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6; CI 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR 2.0; CI 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR 2.0; CI 1.0-4.0) of receiving late radiotherapy compared to married White women.

To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.
To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.
Awareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available.

To examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups.

The authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed.

Sixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings.

Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.
Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.Native Americans (NAs) experience higher rates of chronic pain. To examine the mechanisms for this pain inequity, we have previously shown that NAs report higher levels of pain-related anxiety and pain catastrophizing, which are in turn related to pronociceptive (pain-promoting) processes. But, it is currently unclear why NAs would report greater pain-related anxiety and catastrophizing. Given that NAs are also more likely to experience adverse life events (ALEs) and associated psychological distress, it was hypothesized that higher anxiety/catastrophizing in NAs would be partially explained by higher rates of ALEs and psychological distress. Structural equation modeling was used to analyze these pathways (NA ethnicity ➔ ALEs ➔ psychological distress ➔ pain anxiety/catastrophizing) in 305 healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Pain-related anxiety and situational pain catastrophizing were assessed in response to a variety of painful tasks. The Life Events Checklist was used to assess cumulative exposure to ALEs that directly happened to each participant. A latent psychological distress variable was modeled from self-reported perceived stress and psychological symptoms. Results found that NAs experienced more ALEs and greater psychological distress which was associated with higher rates of pain-related anxiety and pain catastrophizing. Notably, NAs did not report greater psychological distress when controlling for ALE exposure. This suggests that a higher risk of chronic pain in NAs may be due, in part, to psychological distress, pain-related anxiety, and pain catastrophizing that are promoted by exposure to ALEs. These results highlight several targets for intervention to decrease NA pain risk.To compare the risk of procedural complications and mortality after transcatheter aortic valve implantation (TAVI) in nonagenarians (age ≥ 90 years) compared to younger patients ( less then  90 years). Although TAVI could be considered as a treatment option in nonagenarians, several previous studies have shown conflicting outcomes between nonagenarians and younger patients who underwent TAVI. We conducted a comprehensive literature search through PubMed and EMBASE to investigate the clinical outcomes of nonagenarians after TAVI. The outcomes of interest were short- and long-term mortality and procedural complications. Our study identified 16 observational studies including a total of 179,565 patients (21,674 nonagenarian patients and 157,891 younger patients. Nonagenarians had a significantly higher rate of short- (hazard ratio [HR], 95% confidence interval [CI] 1.48, 1.38-1.59; P  less then  0.001) and long-term mortality (HR, 95% CI 1.34, 1.24-1.44; P  less then  0.001) than younger patients after TAVI. Furthermore, there were significant differences in major and/or life-threatening bleeding (risk ratio [RR], 95% CI 1.21, 1.05-1.39; P = 0.008), stroke (HR, 95% CI 1.24, 1.11-1.40; P  less then  0.001), and major vascular complication (RR, 95% CI 2.15, 1.35-3.42; P = 0.001) between nonagenarians and younger patients after TAVI. Minor vascular complication, myocardial infarction and permanent pacemaker implantation rate were similar between the two groups. find more Nonagenarians had significantly higher rate of short- and long-term mortality, major and/or life-threatening bleeding, stroke, and major vascular complication after TAVI. Although TAVI is a treatment option in nonagenarians, careful and appropriate selection of patients is essential to improve clinical outcomes.Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography.
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