Diagnostic Experience Research Articles

Barriers and facilitators to early-stage lung cancer care in the USA: a qualitative study.

Improved outcomes in lung cancer treatment are seen in high-volume academic centers, making it important to understand barriers to accessing care at such institutions. Few qualitative studies examine the barriers and facilitators to early-stage lung cancer care at US academic institutions. Adult patients with suspected or diagnosed early-stage non-small cell lung cancer presenting to a multidisciplinary lung cancer clinic at a US academic institution over a 6-month period beginning in 2019 were purposively sampled for semi-structured interviews. Semi-structured interviews were conducted and a qualitative content analysis was performed using the framework method. Themes relating to barriers and facilitators to lung cancer care were identified through iterative team-based coding. The 26 participants had a mean age of 62years (SD: 8.4years) and were majority female (62%), white (77%), and urban (85%). We identified 6 major themes: trust with providers and health systems are valued by patients; financial toxicity negatively influenced the diagnostic and treatment experience; social constraints magnified other barriers; patient self-advocacy as a facilitator of care access; provider advocacy could overcome other barriers; care coordination and good communication were important to patients. We have identified several barriers and facilitators to lung cancer care at an academic center in the US. These factors need to be addressed to improve quality of care among lung cancer patients. Further work will examine our findings in a community setting to understand if our findings are generalizable to patients who do not access a tertiary cancer care center.

LATE-NC staging in routine neuropathologic diagnosis: an update

An international consensus report in 2019 recommended a classification system for limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC). The suggested neuropathologic staging system and nomenclature have proven useful for autopsy practice and dementia research. However, some issues remain unresolved, such as cases with unusual features that do not fit with current diagnostic categories. The goal of this report is to update the neuropathologic criteria for the diagnosis and staging of LATE-NC, based primarily on published data. We provide practical suggestions about how to integrate available genetic information and comorbid pathologies [e.g., Alzheimer’s disease neuropathologic changes (ADNC) and Lewy body disease]. We also describe recent research findings that have enabled more precise guidance on how to differentiate LATE-NC from other subtypes of TDP-43 pathology [e.g., frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS)], and how to render diagnoses in unusual situations in which TDP-43 pathology does not follow the staging scheme proposed in 2019. Specific recommendations are also made on when not to apply this diagnostic term based on current knowledge. Neuroanatomical regions of interest in LATE-NC are described in detail and the implications for TDP-43 immunohistochemical results are specified more precisely. We also highlight questions that remain unresolved and areas needing additional study. In summary, the current work lays out a number of recommendations to improve the precision of LATE-NC staging based on published reports and diagnostic experience.

Two years on and four waves later: Johannesburg diagnostic radiographers’ experiences of COVID-19

IntroductionAt the onset of COVID-19 diagnostic radiographers from Gauteng, South Africa, shared their experiences of the new workflow and operations, their well-being and their resilience during this time. They experienced emotional, physical and financial fatigue. It is now over two years later, and South Africa has experienced four waves of COVID-19. Therefore, this study explored diagnostic radiographers' experience of COVID-19 after two years and four waves. MethodsA qualitative explorative, descriptive and contextual study was conducted by collecting data through nine virtual individual in-depth interviews. Responses from the diagnostic radiographers in Johannesburg, Gauteng, South Africa, underwent thematic analysis. ResultsThematic analysis revealed two themes and related categories. Theme one: participants shared synchronistic experiences with the four COVID-19 waves, the heterogeneous vaccination ideologies and their support and coping skills. Theme two: lessons learnt and the way forward. ConclusionParticipants shared feeling overwhelmed at the onset of COVID-19 and feared infecting their family, friends and colleagues. However, their anxiety and fear decreased with time. They experienced the Delta variant as the worst and felt supported by their colleagues more than by management. They recounted observations of vaccine hesitancy but acknowledged that vaccination had alleviated some of the fear and anxiety. Participants' coping skills varied, and reflecting on their experience, they shared the lessons learnt and the way forward.

DSCNN-LSTMs: A Lightweight and Efficient Model for Epilepsy Recognition.

