Ehlersruiz2127

Moreover, it is devoid of changes in calcium homeostasis and hypothalamic-pituitary-adrenal axis. As a result of its unique formulation, it is easily spread, is rapidly absorbed, and has a rapid onset of action. These features upgrade patient's satisfaction and they may increase adherence to topical therapy.Women with perinatal depression have an increased risk for breastfeeding cessation, yet few studies have explored their lived experience. In this qualitative study, semistructured interviews were conducted with a purposeful sample of women (N = 10) who self-reported perinatal depression. Using Giorgi's descriptive phenomenological method of data analysis, five components were found to embody their lived experience of breastfeeding (a) choosing selflessness, (b) harboring inadequacy, (c) deliberate persevering, (d) discerning meaning, and (e) cherishing intimacy. Findings contribute to understanding the experience of breastfeeding for this population and could provide guidance to improve lactation management and perinatal mental health education for nurses.PURPOSE Adult T-cell lymphoma/leukemia (ATL) is a rare and aggressive peripheral T-cell malignancy caused by human T-cell lymphotropic virus-1 infection, which occurs in areas of high prevalence, predominantly in Japan and the Caribbean basin. Most ATL literature is derived from Japan and little is published about Caribbean patients. We describe the clinicopathologic characteristics and treatment outcomes of our Caribbean patients who have ATL at the State University of New York Downstate Medical Center and Kings County Hospital. PATIENTS AND METHODS We conducted a retrospective analysis of our patients with ATL who were diagnosed between 2005 and 2017. Medical records were reviewed for clinicopathologic data and treatment outcomes. The final analysis included acute and lymphomatous subtypes only. For the univariable analysis, outcomes were calculated by using a log-rank test, and survival curves were estimated by the Kaplan-Meier method. RESULTS We identified 63 patients with acute (55%) and lymphomatous (45%) subtypes, 95% of whom had Ann Arbor stage III to IV disease. The median age was 54 years, and the study population was predominantly female (65%). Most patients (82%) received first-line etoposide, cyclophosphamide, vincristine, doxorubicin, and prednisone (EPOCH) or cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) chemotherapy (10%) with an overall response rate of 46%. The median overall survival was 5.5 months, and the median progression-free survival was 4 months. learn more Incidence of atypical immunophenotype (32%) was higher than previously reported in the Japanese literature and was associated with worse survival (P = .04). Abnormal cytogenetics correlated with shorter progression-free survival (P less then .05). CONCLUSION We describe here the clinicopathologic characteristics and treatment outcomes of our Caribbean patients with aggressive ATL, which is largely chemotherapy resistant, and the challenges of treating a population with unmet medical needs.OBJECTIVE Although recent clinical trials showed that ultrasound (US) remission is not required to achieve good outcomes at the group level, it currently remains unclear whether the prognosis of individual patients in clinical remission, but not US remission, i.e., those with subclinical sonographic synovitis (SSS), is favorable. However, it is no longer acceptable to perform US on all patients in order to identify those with SSS. Therefore, the present study was initiated to elucidate the conditions under which SSS is frequently detected. METHODS In total, 563 consecutive RA patients were recruited. Bilateral 2-5 MCP, wrist, ankle, and 2-5 MTP joints were scanned by US, and Gray scale and Power Doppler (PD) images were scored semi-quantitatively. Clinical data were obtained by physicians who were blind to US results. Changes in the modified Total Sharp Score (mTSS) of tocilizumab (TCZ) users were calculated. RESULTS A total of 402 patients were included. SSS was more frequently detected in patients with more severe joint deformity, even if they were in remission. In contrast, a high Patient Global Assessment of Disease (PtGA) did not reflect SSS. Furthermore, the relationship between PtGA and PD scores was weak. Although the frequency of SSS was high in TCZ user, the presence of SSS in TCZ users not always results in the progression of mTSS. CONCLUSIONS While remission is overestimated in patients with severe joint deformity, underestimations may occur in those who do not fulfill remission criteria because of a high PtGA.BACKGROUND The chaotic and complex nature of delivering patient care in the prehospital setting complicates the provision of real-time formative feedback to paramedic students. Although the use of simulations is widespread in emergency medical services (EMS) education, a high degree of variability precludes consistent performance assessment in EMS. OBJECTIVES The objective of this study was to define and validate key domains required to evaluate paramedic prehospital performance. METHODS We conducted a two-phase study that combined focus group and Delphi methodology. Participants were purposefully selected to attain diverse panels regarding sex, race, ethnicity, professional roles, levels of education, geographical area, and experience as a paramedic and educator. In Phase I, a panel of 11 subject matter experts (SMEs) were tasked with identifying the essential domains to be evaluated in a paramedic performance assessment. In Phase II, another panel of 11 SMEs and a four-round modified Delphi method with 28 paramedic program directors were used to validate the domains identified in Phase I. RESULTS The first focus group identified and achieved consensus on five domains (1) effective communication, (2) scene management, (3) patient assessment, (4) patient management, and (5) professional behavior. These domains were validated by the second focus group. The first round of the Delphi process generated 64 content domains, which were reduced to nine unique content domains via thematic analysis. These nine content domains fit well within the broader domains identified by the focus groups with one specific area, critical thinking and reasoning, being listed in two key areas based on the definitions of the focus group domains of patient assessment and patient management. CONCLUSION The content domains identified in this study provide EMS educators a theoretical framework for designing the performance assessment of newly trained professionals in the prehospital setting.