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irrespective of an atrial fibrillation diagnosis. Notably, two of the thromboembolic events in the NOAC group occurred while therapy was held or inappropriately dosed; when these events are removed, the rate of thromboembolism is 3.8%. This rate is consistent with the VKA group. Our study adds to a small pool of literature regarding the use of NOACs following bioprosthetic cardiac valve replacement and suggests that NOACs may have similar efficacy and improved safety as compared with VKA therapy. Large randomized controlled trials are warranted to confirm our observations.
To deliver effective care, healthcare systems should understand patients' preferences for weight management across a spectrum of needs. Our objective was to describe patients' perceptions of what helps or hinders weight loss and maintenance.
Semistructured interviews were conducted with patients who accessed weight management services at a large integrated health system in 2018. The interview guide was developed and iteratively refined through a literature search and by consulting experts. selleck products Questions included the respondent's weight history, interactions with the health system, and current health status. The analysis used a grounded theory approach, and each transcript was double-coded in 2019. Codes were sorted into themes. All discrepancies were resolved through team discussion.
Fifteen patients were interviewed. The majority of respondents (87%) reported multiple weight loss attempts. Three themes were identified. First, advice should be matched to a patient's knowledge and prior experience (eg, usingd sustain their goals.
Studies have shown that patients enrolled in Medicaid have difficulty obtaining access to care compared with patients with private insurance. Whether variables such as geographic location, state expansion versus nonexpansion, and private versus academic affiliation affect access to care among foot and ankle surgery patients enrolled in Medicaid has not been previously established. The purpose of this study was to assess the differences in access to care between patients who are privately insured and those with Medicaid in need of foot and ankle consultation. Secondary objectives include assessment of whether access to care for foot and ankle patients with Medicaid differs between those with acute and chronic conditions, Medicaid expanded and unexpanded states, geographic regions within the United States, and academic versus private practices.
Twenty providers from each of five Medicaid-expanded and five nonexpanded states in different US geographic regions were randomly chosen via the American Orthopaedices that accept Medicaid.
It is well known that twin pregnancies confer a high degree of adverse perinatal outcomes. Fetal growth restriction, preterm labor/delivery, and hypertensive disorders of pregnancy are among the causal etiologies associated. Hematologic parameters, specifically, the neutrophillymphocyte ratio (NLR), the plateletlymphocyte ratio (PLR), and some of the routine complete blood cell count components denote a peculiar inflammatory and immunologic profile and have been used as clinical markers for specific obstetric syndromes. To our knowledge, no study has ever evaluated NLR/PLR in twins as a distinct population from singletons. Our primary objective was to analyze NLR/PLR in twins compared with singletons. Our secondary objective was to compare white blood cells, neutrophils, lymphocytes, and platelets between twins and singletons.
We conducted a retrospective case-control study comparing NLR/PLR markers in twin gestations (dichorionic/diamniotic and monochorionic/dichorionic) versus singleton pregnancies, froter and a decrease in platelet in the second trimester reflect both the physiologic inflammatory/immune reaction of early pregnancy and denote a vital response for the development of normal placentation in twin gestations.
The concept of "historical alternans" (HA), a teaching folklore term referring to different descriptions of patient histories to trainees versus attending clinicians, can cause disjointed care and be a source of frustration for the trainee. Increased focus on the proper evaluation and treatment of pain in the emergency department (ED) setting prompts an evaluation of the HA concept as it relates to pain.
We conducted a prospective observational pilot study comparing pain descriptions given to attending and trainee clinicians in the ED using a five-question pain description survey. Trainees included emergency medicine physician residents, emergency medicine physician assistant residents, off-service residents, and students. Trainees completed the first survey and attending clinicians repeated survey questions after at least a 10-minute washout. Surveys include descriptions of pain as part of patients' primary concern, severity indicated by a verbal numerical rating score (VNRS), and pain location, quality,esent, they were not significant. HA does occur in the ED setting, but the magnitude of difference may be minimal.
Most patient encounters had at least one difference in categorical pain descriptors between trainee and attending clinicians. Although differences in severity of pain were present, they were not significant. HA does occur in the ED setting, but the magnitude of difference may be minimal.
Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate.
The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions.
After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender.
