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Sixteen patients completed the study, 8 starting with each instrument. Light swab touch evoked significant pain, and lidocaine reduced pain to zero or mild levels. The pain threshold was 25 g, and only 38% could tolerate testing past 100 g without lidocaine. The Verbal Pain Scale correlated well with the Numerical Rating Scale.

Light rolling cotton swab touch using the 4-item verbal scale can map vestibulodynia tenderness that can be extinguished by lidocaine, consistent with distinguishing a mucosal condition. Forces by vulvalgesiometer of greater than 100-200 g may evoke pain other than mucosal allodynia.
Light rolling cotton swab touch using the 4-item verbal scale can map vestibulodynia tenderness that can be extinguished by lidocaine, consistent with distinguishing a mucosal condition. Forces by vulvalgesiometer of greater than 100-200 g may evoke pain other than mucosal allodynia.A 21-year-old man was referred for refractive surgery evaluation. He had a history of advanced keratoconus that led to penetrating keratoplasty (PKP) in the right eye 2 years ago. Spectacle dependence and poor visual quality in this right eye is his chief concern. He cannot tolerate contact lenses. The uncorrected (UDVA) and corrected distance visual acuity (CDVA) were 20/400 and 20/50, respectively. The manifest refraction was -2.75 -8.00 × 165 in the right eye. He presented frank keratoconus in the left eye with a UDVA of 20/200 and a CDVA of 20/100. The manifest refraction was -6.0 -4.75 × 95. PR171 The intraocular pressure was normal, and the results from a slitlamp examination showed a clear corneal graft in the right eye. The topographic and tomographic maps revealed a high astigmatism (Figures 1 to 3). This case is about a refractive surgery option for refractive error after PKP in the right eye. What kind of refractive surgery (if any) would you recommend to this patient's right eye? Would you consider any modality of excimer laser? In this case, what are your limits for final? Would you consider intrastromal corneal ring segments (ICRS)? Would you consider a phakic intraocular lens (pIOL)?We used an online survey to measure how personal acquaintance with referring primary care providers (PCPs) affects specialists' experience of care coordination as use of a shared electronic health record (EHR) increases. Only 9% of specialists rated Overall Coordination as 9 or 10 out of 10. Personal acquaintance positively impacted Overall Coordination and all measured coordination subdomains. This effect was attenuated, but persisted, even at higher levels of EHR sharing. The impact of a shared EHR alone was limited to Overall Coordination and the Data Transfer subdomains. Health systems can improve coordination through investment in clinician relationships, while research should address the gaps in coordination even with widespread personal acquaintance and shared EHRs.Managing patient access to care in health care delivery organizations is instrumental in shaping patient experiences. We convened an inclusive stakeholder panel, informed by evidence, to understand the dimensions and establish definitions of access and access management. The literature varies in access definitions, but the temporal measure "time to third next available appointment" was consistently used as an indicator of access. Panel deliberations highlighted the importance of patient-centeredness and resulted in comprehensive definitions for access management, optimal access management, and optimal access. Health care organizations and researchers can use the developed definitions and concepts as starting points for initiatives to improve access management.In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.Organizational factors impacting burnout have been underexplored among providers in low-income, minority-serving, safety-net settings. Our team interviewed 14 health care administrators, serving as key decision makers in Federally Qualified Health Center primary care clinics. Using a semistructured interview guide, we explored burnout mitigation strategies and elements of organizational culture and practice. Transcribed interviews were coded and analyzed using the Braun and Clark (2006) Thematic Analysis method. Mission-Driven Ethos to Mitigate Provider Burnout emerged as the primary theme with 2 categories (1) Promoting the Mission "Bleeders" and (2) Competing Priorities "Billers." These categories represent various properties and reflect administrators' use of organizational mission statement as a driver of staff recruitment, training, retention, and stratification. Data collection occurred before and during the COVID-19 global pandemic, as such additional themes associated with administrative behaviors during a prolonged, clinical crisis provide insight into possible strategies that may mitigate burnout in this setting.
Pulmonary arterial hypertension (PAH) is a pulmonary vascular disease causing right ventricular (RV) hypertrophy, failure, and death. Some miRNAs are involved in the pathophysiology of PAH. As the current treatments cannot prevent the progression of the disease, we investigated whether 3 plant derivatives, namely perillyl alcohol (PA), quercetin (QS), and berberine (BBR), can improve RV function and affect the expression of miR-204, miR-27a, and biochemical factors in monocrotaline-induced PAH (MCT-PAH). Thirty-six rats were divided into control (CTL), MCT, MCT+Veh (vehicle), MCT+PA, MCT+QS, and MCT + BBR groups (n = 6 each). After inducing PAH using MCT (60 mg/kg), PA (50 mg/kg), QS (30 mg/kg), and BBR (30 mg/kg) were administrated daily for 3 weeks. miR-204 expression, total antioxidant capacity, and antiapoptotic protein Bcl-2 significantly declined in the RV of PAH rats, and PA, QS, and BBR treatment significantly compensated for these decreases. Proapoptotic protein Bax and p21 cell cycle inhibitor increased in the RV.
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