of amputation on brain plasticity. Cognitive load is estimated via neuroimaging techniques, including electroencephalography, functional magnetic resonance imaging, and functional near-infrared spectroscopy (fNIRS). Because fNIRS measures cognitive load directly, has good temporal and spatial resolution, and is not as restricted by user movement, fNIRS is recommended for most cognitive load studies.

Endometriosis Is Undervalued: A Call to Action.

Endometriosis is an inflammatory chronic pain condition caused by uterine tissue growing outside of the uterus that afflicts at least 11% of women (and people assigned female at birth) worldwide. This condition results in a substantial burden to these women, and society at large. Although endometriosis was first identified over 160 years ago, substantial knowledge gaps remain, including confirmation of the disease's etiology. Research funding for endometriosis is limited, with funding from bodies like the National Institutes of Health (NIH) constituting only 0.038% of the 2022 health budget-for a condition that affects 6.5 million women in the US alone and over 190 million worldwide. A major issue is that diagnosis of endometriosis is frequently delayed because surgery is required to histologically confirm the diagnosis. This delay increases symptom intensity, the risk of central and peripheral sensitization and the costs of the disease for the patient and their nation. Current conservative treatments of presumed endometriosis are pain management and birth control. Both of these methods are flawed and can be entirely ineffective for the reduction of patient suffering or improving ability to work, and neither addresses the severe infertility issues or higher risk of certain cancers. Endometriosis research deserves the funding and attention that befits a disease with its substantial prevalence, effects, and economic costs. This funding could improve patient outcomes by introducing less invasive and more timely methods for diagnosis and treatment, including options such as novel biomarkers, nanomedicine, and microbiome alterations.

Understanding the Development of a Design Thinking Mindset During a Biomedical Engineering Third-Year Course.

As students gain more experience with design concepts, they should progress from novice to expert design thinkers. The purpose of this research was to identify the constructs of growth in design thinking (DT) over short- (one weekend) and long-term (10 weeks) design challenges. A DT mindset questionnaire was completed by students in a third-year undergraduate biomedical design course at the beginning of the course, after a one-weekend design challenge, and on completion of the course. After the short design challenge, an improvement in 15 of the 19 constructs was observed relative to baseline. Six of these constructs: mindfulness and awareness of the process, embracing risk, abductive thinking, envisioning new things, creative confidence, and optimism to make an impact, were sustained over the course of the semester indicating that a prolonged period of experiential learning can maintain short-term gains in DT. Three of the constructs: holistic views (considering the problem as a whole), diversity, and curiosity showed improvement following the short-term design challenge, then deterioration suggesting that situational circumstances are significant contributors to these constructs of DT. DT generally improves with the opportunity to collaborate, communicate, and design for a specific outcome. However, situational factors including team diversity, instructor expertise, dedicated time for team collaboration, and prior experiences can affect changes in the DT skillset.