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Having a baby ladies along with cystic fibrosis: 14 scenario accounts and materials review
Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. CONCLUSION New care models need to be developed to integrate mental health care into the current perioperative care practice. RATIONALE AND OBJECTIVES While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Valproate in vitro Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties. Creutzfeldt-Jakob disease (CJD) is a prion disease characterized by rapidly progressive dementia that is often followed by behavioral disturbances, ataxia, myoclonus, and akinetic mutism. The initial symptoms of CJD reportedly vary, but the onset is usually gradual. Here, we report a case of CJD with a sudden, stroke-like onset of right hemiparesis to alert readers that CJD can mimic a stroke during its early stage. OBJECTIVES This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS Physicians' Spe-DCS (β = -.21 ; p = .014) and weekly time spent with cancer patients (β = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p less then .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict. BACKGROUND Anaplastic lymphoma kinase (ALK) rearranged metastatic non-small cell lung cancer (NSCLC) comprises 5%-7% of all lung cancer and carries a good prognosis with available ALK-inhibitors. Majority of registration trials in ALK-inhibitors did not include Indian patients. Hence, this study was planned to analyze the outcome of Indian patients treated with ALK-inhibitors and associated challenges. METHODS This is a multi-center study in 5 major tertiary care cancer centers across India treating ALK-rearranged NSCLC patients from April 2013 to April 2019. ALK rearrangement was determined by Ventana immunohistochemistry with D5F3 clone and/or by break-apart FISH. Patients treated with ALK-inhibitors in any lines of treatment were included in this study. Patients were evaluated for clinicopathologic features, patterns of ALK-inhibitors use and outcome. Progression free-survival (PFS) and overall survival (OS) were calculated and data were censored on April 30, 2019. RESULTS A total of 274 patients were studle predicted PFS. Presence of brain metastasis (P = 0.039) and first line ALK-inhibitors use (P = 0.032) emerged as poor prognostic factor for OS on multivariate analysis. PFS rate was 70%, 47%, and 31% at 6, 12, and 18 months respectively. CONCLUSION This is one of the largest real-world data on outcome of ALK inhibitors in ALK-rearranged NSCLC from Asia. In absence of second line ALK inhibitor, initial chemotherapy followed by ALK-inhibitors (switch maintenance) had better outcome. This fact may be studied in individual patient data meta-analysis. Poor performance status and brain metastases at presentation are poor prognostic factors for overall survival. Second-line ALK inhibitor use crucial for better outcome and access to clinical trials are much needed in Indian patients.
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