Patients´ experiences in a newly established clinic for late complications after colorectal and anal cancer treatment: a qualitative study

Purpose Treatment of late complications is not systematically provided in Denmark. We therefore established a clinic to treat patients´ late complications. With this study we wanted to explore patients´ experiences with treatment and care in the clinic, including their recommendations for the future organization and structure of the clinic. Methods We conducted a qualitative semi-structured interview study with patients who had attended our late complication clinic after treatment for colorectal or anal cancer. Results We included 14 patients. We found two main categories: 1: benefitting from the late complication clinic and 2: preparation and delivery of the consultations. Patients benefitted from attending the late complication clinic and some experienced complete relief from symptoms. Others did not, but they gained hope that they might be able to receive treatment in the future. Patients wished for more information about late complications, preferring that the most common symptoms were described along with patient-friendly treatment options. The patients were satisfied with telephone consultations, as they were easy to fit into a daily schedule, and patients found it easy to express themselves openly. Conclusions Patients were satisfied with the late complication clinic as they felt it gave them a safety net. For the future, patients recommended provision of more information about late complications and possible treatments.

Prospective study evaluating dynamic changes of cell-free HPV DNA in locoregional viral-associated oropharyngeal cancer treated with induction chemotherapy and response-adaptive treatment

Background Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) has a favorable prognosis which has led to efforts to de-intensify treatment. Response-adaptive de-escalated treatment is promising, however improved biomarkers are needed. Quantitative cell-free HPV-DNA (cfHPV-DNA) in plasma represents an attractive non-invasive biomarker for grading treatment response and post-treatment surveillance. This prospective study evaluates dynamic changes in cfHPV-DNA during induction therapy, definitive (chemo)radiotherapy, and post-treatment surveillance in the context of risk and response-adaptive treatment for HPV + OPC. Methods Patients with locoregional HPV + OPC are stratified into two cohorts: High risk (HR) (T4, N3, $$\ge$$ ≥ 20 pack-year smoking history (PYH), or non-HPV16 subtype); Low risk (LR) (all other patients). All patients receive induction chemotherapy with three cycles of carboplatin and paclitaxel. LR with ≥ 50% response receive treatment on the single-modality arm (minimally-invasive surgery or radiation alone to 50 Gy). HR with ≥ 50% response or LR with ≥ 30% and < 50% response receive treatment on the intermediate de-escalation arm (chemoradiation to 50 Gy with cisplatin). All other patients receive treatment on the regular dose arm with chemoradiation to 70 Gy with concurrent cisplatin. Plasma cfHPV-DNA is assessed during induction, (chemo)radiation, and post-treatment surveillance. The primary endpoint is correlation of quantitative cfHPV-DNA with radiographic response. Discussion A de-escalation treatment paradigm that reduces toxicity without compromising survival outcomes is urgently needed for HPV + OPC. Response to induction chemotherapy is predictive and prognostic and can select candidates for de-escalated definitive therapy. Assessment of quantitative cfHPV-DNA in the context of response-adaptive treatment of represents a promising reliable and convenient biomarker-driven strategy to guide personalized treatment in HPV + OPC. Trial registration This trial is registered with ClinicalTrials.gov on October 1st, 2020 with Identifier: NCT04572100.

Clinical Performance of the Xpert® CT/NG Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae: A Multicenter Evaluation in Chinese Urban Hospitals

BackgroundWe aimed to evaluate the clinical performance of the GeneXpert® (Xpert) CT/NG assay for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using urine and cervical swabs collected from patients in China.MethodsThis study was conducted from September 2016 to September 2018 in three Chinese urban hospitals. The results from the Xpert CT/NG test were compared to those from the Roche cobas® 4800 CT/NG test. Discordant results were confirmed by DNA sequence analysis.ResultsIn this study, 619 first void urine (FVU) specimens and 1,042 cervical swab specimens were included in the final dataset. There were no statistical differences between the results of the two tests for the detection of CT/NG in urine samples (p &gt; 0.05), while a statistical difference was found in cervical swabs (p &lt; 0.05). For CT detection, the sensitivity and specificity of the Xpert test were 100.0% (95%CI = 96.8–99.9) and 98.3% (95%CI = 96.6–99.2) for urine samples and 99.4% (95%CI = 96.5–100.0) and 98.6% (95%CI 97.5–99.2) for cervical swabs, respectively. For NG detection, the sensitivity and specificity of the Xpert test were 99.2% (95%CI = 94.9–100.0) and 100.0% (95%CI = 99.0–100.0) for urine and 100% (95%CI = 92.8–100.0) and 99.7% (95%CI = 99.0–99.9) for cervical swabs, respectively.ConclusionThe Xpert CT/NG test exhibited high sensitivity and specificity in the detection of CT and NG in both urine and cervical samples when compared to the reference results. The 90-min turnaround time for CT and NG detection at the point of care using Xpert may enable patients to receive treatment promptly.