Epilepsy is the second most common disease of the nervous system. Because of its high disability rate and the long course of the disease, it is a worldwide medical problem and social public health problem. Therefore, the timely detection and treatment of epilepsy are very important. Currently, medical professionals use their own diagnostic experience to identify seizures by visual inspection of the electroencephalogram (EEG). Not only does it require a lot of time and effort, but the process is also very cumbersome. Machine learning-based methods have recently been proposed for epilepsy detection, which can help clinicians make rapid and correct diagnoses. However, these methods often require extracting the features of EEG signals before using the data. In addition, the selection of features often requires domain knowledge, and feature types also have a significant impact on the performance of the classifier. In this paper, a one-dimensional depthwise separable convolutional neural network and long short-term memory networks (1D DSCNN-LSTMs) model is proposed to identify epileptic seizures by autonomously extracting the features of raw EEG. On the UCI dataset, the performance of the proposed 1D DSCNN-LSTMs model is verified by cross-validation and time complexity comparison. Compared with other previous models, the experimental results show that the highest recognition rates of binary and quintuple classification are 99.57% and 81.30%, respectively. It can be concluded that the 1D DSCNN-LSTMs model proposed in this paper is an effective method to identify seizures based on EEG signals.

Chronicling the diagnostic journey, symptom experiences, and disease impact in frontotemporal degeneration

AbstractBackgroundFrontotemporal degeneration (FTD) is an umbrella term encompassing a range of rare neurodegenerative disorders that cause progressive decline or changes in cognition, language, behavior, and personality. The FTD Insights Survey was created with the aim of gathering information on the lived experience of FTD. Here we present a subset of survey data chronicling the diagnostic journey, symptoms experienced, and the impact of FTD on distress, quality of life, and independence, in the mild to moderate stages of the disease course.MethodIn total, 1,796 individuals completed the survey. Persons reported as severe to profoundly impaired due to FTD, as well as past caregivers, were excluded for this analysis. The resulting cohort included 219 individuals diagnosed with FTD and 437 current care partners, representing a range of FTD diagnoses (n = 395 behavioral variant frontotemporal dementia or Pick’s disease; n = 155 primary progressive aphasia; n = 61 progressive supranuclear palsy or corticobasal syndrome; n = 13 FTD with amyotrophic lateral sclerosis; n = 32 unknown).ResultAround half of survey respondents saw three or more doctors before an FTD diagnosis was given, and a range of prior diagnoses, including primary psychiatric disorders, Parkinson’s disease, or Alzheimer’s disease, were noted. Most frequently endorsed symptoms tended to be consistent with clinical characteristics of the specific diagnosis, though there was significant variability in symptoms reported within diagnostic categories as well as considerable overlap in symptoms between diagnostic categories. Cognitive and language symptoms of FTD were generally most distressing to the person diagnosed, and a loss of independence was highly endorsed as affecting quality of life. The distinct perspectives of diagnosed persons and care partners regarding disease impact differed notably for bvFTD/Pick’s disease. Participating independently in activities, within the home, outside the home, and with other people, were reported as challenging for people living with FTD, underscoring the significant disruption to daily living even at the mild and moderate stages of disease.ConclusionOverall, by heeding the perspectives of those living with FTD, we can begin to design more meaningful research studies, provide better care, and develop new therapies that improve quality of life

A Survey on the Quality of Life of Prostate Cancer Patients in Korean Prostate Cancer Patients Association

Purpose: We aimed to collect opinions on the diagnostic experiences and quality of life profiles for men with prostate cancer in Korea as part of the “Blue Ribbon Campaign” of the Korean Urological Oncology Society.Materials and Methods: Korean Urological Oncology Society conducted an online survey of 212 prostate cancer patients belonging to the Prostate Cancer Patient Association. A survey on diagnostic experience and quality of life based on Expanded Prostate Cancer Index Composite 26 Short Form were conducted.Results: About half of all respondents (50.5%) answered, “I experienced symptoms of urine leakage more than once a week,” during the last four weeks, 85% of the respondents said their sexual function level was “weak,” and 64.2% said, “very weak.” When asked about the level of erectile dysfunction, 58 percent of the respondents answered, “I never had an erection when I wanted one.” Of the respondents, 47.1% of men said that clinical stage at initial presentation was prostate cancer stage 3–4 and 99.1% of the respondents hoped that the prostate-specific antigen (PSA) test would be included in the national cancer screening.Conclusions: Through this survey of patients, we were able to confirm the difficulties of the low quality of life currently experienced by prostate cancer patients and what they want to do with prostate cancer treatment. All patients are eager to include a PSA test in the national cancer screening so that prostate cancer can be detected early and patients can receive proper treatment at an appropriate time.

The diagnostic experience of women with fragile X-associated primary ovarian insufficiency (FXPOI).

