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1.
J Pediatr ; 213: 196-202, 2019 10.
Article in English | MEDLINE | ID: mdl-31230890

ABSTRACT

OBJECTIVE: To describe the experiences of youth regarding confidentiality with their healthcare provider and how confidentiality affects their interactions with the healthcare system. STUDY DESIGN: Using MyVoice, a national mixed methods text message poll, 4 qualitative probes were asked to 1268 youth age 14-24 years from July 2017 through December 2017. Respondents were asked about their opinions and experiences with confidentiality in their healthcare. Data were analyzed using a modified grounded theory approach. RESULTS: The overall response rate was 75% (n = 948) with a mean age of 18.6 years (SD = 3.2). Respondents were mostly female (56%) and white (70%) with 44% reporting some college education or greater. Qualitative analysis revealed that the majority of youth have not had a conversation with their provider about confidentiality; many youth think all care should be confidential; youth worry about privacy and future discrimination; and youth may lie about their risk behaviors or not seek healthcare when concerned about confidentiality. CONCLUSIONS: Confidentiality in healthcare is concerning to many youth and affects how they interact with the healthcare system. It is imperative for healthcare providers to discuss confidentiality while building trusting relationships with each youth to provide the highest level of care for this vulnerable population.


Subject(s)
Confidentiality , Patient Satisfaction , Physician-Patient Relations , Adolescent , Communication , Female , Grounded Theory , Health Personnel , Humans , Male , Patient Participation , Poverty , Privacy , Qualitative Research , Risk-Taking , Social Media , Text Messaging , Young Adult
2.
Pain Med ; 18(8): 1582-1592, 2017 Aug 01.
Article in English | MEDLINE | ID: mdl-28340147

ABSTRACT

OBJECTIVE: Fibromyalgia is a chronic pain condition with few effective treatments. Many fibromyalgia patients seek acupuncture for analgesia; however, its efficacy is limited and not fully understood. This may be due to heterogeneous pathologies among participants in acupuncture clinical trials. We hypothesized that pressure pain tenderness would differentially classify treatment response to verum and sham acupuncture in fibromyalgia patients. DESIGN: Baseline pressure pain sensitivity at the thumbnail at baseline was used in linear mixed models as a modifier of differential treatment response to sham versus verum acupuncture. Similarly, needle-induced sensation was also analyzed to determine its differential effect of treatment on clinical pain. METHODS AND PATIENTS: A cohort of 114 fibromyalgia patients received baseline pressure pain testing and were randomized to either verum (N = 59) or sham (N = 55) acupuncture. Participants received treatments from once a week to three times a week, increasing in three-week blocks for a total of 18 treatments. Clinical pain was measured on a 101-point visual analog scale, and needle sensation was measured by questionnaire throughout the trial. RESULTS: Participants who had higher pain pressure thresholds had greater reduction in clinical pain following verum acupuncture while participants who had lower pain pressure thresholds showed better analgesic response to sham acupuncture. Moreover, patients with lower pressure pain thresholds had exacerbated clinical pain following verum acupuncture. Similar relationships were observed for sensitivity to acupuncture needling. CONCLUSIONS: These findings suggest that acupuncture efficacy in fibromyalgia may be underestimated and a more personalized treatment for fibromyalgia may also be possible.


Subject(s)
Acupuncture Analgesia , Fibromyalgia/therapy , Pain Management/methods , Pain Threshold/physiology , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Measurement , Young Adult
3.
Gynecol Oncol Case Rep ; 4: 29-31, 2013.
Article in English | MEDLINE | ID: mdl-24371671

ABSTRACT

► PET-CT scan was positive for metastasis of vulvar cancer to lymph nodes however they were histologically negative. ► Frozen section analysis should be performed at the time of surgery to confirm status of suspicious lymph nodes.

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