A review of disparities in access to infertility care and treatment outcomes among Hispanic women

Hispanic women have lower rates of use of infertility services than non-Hispanic White women. There are many barriers that impede access to infertility care including economic, geographic, cultural, and societal factors and there are disparities in treatment outcomes. Hispanic women are less likely to seek infertility care than non-Hispanic White women and even after infertility evaluation, Hispanic women are less likely to receive treatment for their infertility. Lower use of infertility treatments among Hispanic women is unlikely to be driven solely by economic factors. There is disappointingly little data on in-vitro fertilization treatment outcomes including the population of Hispanic women, and existing data has yielded conflicting results. Incomplete and variable reporting of race data across clinics raises the potential for misclassification bias and invalid study conclusions. Addressing disparities in access to reproductive medicine in the Hispanic population will required a multifaceted approach including expanded insurance coverage, improved education for both patients and providers, and additional research on barriers to care.

The Impact of a Pandemic COVID-19 on the Incidence of Borreliosis in Poland

Purpose Lyme disease is the most common tick-borne disease, caused by spirochetes of the genus Borrelia, transmitted by ticks of the Ixodes genus in Poland. The purpose of this analysis was whether the COVID-19 outbreak had a significant impact on the number of reported Lyme disease cases. Materials and Methods The data included in the World Health Organization (WHO) and the data from the “Reports on incidence of infectious diseases, infections and poisoning in Poland” presented by the Department of Epidemiology NIZP-PZH were analyzed. Results To the end of 2020, there were registered 12, 524 Lyme disease cases. In the same period, in 2018 and 2019 were registered, respectively, 20, 150 and 20, 614 Lyme disease cases. The overall number of Lyme disease cases in 2018 and 2019 was at a similar level. The monthly increase in the number of cases was also at a similar level. The year 2020 in January and February was characterized by the same increase in the number of cases as in previous years. The difference started to be noticeable in March and the lowered growth compared to the previous years has been maintained to this day. In December, about 8, 000 fewer cases of Lyme disease were registered than in previous years. Conclusion The reduced number of cases of Lyme disease coincided with the beginning of the COVID-19 epidemic in Poland in March 2020. Every year, the incidence of Lyme disease in Poland is at a similar level with a similar monthly increase. The outbreak of the COVID-19 pandemic had a significant impact on the number of cases recorded, which could have catastrophic consequences for people who did not receive treatment in the right time.

Awareness and attitude of TB amongst undergraduates at the Rivers State University

Background:Creating awareness of TB amongst undergraduates of institutions of higher learning cannot be over emphasized. Health care delivery can be disseminated outside the walls of the hospital indirectly through undergraduates of higher learning by providing relevant information about disease condition, in this scenario TB in focus. Aim:To determine the awareness and attitude ofTB amongst undergraduates at the Rivers State University. Method:This was a cross-sectional study of 311 undergraduates at the Rivers State University. Permission to conduct the study was granted by the Provost of the College of Medicine, Rivers State University. Informed consent was obtained from the respondents. The data collected was analysed using SPSS version 25. Results:Three hundred and eleven respondents participated in the study. There were 186 (60%) males and 125 (40%) females. The mean age was 24years; 285(91.6%) were aware of TB; 251(80.7%) of relations of respondents had open TB of which 40 (12.9%) were treated;36 (11.5%)had contact training for TB, while 172 (55.3%) were aware of Direct Observe Therapy (DOT) for the treatment of TB. Conclusion: The study revealed that the awareness of TB amongst undergraduates at Rivers State University was 91.6%; 80.7% of the relatives of the respondents of the undergraduates had open TB of which only 12.9% were treated and 11.5% had contact training; 55.3% were aware of DOT. There is need to encourage persons with TB to receive treatment.

“C@nnected” : Group videoconferencing intervention to improve maternal sensitivity in mothers-infant dyads attending primary care in Chile: Protocol for a randomized feasibility trial (Preprint)

BACKGROUND Early childhood development is highly dependent on the sensitive care provided by their caregivers. Interventions focused on supporting parents to improve their sensitivity have been shown to be effective. The COVID-19 pandemic has had a great impact on mental health. Pregnant women and mothers of infants being an especially vulnerable group, and maternal sensitivity is particularly affected. On the other hand, access to face-to-face interventions is restricted, above all group interventions, so it is relevant to have remote interventions to support this group of mothers. OBJECTIVE The objective of the study is to evaluate the feasibility and acceptability of a group videoconferencing intervention : “C@nnected” to improve maternal sensitivity aimed at mother-infant dyads attended in Primary Health Care in vulnerable areas of Santiago , Chile. METHODS This is a randomized pilot feasibility study single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation (with more people allocated to the intervention arm). The intervention consists of four group videoconferencing sessions, adapted from a face-to-face intervention of proven effectiveness. The control group will receive treatment as usual plus educational brochures. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Changes in clinical outcomes will also be evaluated: maternal sensitivity, depressive symptoms, postnatal maternal attachment, and infant socio-emotional development. RESULTS We have completed the adaptation of the face-to-face intervention to the videoconferencing format, our study is currently in the recruitment phase, which is expected to be completed by January 2022, the results of the study are expected by August 2022. CONCLUSIONS This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. CLINICALTRIAL ClinicalTrials.gov, NCT04904861.