The fragile X premutation occurs when there are 55-200 CGG repeats in the 5' UTR of the FMR1 gene. An estimated 1 in 148 women carry a premutation, with 20-30% of these individuals at risk for fragile X-associated primary ovarian insufficiency (FXPOI). Diagnostic experiences of FXPOI have not previously been included in the literature, limiting insight on experiences surrounding the diagnosis. This study identifies barriers and facilitators to receiving a FXPOI diagnosis and follow-up care, which can inform care and possibly improve quality of life. We conducted qualitative interviews with 24 women with FXPOI exploring how FMR1 screening, physician education, and supportive care impacted their experience. Three subgroups were compared: women diagnosed through family history who have biological children, women diagnosed through family history who do not have biological children, and women diagnosed through symptoms of POI. Themes from interviews included hopes for broader clinician awareness of FXPOI, clear guidelines for clinical treatment, and proper fertility workups to expand reproductive options prior to POI onset. Participants also spoke of difficulty finding centralized sources of care. Our results indicate a lack of optimal care of women with a premutation particularly with respect to FMR1 screening for molecular diagnosis, short- and long-term centralized treatment, and clinical and emotional support. The creation of a "FXPOI health navigator" could serve as a centralized resource for the premutation patient population, assisting in connection to optimal treatment and appropriate referrals, including genetic counseling, mental health resources, advocacy organizations, and better-informed physicians.

Experience in the treatment of radioinduced angiosarcoma of the breast in a patient with primary multiple lesions of the breast and bladder. Case report

Among the multiple primary malignant tumors, breast cancer is the most common and in most cases it is combined with the second mammary gland, uterine body, stomach, colon, skin and ovary. Breast angiosarcoma is a very rare disease with unfavorable prognosis. Radiation therapy to the area of the breast is considered to be the main risk factor for the radiation-induced angiosarcoma. Diagnosis is based on the clinical aspect, the results of morphological and immunohistochemical findings. There are no uniform standards for the treatment of this pathology; a surgical method, systemic therapy, and radiation therapy are used. The article presents a clinical case of a female patient born in 1952, who was diagnosed with synchronous multiple primary cancer in 2014: stage 2A left breast cancer (cT2N0M0); bladder cancer stage I (cT1cN0M0). After the complex treatment, the patient received adjuvant endocrine therapy with Tamoxifen. In December 2018, single bluish formations appeared in the area of the postoperative scar, followed by a rapid growth of formations on the skin within a month, with a tendency to merge and necrosis. The patient was sent for biopsy of the formations with suspected recurrence of the disease. Immunomorphological patterns correspond to the angiosarcoma in the skin of the mammary gland. A simple mastectomy was performed. After 3 months, growth of angiomyosarcoma in the soft tissues of the anterior chest wall continued. Excision of the tumor in the soft tissues of the chest was performed and the patient underwent postoperative course of radiation therapy with a single focal dose (SFD) 2.5 Gy, total boost isodose of 50 Gy. At follow-up examinations held from January to December 2021, there is no evidence for continued growth and recurrence of the disease. The presented clinical observation demonstrates the experience of diagnostics and treatment of radiation-induced angiosarcoma in the patient with multiple primary synchronous lesions of the breast and bladder.

Caregiver Experiences Navigating the Diagnostic Journey in a Rapidly Progressing Dementia.

People with suspected Alzheimer's disease and related dementias (ADRD) and their families experience a burdensome process while seeking a diagnosis. These challenges are problematic in the most common dementia syndromes, but they can be even more distressing in rarer, atypical syndromes such as rapidly progressive dementias (RPDs), which can be fatal within months from onset. This study is an examination of the diagnostic journey experience from the perspective of caregivers of people who died from the prototypic RPD, sporadic Creutzfeldt-Jakob Disease (sCJD). eIn this mixed-methods study, qualitative data were drawn from interviews with former caregivers of 12 people who died from sCJD. Chart review data were drawn from research and clinical chart data about the person with sCJD. Data were analyzed by a multidisciplinary research team using qualitative and descriptive statistical analysis. We identified 4 overarching themes that characterized the experience of the diagnostic journey in sCJD: clinician knowledge, clinician communication, experiences of uncertainty, and the caregiver as advocate. We also identified 4 phases along the diagnostic journey: recognition, the diagnostic workup, diagnosis, and post-diagnosis. Sub-themes within each phase include struggles to recognize what is wrong, complex processes of testing and referrals, delay and disclosure of diagnosis, and access to resources post-diagnosis. Findings suggest that more work is needed to improve clinician diagnostic knowledge and communication practices. Furthermore, caregivers need better support during the diagnostic journey. What we learn from studying sCJD and other RPDs is likely applicable to other more common dementias.

