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Patient race/ethnicity and education were associated with differences in diabetes quality measures. Depending on the approach used to rate providers, not adjusting for these patient characteristics may penalize or reward providers based on the populations they serve.Congenital superior vena cava (SVC) stenosis is a very rare anomaly, especially in pediatric population. Coexistence with obstructed supracardiac total anomalous pulmonary venous connection (TAPVC) has never been reported. Clinical examination should prompt detailed and focused evaluation for this treatable etiology. Pericardial patch augmentation can cure SVC stenosis, and may allow for growth potential as well. Staurosporine inhibitor We describe a case of congenital SVC stenosis in a case of obstructed supracardiac TAPVC in a 3-month-old infant, managed successfully.The present study extends previous research by examining the moderating/mediating role of social physique anxiety (SPA) on the relationship between physical appearance comparisons (PAC) and symptoms of disordered eating (DE) in adolescent population. A total of 555 emerging adults (59% women) ranging from 18 to 30 years of age (M = 21.34, SD = 2.80) were recruited from two public universities from Spain using a non-probabilistic sampling technique. Participants completed a self-reported questionnaire comprising the variables of research interest. Once the effects of sex (i.e., being men or women), age, body mass index, and depressive symptoms were controlled for, the results from bootstrapping cross-sectional regression analyses supported both the moderating and mediating effect of SPA on the relationship between PAC and DE. Sex did not moderate any of these relationships. From these findings, it follows that incorporating strategies aimed at decreasing PAC and SPA may contribute to improved prevention efforts aimed at decreasing DE among Spanish emerging adults of both sexes.Limited by conventional data collection methods, it is unclear how community-dwelling multimorbid people's daily routines are affected by their co-occurring illnesses. This study investigated the differences in everyday life schedules between multimorbid and nonmultimorbid people. Three hundred community-dwelling adults, representative of the Hong Kong Chinese population, provided real-time self-reports of daily routines over a 7-day study period. Stratified by baseline multimorbidity status, we implemented generalized linear mixed models (binomial) for each of the four outcomes meal, chores, conversation, and work/school, with time intervals as independent variable and potential confounders adjusted. The odds of engaging in these activities were compared between multimorbid and nonmultimorbid participants by time intervals. Significant differences were identified. Unlike nonmultimorbid participants, late evening (2200-2400) was estimated to be the most frequently observed meal time among multimorbid participants (adjusted odds ratio [AOR] = 8.21, 95% confidence interval [CI] = 2.59-26.01 vs. 1400-1600), who also did chores significantly earlier in the morning (AOR = 1.97, 95% CI = 1.09-3.58 in 800-1000 vs. 1400-1600). Conversations were significantly less likely among multimorbid participants throughout the day. Last, multimorbid participants seemed to have less typical working/schooling hours. Further studies are warranted to investigate how these disruptions may lead to lower levels of quality of life and poorer mental health.Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.

Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) represents a unique subset of critically ill patients, with a paucity of data regarding long-term survival and correlated characteristics. We present a retrospective cohort of PC-ECMO patients, with outcomes at 1 and 3 years.

Data were collected retrospectively for all patients requiring ECMO within 72 hours of an index cardiac operation (excluding assist devices and transplants). Primary outcomes were the ability to wean from ECMO, hospital survival, and long-term survival.

Thirty-one patients required PC-ECMO, representing a total of 172 days of ECMO support. Overall survival data were the ability to wean 58%, hospital survival 52%, 1-month survival 42%. The estimated 12- and 36-month survival for all PC-ECMO patients was 35% and 29%, respectively. Twelve and 36-month survival for all hospital survivors was 62% and 56%. Operative times, the Society of Thoracic Surgeons risk scores, type of operation, open chest status, hemorrhage, and cannulomparable to other surgically treated diseases.

Currently, no available tool easily and effectively measures both the frequency, intensity and distress of symptoms among patients receiving radiotherapy. A core symptom set (fatigue, insomnia, pain, appetite loss, cognitive problems, anxiety, nausea, depression, constipation, diarrhoea and skin reaction) has been identified and assessed across oncology research to better understand the pattern of symptoms and treatment side effects.

The aim was to develop a tool measuring the multiple-symptom experience in patients undergoing radiotherapy and evaluate its psychometric properties (validity, reliability and responsiveness).

This study has a prospective, longitudinal and quantitative design.

