Boonelivingston1522

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INTRODUCTION Transparency about the costs that patients incur is an increasingly important factor in making decisions throughout the course of diagnosis and treatment. Both patients and providers regard honest, informed discussions about these costs as critical to providing person-centered care, but often encounter a range of barriers to initiating and maintaining these conversations. METHODS The Patient Advocate Foundation/National Patient Advocate Foundation with partial funding from the Robert Wood Johnson Foundation has conducted both quantitative and qualitative research with patients and providers designed to identify key issues related to cost of care discussions. RESULTS Key issues identified include components of financial toxicity for patients, both related to direct costs and to quality of life, as well as questions as to who should initiate these conversations, when they should take place, and what kind of information and training are needed to make these conversations meaningful. CONCLUSIONS This article reports the results of this work with recommendations for providers about how to incorporate cost of care discussions into the normal clinical work flow and patient life flow. BACKGROUND Cervical cancer is the fourth most common cancer amongst women worldwide. In the United States, its incidence and mortality have been declining due to the wide scale implementation of cytological screening programs. However, there have been geographic disparities in cervical cancer, particularly in the US. OBJECTIVE This review will outline the overall incidence of cervical cancer and discuss the causes for disparities in its incidence and mortality rates. METHODS A literature review was performed from 1999 to 2020 of English language manuscripts on the incidence and reasons for disparities in mortality rates of cervical cancer. RESULTS Racial and ethnic minorities, socioeconomically disenfranchised, and those in rural areas have disparate rates of vaccination, screening and treatment of cervical cancer, leading to worse outcomes. CONCLUSIONS By addressing these disparities via increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved. Oncogenic fusions involving neurotrophic receptor tyrosine kinase (NTRK) genes are being increasingly identified in a range of mesenchymal tumours unrelated to infantile fibrosarcoma or cellular congenital mesoblastic nephroma, where the canonical ETV6-NTRK3 fusion was first described more than two decades ago. Recognition of these NTRK-rearranged tumours poses a diagnostic challenge to surgical pathologists due to their non-specific clinical and pathological features. However, their recognition is of heightened importance, particularly in locally advanced and metastatic sarcomas, due to the recent availability of selective and highly effective targeted therapy. Herein, we present an Australian multi-institutional series of six of these rare NTRK-rearranged mesenchymal neoplasms to share the local experience and diagnostic challenges as well as to highlight key morphological patterns and immunoprofiles that provide the most helpful clues in routine practice. We also propose a diagnostic algorithm for the detection of these fusions, drawing attention to the limitations of ancillary studies including immunohistochemistry against tropomyosin receptor kinase (TRK) protein, fluorescence in situ hybridisation (FISH) and next generation sequencing. BACKGROUND Attachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women. AIM The present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness. METHOD This is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function. Epacadostat RESULTS We found that both attachment anxiety and sexual refusal showed a significant associatiolationship. CONCLUSIONS Our results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties. Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;XXXXX-XXX. OBJECTIVE Adult-onset laryngomalacia is a rare clinical entity that has been infrequently reported. This study aims to evaluate the clinical presentation, diagnosis, and management of adult-onset laryngomalacia through literature review and report of a case. METHODS PubMed and Google Scholar databases were queried for articles published from 1960 to 2019 including only patients aged 18 years and older. Included keywords were 'laryngomalacia', 'adult laryngomalacia', 'acquired laryngomalacia', 'idiopathic laryngomalacia', 'laryngeal obstruction', 'floppy epiglottis', 'floppy epiglottis', and 'epiglottis prolapse'. Data extracted from literature included clinical presentation, diagnostic workup, surgical management, and follow-up care. SOURCES PubMed and Google Scholar. RESULTS A total of 21 articles reported 41 cases of adult-onset laryngomalacia. Within these cases, 5 etiologies were identified neurologic (n = 14), exercise-induced (n = 9), post-operative (n = 7), idiopathic (n = 7), and age-related (n = 4) laryngomalacia. Anterior prolapse of arytenoids and aryepiglottic folds was the most common laryngoscopic finding (n = 21), followed by posterior epiglottic prolapse (n = 20). Management included supraglottoplasty (n = 14), epiglottidectomy (n = 8) or epiglottopexy (n = 2). Neurologic etiology required tracheotomy more often than the other etiologies (n = 5, 36% vs. 15%). Three patients were managed expectantly without surgical intervention and reported symptom resolution. CONCLUSION Adult laryngomalacia is a rare diagnosis comprising a spectrum of disease. This diagnosis may be overlooked, but association with neurologic injury or trauma should encourage consideration. In comparison to pediatric laryngomalacia, patients often require surgical intervention. Surgical decision is based on the direction of supraglottic collapse, where supraglottoplasty and partial epiglottidectomy are effective interventions. LEVEL OF EVIDENCE N/A. Epacadostat