Wileymay8359

Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = -1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school.

Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.

Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.

Hypnosis in labour and childbirth is a complex intervention. Both qualitative and quantitative assessment methods have been used, but have targeted different outcomes. We followed a synergistic approach and a reconciliation strategy to further understand and evaluate this intervention.

A mixed-method analysis of quantitative and qualitative evidence was conducted. The assessment of efficacy was based on a recent Cochrane review (9 trials, 2954 women randomised). Four qualitative studies and 4 case studies were included.

The outcomes addressed by the qualitative studies (mostly concerning maternal experiences) and in the quantitative studies (mostly concerning analgesic use) overlapped slightly. Curzerene datasheet Discrepancies across results from the two study types suggested that response shift issues could occur.

Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience.

Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience.Surgery retains a major role in the treatment of Crohn's disease, and the prevention of post-operative recurrence is an essential issue. In fact, despite the increasing use of biotherapies, almost all of the patients who undergo surgery will present with a recurrence, initially endoscopic and then clinical, eventually leading to a second intervention in 15 to 20% of cases. Certain risk factors for recurrence such as smoking, repeated and/or extensive resections, anoperineal involvement, myenteric plexitis, epithelioid granulomas, penetrating disease behaviour and lack of post-operative prophylactic treatment have been well established. Currently, measures to prevent post-operative recurrence are based mainly on smoking cessation in all patients and the prescription of anti-TNFα medications for patients with a high risk of recurrence (at least two risk factors for recurrence). However, new surgical techniques have recently been described which could modify post-operative prevention strategies. Kono's lateral anti-mesenteric anastomosis could significantly reduce clinical and endoscopic recurrence compared to conventional anastomosis techniques. Long latero-lateral isoperistaltic stricturoplasties have been shown to be feasible and are associated with a low rate of long-term symptomatic recurrence requiring surgery. In a preliminary series, intestinal resections with extensive mesenteric resection reduced the rate of recurrence in comparison with patients operated on conventionally (3% vs. 40% at five years). If the results of these new surgical techniques are confirmed, the indications for post-operative immunomodulatory treatments could be downgraded in patients currently considered to be at high risk of recurrence.

Adrenocortical carcinoma (ACC) is a rare cancer with few well-powered studies regarding epidemiology or outcomes and even fewer studies to guide an evidence-based management approach. The effect of radiation therapy (RT) is particularly understudied and remains unclear, outside of general oncologic principles. We sought to describe current care patterns in the management of ACC and how these practices affect survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) database.

Patients with ACC who could be staged by the American Joint Committee on Cancer (AJCC) system diagnosed between 1988 and 2015 were included. A classification and regression tree analysis identified subgroups of patients who may have benefitted from RT. Multivariable Cox regression analysis was used to compare overall survival (OS). Propensity score adjustment was used to compare OS for a subset of node-negative, nonmetastatic patients who received adjuvant RT following radical surgery.

Among 865 eligible patients included in the analysis, only 10.5% received RT. In stage III node-negative patients, adjuvant RT following radical surgery was associated with a significantly improved OS compared with surgery alone.

Medically fit persons with stage III, node-negative ACC should receive adjuvant RT after surgical resection.

Medically fit persons with stage III, node-negative ACC should receive adjuvant RT after surgical resection.

Urachal carcinoma (UrC) is a rare malignancy that often presents at an advanced stage with metastases in up to a quarter of patients. There is no consensus on the optimal form of staging for patients with UrC. In the present study, we evaluated the diagnostic value of

F-fluorodeoxyglucose-positron emitted tomography/computed tomography (FDG-PET/CT) for UrC.

We evaluated 40 consecutive patients who were staged for urachal cancer between 2010 and 2020. They underwent a total of 62 FDG-PET/CTs (40 for primary staging, and 22 during follow-up), which were compared with standard-of-care contrast-enhanced CT (CECT). The metabolic detection of primary tumors, lymph node metastases (LNMs), peritoneal metastases (PMs), distant metastases (DMs), and local recurrence by FDG-PET/CT was evaluated. Sensitivity and specificity were calculated compared with CECT. Histopathology or follow-up imaging was the reference standard.