We developed a patient-reported outcome questionnaire, the Radiotherapy-Related Symptoms Assessment Scale to assess the frequency, intensity and distress associated with symptoms. Patients (n=175) with brain tumours undergoing proton beam therapy completed the Radiotherapy-Related Symptoms Assessment Scale and the hentional radiotherapy.

The Radiotherapy-Related Symptoms Assessment Scale is a valid instrument for assessing symptom intensity and distress in patients with brain tumour undergoing PBT, with psychometric properties within the expected range. The Radiotherapy-Related Symptoms Assessment Scale provides nurses with substantial information on symptom experience but requires little effort from the patient. Additional studies are required to further assess the psychometric properties in patients with different cancer diagnoses receiving conventional radiotherapy.

The opioid epidemic has become a major public health crisis in recent years. Discharge opioid prescription following cardiac surgery has been associated with opioid use disorder; however, ideal practices remain unclear. Our aim was to examine current practices in discharge opioid prescription among cardiac surgeons and trainees.

A survey instrument with open- and closed-ended questions, developed through a 3-round Delphi method, was circulated to cardiac surgeons and trainees via the Canadian Society of Cardiac Surgeons. Survey questions focused on routine prescription practices including type, dosage and duration. Respondents were also asked about their perceptions of current education and guidelines surrounding opioid medication.

Eighty-one percent of respondents reported prescribing opioids at discharge following routine sternotomy-based procedures, however, there remained significant variability in the type and dose of medication prescribed. The median (interquartile range) number of pills prescribe.

Although cutaneous melanoma has been widely evaluated, data elucidating the clinical features and prognostic factors of cutaneous metastatic melanoma are limited.

To determine and compare the clinicoprognostic features of cutaneous metastasis in acral and nonacral melanoma.

The Asan Medical Center database was reviewed for cases of cutaneous metastatic melanoma that had been confirmed by skin biopsy between January 1996 and December 2017.

Cutaneous metastasis occurred in 12.4% (61 of 492 cases) of our cohort. The frequency of cutaneous metastasis was higher in nonacral melanoma than that in acral melanoma. The mean duration between the initial diagnosis of a primary tumor and cutaneous dissemination was 19.8months. Cutaneous metastasis developed earlier during the disease course in acral melanoma than that in nonacral melanoma. Cutaneous metastasis was more disseminated, involving multiple anatomy sites in nonacral melanoma than that in acral melanoma. In-transit metastasis was significantly more common in acral melanoma than that in nonacral melanoma. The disease stage at the time of cutaneous metastasis was not significantly different between acral and nonaral melanoma. In-transit metastasis was commonly associated with visceral involvement in acral melanoma but not in nonacral melanoma. The extent and multiplicity of cutaneous metastasis were dependent on the status of other viscera during the cutaneous metastasis. No significant difference in survival during the cutaneous metastasis was observed between acral and nonacral melanoma.

Clinicoprognostic features of cutaneous metastasis were different between acral and nonacral melanoma.

Clinicoprognostic features of cutaneous metastasis were different between acral and nonacral melanoma.

Overwork has been recognized as a risk factor for cerebrovascular and cardiovascular disease (CCVD). To our best knowledge, Japan is the first country in the world to implement an independent act (the 2014 Act) for the prevention of overwork-related disease, which was promoted through application of preventive measures, such as reductions in working hours. We assessed changes in working hours and overwork-related CCVD before and after introduction of the 2014 Act.

We calculated the overwork-related CCVD incidence rate and average monthly working hours for 10 industry groups in Japan with data from 2012 to 2018. We applied a causal mediation analysis to estimate the total effect of implementing the 2014 Act on the overwork-related CCVD and the effect mediated by working hours.

An average of 271 for every 48 million employees developed overwork-related CCVD per year. After introducing the 2014 Act, the incidence rate ratio of overwork-related CCVD was 0.881-fold lower (95% CI 0.780-0.995) compared with before the policy change. The 2014 Act contributed to a decrease of 26% (78 cases per year; 95% CI 29-173) of the overwork-related CCVD incidence per year. Approximately 41% (32 cases per year) of this effect could be explained by reduced working hours.

Our study highlights the impact of the 2014 Act in Japan on the reduction in working hours, which further contributes to the reduction in overwork-related CCVD. Policymakers should consider adopting our innovative approach to assess the mediation effect underlying the implementation of new policies.

Our study highlights the impact of the 2014 Act in Japan on the reduction in working hours, which further contributes to the reduction in overwork-related CCVD. Policymakers should consider adopting our innovative approach to assess the mediation effect underlying the implementation of new policies.