The Posterior Transtriceps Approach for Intra-articular Elbow Arthrography: A Painless Method?

We determined the diagnostic and patient experience advantage of the transtriceps approach for elbow arthrograms. MRIs of two patients who underwent an MRI arthrogram of the elbow in May and June 2022 were retrospectively evaluated. All procedures were performed under fluoroscopic guidance with the patient in the prone position and the arm of interest extended above the head, and the elbow of interest flexed at 90 degrees. A 25 gauge needle was utilized. All MRI examinations were performed on 3-Tesla MRI scanners (Siemens,Hamburg, Germany) and in accordance with our institution's standard elbow arthrogram MRI protocol. The arthrogram was deemed successful if contrast was visualized in the elbow joint, and the MRI examinations were assessed for diagnostic ability and extra-articular leakage. Patient comfort and pain were also assessed. Both arthrograms demonstrated adequate contrast in the elbow joint, and the MRIs confirmed no leakage of contrast or bubbles. The patients felt 0 pain during the procedure on a scale of 0-10. Although the radiocapitellar approach is commonly used for elbow arthrograms, we found the transtriceps approach to be diagnostically sound, painless, and easier to perform.

RF30 | PSAT178 Severe Hyperparathyroidism in a Newborn: Response to Cinacalcet

Abstract Background Neonatal severe hyperparathyroidism (NSHPT) is a rare potentially lethal disorder caused by inactivating mutations in the calcium sensing receptor (CASR) gene. In newborns it presents with multiple bone fractures often confused with forms of osteogenesis imperfecta. Diagnostic and therapeutic experience with this condition is limited, hence here we describe a term baby we identified and treated with this disorder. Case Description A 39-week-old Hispanic female, born small for gestational age (BW 2.38 kg) via vaginal delivery to a 33-year-old G3P2 healthy mother was noted to have relative asymmetry of the thighs/hips. X-rays revealed bone demineralization and multiple fractures including distal femur and proximal tibia bilaterally and rib fractures in various stages of healing. Initially, osteogenesis imperfecta was thought likely and Endocrinology was consulted. Laboratories showed hypercalcemia (calcium 12.1 mg/dL (normal 8.5-11.2), elevated serum PTH 439 pg/mL (12-72). Serum phosphorus (4.2 mg/dL), 25-OH Vitamin D (44 ng/mL) and alkaline phosphatase (232 IU/L) were normal; urine calcium/creatinine ratio was low (0.006 mg/mg). EKG showed non-specific T wave abnormalities and echocardiogram mild pulmonary hypertension. Neck ultrasound and sestamibi scan showed no parathyroid mass. She was placed on oxygen due to desaturations and had poor tone and suck. Father had documented hypercalcemia (calcium 12.6 mg/dL, PTH 53 pg/mL). Paternal aunt and grandmother also had history of hypercalcemia. Serum levels of calcium and PTH remained elevated for 2 weeks despite treatment with IV fluids and furosemide and a low calcium/vitamin D formula. On day 12 we began a trial of cinacalcet, a type 2 calcimimetic, at starting doses of 0.4 mg/kg/day divided BID orally. Over 4 days the patient showed a dramatic reduction in serum levels of calcium and PTH to 8.6 mg/dL and 24 pg/mL, respectively. Over time her clinical course improved with better tone and suck and normal oxygenation. Cinacalcet was titrated up to 2.3 mg/kg/day (2mg PO tid) and baby discharged on day 20. Gene sequencing revealed a known heterozygous pathogenic variant in an exon 4 hotspot of the CASR gene, c.658C>T (p.Arg220Trp), consistent with familial hypocalciuric hypercalcemia. Father was confirmed to have the same pathogenic variant as the child. She has now been followed for 6 months, all fractures are healing with persistently normal PTH and calcium levels. She is thriving, her development appears to be normal, able to eat orally, sit, track and smile. Conclusion Neonatal severe hyperparathyroidism can occur in infants who are heterozygous for a CASR mutation and can manifest as multiple congenital fractures. A family history of asymptomatic parental hypercalcemia/hyperparathyroidism and targeted gene sequencing can be diagnostic of NSHPT. Activators of the CASR are a promising therapy for heterozygous CASR loss-of-function pathogenic variants and can lead to reversal of skeletal demineralization and markedly improved clinical status. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 1:18 p.m. - 1:23 p.m.

The diagnostic experience for people with MND and their caregivers in the U.K.