Europe in the aftermath of the refugee crisis: the effect on forensic psychotherapy

After World War II Germany has repeatedly suffered waves of immigration. With eighteen to twenty per cent of the entire German population now being of foreign descent, it is puzzling that public opinion widely ignores the impact of migration on Germany’s national destiny and identity. As forensic therapists we routinely apply a set of assumptions and routines, by which we address internal and external culture conflicts of migrants. Each wave has challenged the justice system and the legislature, and forensic therapists are used to working around legal boundaries to safeguard that migrants receive treatment and are not deported. The uniqueness of the present wave of migration lies in the overwhelmingly high numbers of arrivals in a very short time span, many of whom were traumatised unaccompanied male minors with ill-informed expectations. Europe in its entirety has seen the breakdown of existing structures for receiving and accommodating refugees alongside a surge of solidarity, but also with some alarming loss of empathy. Public bias against migration is beginning to impinge on our forensic work, as we deal with migrants, whose difficult life situation has had a bearing on their criminal behaviour, while forensic assessments determine whether they are going to be deported or not. We as forensic therapists are therefore caught in a professional dilemma whichever way we turn.

We’re in This Together: Community Coalition Approaches to Treating Depression

Background and Objective: Depression is the leading cause of disability worldwide, yet approximately one-third of adults diagnosed with major depressive disorder do not receive treatment. Health coalitions are one strategy towards addressing this issue through collaborative, multi-sector interventions implemented within community organizations. In this narrative review, we examine what evidence exists that coalitions may improve outcomes of depression. Methods: A search for peer-reviewed literature was conducted using PubMed, CINHAL, MEDLINE, and PsychINFO databases. The search was limited to studies published in the English language. No limitations were placed on location or date of publication. Initial search produced a total of 236 articles. Of these, 34 met inclusion criteria. Papers that did not address depression interventions in the context of community health coalitions were excluded. Results: Community Partners in Care, a double-blinded randomized control trial, is the primary model in literature that describes outcomes of coalitions in addressing depression. 6-month outcomes revealed that participants treated through a coalition model (n=504) as opposed to those in a non-coalition approach (n=512) had significantly improved self-reported mental health related quality of life and a reduced number of behavioral health hospitalizations. 3-year and 4-year outcomes revealed participants in the coalition model had increased odds of clinical depression remission. While many other studies documented coalition-based interventions, there was little to no report of treatment effectiveness. Project Impact: Current literature suggests that coalitions may be an effective method of addressing depression, particularly in under-resourced areas where community members are more likely to access care through social services. In addition, churches and schools were identified as key partners for coalitions, as trusted informal networks for mental health support. While results support coalition utility for mental health intervention, more research is needed to determine what, if any, unique attributes of coalitions are necessary to insure effective mental health interventions.

Clinical outcomes after telemedicine abortion with and without ultrasound: a multinational cohort study

Objective: To evaluate the association between pre- and postabortion ultrasound and clinical outcomes after telemedicine abortion. Design: Cohort study Setting: Chile, Northern Ireland, Poland, South Korea. Population: 5298 women who performed abortion through the telemedicine service Women on Web (WOW), January 1st 2016 – December 31st 2019. Methods: We performed a retrospective cohort study on the associations between use of ultrasound pre-abortion and clinical outcomes using unconditional multivariate logistic regression. Intervention rates following routine or clinically indicated postabortion ultrasound were analysed using descriptive statistics. Main outcome measures: Self-reported rates of heavy bleeding, clinical visits within 2 days of the abortion, treatment for incomplete abortion, continuing pregnancy, and satisfaction. Results: Women with and without a pre-abortion ultrasound had similar rates of heavy bleeding (10.5% vs10%, AOR 0.98, 95% CI= 0.8-1.19), continuing pregnancy (1% vs 1.3%, AOR 0.68, 95% CI= 0.39-1.19), and satisfaction (96.8% vs 97%, AOR 0.95, 95% CI= 0.67-1.35). Women with a pre-abortion ultrasound were more likely to visit a hospital within two days of the abortion (6.6% vs 4.4%, AOR 1.35, 95% CI= 1.04-1.75) and receive treatment for incomplete abortion (13.7% vs 8.7%, AOR 1.58, 95% CI= 1.32-1.9). Overall rates of surgical evacuation for incomplete abortion were 9.8% after routine postabortion ultrasound and 27.6% for clinically indicated ultrasound. Conclusion: Non-use of pre-abortion ultrasound was not associated with higher rates of adverse clinical outcomes or lower satisfaction. Routine postabortion ultrasound may result in unnecessary clinical interventions. The results come from observational data where a certain selection bias is possible.