Of all 40 patients, 33 patients (83%) had urachal adenocarcinoma-26 (65%) with a mucinous co corroborated with larger series.

Health inequities and socio-economic disadvantage are causes for concern in Aotearoa New Zealand. Becoming pregnant can increase a woman's vulnerability to poverty, with the potential for an increase in multiple stressful life events. Providing midwifery care to women living in socio-economic deprivation has been found to add additional strains for midwives. Exploring the perspectives of the midwives providing care to women living with socio-economic deprivation can illuminate the complexities of maternity care.

To explore the impact on midwives when providing care for socio-economically disadvantaged women in Aotearoa New Zealand.

Inductive thematic analysis was used to analyse an open-ended question from a survey that asked midwives to share a story around maternal disadvantage and midwifery care.

A total of 214 stories were received from midwives who responded to the survey. Providing care to disadvantaged women had an impact on midwives by incurring increased personal costs (time, financial and emotional), requiring them to navigate threats and uncertainty and to feel the need to remedy structural inequities for women and their wider families. These three themes were moderated by the relationships midwives held with women and affected the way midwives worked across the different maternity settings.

Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.

Midwives carry a greater load when providing care to socio-economically deprived women. Enabling midwives to continue to provide the necessary support for women living in socio-economic deprivation is imperative and requires additional resources and funding.The pectoralis major flap (PMF) is one of the most used pedicled flaps for reconstructive surgery in head and neck. Basing on previous studies observing that a vascular accident or pedicle ligation not always resulted in necrosis of free flaps, sometimes after a short critical period, we describe the possibility to perform the division of the PMF pedicle. The autonomization of PMF is based on the hypothesis that the flap, after a critical period, develops a neoangiogenesis at the free portion in the recipient site. It represents a possible choice in selected patients with relapse or second tumour of the oral floor and/or mobile tongue, who have been already treated with PMF reconstruction. We provide a step-by-step description of the autonomization and use of the modified PMF. Moreover, we reported advantages and pitfalls. The modified PMF represents a safe reconstructive choice for patients advised against a free flap or a second pedicled flap, with good surgical outcomes.

Bariatric surgery has been a popular way for many women to reach a healthy body mass index, and as a consequence, a decreased body mass, which causes a greater chance of fertility, with improved pregnancy and better maternal outcomes.

Describe a single-center experience of pregnancies complicated by internal hernias after gastric bypass.

Academic Medical Center.

During 2011 and 2019 a series of patients were treated for internal hernia after gastric bypass at our teaching hospital. The hospital records were retrospectively reviewed.

Seven women were treated. Median age was 33 years (range 24-39 yr). Median gestational age was 25.6 weeks (range 5-33 wk). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range 1-7 yr). Median body mass index was 24 kg/m

(range 24-31 kg/m

). Five (71.4%) patients underwent an exploratory laparotomy, and 2 (28.5%) patients a diagnostic laparoscopy. In all patients, an internal hernia of the small bowel in the Petersen space was encountered. Median length of pregnancy was 38 weeks (range 33.6-39.6 wk). Six (85.7%) patients underwent C-section, and 1 (14.2%) patient gave birth by vaginal delivery. There was only 1 maternal postoperative complication and no fetal postoperative complications. Median follow-up was 9 months (range 2-20 mo).

The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.

The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.

The Emory Family Medicine Clinic (EFMC) sought to identify perceptions of recent patient-provider communications for patients with diabetes, factors influencing patient compliance with clinical recommendations, and patients' desire for additional resources to facilitate diabetes management.

Four focus group discussions were held June-August 2018 (3-9 participants each, 21 total). EFMC patients with uncontrolled diabetes received a phone invitation. A template analytic strategy, characterized by an initial set of codes based on interview content and expected types of responses and inductive codes, was used to thematically code the data.

Most participants were single (62%), college educated (62%), had incomes less than $60,000 (76%), and were younger than 50 years old (62%). For themes related to barriers to compliance the participants mentioned the "business of medicine," convenience factors, food choices, accountability, feeling overwhelmed, costs, location/transportation, and miscommunications. Prevailing themes regarding facilitating compliance included a desire for help with self-accountability and prioritization of recommendations.