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Background: The Pulmonary Embolism Quality of Life questionnaire (PEmb-QoL) assesses quality of life (QoL) in patients with previous pulmonary embolism (PE). Objective: Our aim was to assess the agreement between the PEmb-QoL and interviews and to explore other QoL concerns in patients diagnosed with PE. Methods: This mixed-method study included interviews with 21 patients about QoL after PE, followed by the PEmb-QoL questionnaire. In interviews, patients were asked about their lived experiences and impact of PE. Our analysis identified the frequency and severity of decreased QoL in qualitative interviews and compared with the PEmb-QoL score. Excerpts that described the effect of PE on QoL in interview transcripts were transcoded to match the answers corresponding to the 1 to 6 numeric values for each question from the PEmb-QoL using a predetermined matrix (eg, "constant" and "daily" = all of the time = value 1) and directly compared with responses on the PEmb-QoL in the areas of emotional complaints and activities of daily living/social limitations. Results: Interviews showed more functional impairment than predicted by PEmb-QoL. For fear of recurrence, 86% of participants had disagreements between PEmb-QoL scores and transcoded interview scores. We found 42% disagreement between reported descriptions of the inability to do or enjoy hobbies in interviews and the PEmb-QoL score. Conclusion: Patient interviews showed discordances compared with a validated psychometric tool. To capture a more detailed and accurate picture of the effect of PE on QoL, providers and researchers should consider the addition of qualitative methods to assess outcomes.
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BACKGROUND: Establishing trust and effective communication can be challenging in the emergency department, where a prior relationship between patient and provider is lacking and decisions have to be made rapidly. Venous thromboembolism (VTE) represents an emergent condition that requires immediate decision making. OBJECTIVE: The aim of this paper was to document the experiences, perceptions, and the overall impact of health care provider communication on patients during the diagnosis of VTE in the emergency department. METHODS: This was a qualitative method study using semistructured interviews to increase understanding of the patient experience during the diagnosis of VTE and impact of the health care provider communication on subsequent patient perceptions. RESULTS: A total of 24 interviews were conducted. Content analysis revealed that certain aspects of health care providers' communication-namely, word choice, incomplete information, imbalance between fear over reassurance and nonverbal behavior-used to deliver and explain VTE diagnosis, treatment, and prognosis increases patients' fears. CONCLUSION: These interviews elucidate areas for improvement of communication in the emergency care setting for acute VTE.
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INTRODUCTION: The growing interest on how peri-operative interventions, especially regional anesthesia, during cancer surgery can alter oncological outcome increasing disease free survival is probably responsible for the birth of the new subspecialty called onco-anesthesia. A paradigm shift in the concept of anesthetic management has occurred recently owing to the innumerable diverse revelations from the ongoing research in this field. DISCUSSION: Long lasting but reversible epigenetic changes can occur due to surgical stress and perioperative anesthetic medications. The exact relationship between these factors and tumor biology is being studied further. A popular topic under research now is the influence of regional anesthesia on cancer recurrence. Combining nerve blocks with total intravenous anesthesia (TIVA) brings down the requirement of opioids and volatile anesthetic agents implicated in cancer recurrence. The study of mechanism of pain at the molecular level has led to the discovery of novel modes of prevention of chronic post-surgical pain. Newer combination aggressive treatment therapies -intraoperative chemotherapy and radiotherapy, isolated limb perfusion, photodynamic therapy and robotic surgery require specialized anesthetic management. The COVID pandemic introduced new guidelines for safe management of oncosurgical patients .Use of genomic mapping to personalize pain management will be the breakthrough of the decade. CONCLUSION: The discovery that anesthetic strategy could have significant oncological sequel is a quantum leap forward. Avoiding some anesthetic medications may decrease cancer recurrence. Comprehensive cancer care and translational research will pave the way to uncover safe anesthetic practices.
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Anesthesia/methods , Cancer Pain/therapy , Female , Humans , MaleABSTRACT
PurposeThe world is battling with one of the biggest health crisis caused by novel COVID-19. This paper aims to understand the effect of quarantine on the psychological health of college students and the coping strategies adopted by them.Design/methodology/approachThe study adopted the interview method and focused on two crucial open-ended questions: how quarantine has impacted and what are the strategies adopted to overcome the same. The response was recorded through email and phone from a sample of 30 students.FindingsMost of the students stated that they are going through issues like anxiety, depression, infection fear, ambiguity due to this pandemic and the lockdown related to it. However, they engage themselves with various activities that help them to combat this situation.Practical implicationsEducation institutions can focus on conducting online fest and other events to engage students more productively. They can also focus on developing a wellness application to support these students. They can provide solutions and tips to balance mental health and wellness during these times.Originality/valueEveryone knows about COVID-19 and the measures taken related to it, but not much about the impact of it on mental health. This paper discusses the negative impact of quarantine on students and coping strategies adopted by them. The strategies mentioned in the study can guide quarantined people, student community, parents, counsellors and academic facilitators to handle the situation in a better way.
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In the emergency of the SARS-CoV-2 pandemic, great efforts were made to quickly provide serology testing to the medical community however, these methods have been introduced into clinical practice without the complete validation usually required by the regulatory organizations. SARS-CoV-2 patient samples (n = 43) were analyzed alongside pre-pandemic control specimen (n = 50), confirmed respiratory infections (n = 50), inflammatory polyarthritis (n = 22) and positive for thyroid stimulating immunoglobulin (n = 30). Imprecision, diagnostic sensitivity and specificity and concordance were evaluated on IgG serologic assays from EuroImmun, Epitope Diagnostics (EDI), Abbott Diagnostics and DiaSorin and a rapid IgG/IgM test from Healgen. EDI and EuroImmun imprecision was 0.02-14.0% CV. Abbott and DiaSorin imprecision (CV) ranged from 5.2%-8.1% and 8.2%-9.6% respectively. Diagnostic sensitivity of the assays was 100% (CI: 80-100%) for Abbott, EDI and EuroImmun and 95% (CI: 73-100%) for DiaSorin at ≥14 days post PCR. Only the Abbott assay had a diagnostic specificity of 100% (CI: 91-100%). EuroImmun cross-reacted in 3 non-SARS-CoV-2 respiratory infections and 2 controls. The DiaSorin displayed more false negative results and cross-reacted in six cases across all conditions tested. EDI had one cross-reactive sample. The Healgen rapid test showed excellent sensitivity and specificity. Overall, concordance of the assays ranged from 76.1% to 97.9%. Serological tests for SARS-CoV-2 showed good analytical performance. The head-to-head analysis of samples revealed differences in results that may be linked to the use of nucleocapsid or spike proteins. The point of care device tested demonstrated adequate performance for antibody detection.