ObjectiveHow an MND diagnosis is communicated has implications for how individuals adapt to their illness. The consultation process with the neurologist, diagnosis delivery, and adherence to UK guidelines, were explored from the perspectives of people diagnosed with MND and family caregivers. MethodsA cross-sectional approach with people with MND and their caregivers in UK. An anonymous online survey, based on the SPIKES protocol for delivering bad news and containing questions focusing on the UK NICE MND guideline, was distributed in 2018–19. Results69 people with MND and 39 caregivers responded. People with MND were more likely than caregivers to rate highly their neurologist's skills and ability and their satisfaction with delivery of the diagnosis. The amount of time spent with the neurologist at diagnosis had an impact on the level of satisfaction and rating of the neurologist's skills and abilities. The SPIKES criteria were generally not met. Many of the NICE MND guideline recommendations were not met, though adherence was greater in MND Centres. ConclusionsWhile there is evidence of satisfaction with the delivery of the diagnosis amongst people with MND and caregivers, there is room for improvement. There is a need for greater awareness of the requirements of people with MND and caregivers. There is also a need to raise awareness of the NICE MND guideline and ensure adequate training, time and funding to ensure communication at this difficult time is acceptable and effective. Where possible it would be preferable for referrals to be made to MND centres.

Mental well-being of healthcare workers in two hospital districts with differing COVID-19 incidence

Abstract Objectives Healthcare systems and healthcare workers have been under considerable strain during the COVID-19 pandemic in many countries. Our study aimed to assess the mental well-being of Finnish healthcare workers from two hospital districts with differing COVID-19 incidence rates (HUS, Hospital district of Helsinki and Uusimaa/Helsinki University Hospital; and Kymsote, Social and Health services in Kymenlaakso region) during the first wave of the COVID-19 pandemic in spring 2020. Material and methods The data of this prospective survey study was collected during summer 2020, and a total of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated. Mental health symptoms were self-reported, and symptom criteria followed ICD-10 classification, excluding duration criteria. We divided participants into symptom categories “often/sometimes” (those who met the diagnostic criteria), and “rarely/never” (those not meeting the diagnostic criteria), and compared these groups to sociodemographic factors and factors related to work, workload, and well-being. Results Despite differences in COVID-19 incidence, the degree of mental health symptoms did not differ between HUS and Kymsote districts (p = 1). A significant relationship was found between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort, p < 0.001), insufficient recovery from work (p < 0.001), and subjective increased workload (p < 0.001). Conclusions These findings show the importance of sufficient, well-designed instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure their adequate recovery from work. Sufficient control of the epidemic to keep the burden of the healthcare system as low as possible is essential for healthcare workers’ well-being. Key messages

BS-80K: The first large open-access dataset of bone scan images

Background:Radionuclide bone scanning is one of the most common tools in the inspection of bone metastasis. Conventionally, the analysis of bone scan image is derived from manual diagnosing. However, this task requires extensive subjective diagnostic experience and is extremely time-consuming. To this end, a series of studies concerning computer-aided diagnosis via machine learning tools have been proposed. Although some inspiring progress has been achieved, the implemented bone scan image datasets in these research areas are generally too small, private or non-general, which limits their practical significance and impedes the follow-up research. Method:To address this issue, we present a large, publicly available and general dataset consisting of 82544 bone scan images associated with 3247 patients from West China Hospital, named BS-80K. In BS-80K, each patient provides two whole bone scan images corresponding to the anterior view (ANT) and the posterior view (POST). For each view, there are 13 region-wise slices of the body parts susceptible to bone metastasis. Based on an authorized original labeling criterion, labels annotated by experienced specialists are offered with the images. Moreover, within each whole body image, multiple bounding boxes containing suspectable hot spots and their annotations are supplied as well. All images in BS-80K have been de-identified to protect patients’ privacy. Results:Based on 6 popular deep learning models for classification and object detection, we provide the benchmark for a number of computer-aided medical tasks, including general bone metastasis prediction and object detection for whole body images, and specific bone metastasis prediction for different body parts. According to extensive experiments, the adopted classification models achieve remarkable results in accuracy and specificity (around 95%) on most metastasis prediction tasks, which are approximate to the average ability of corresponding specialists. As for the object detection task, the best average precision of the adopted models reaches 0.2484 and the lowest is 0.1334. Discussion:Through the comparison of metastasis prediction performance between the benchmark and related work, we observe that the widely used models trained by BS-80K achieve significantly better results than the elaborately designed models trained by smaller datasets. This indicates that with the large amount of data, BS-80K has great potential to galvanize the research about computer-aided analysis on bone scan image. Conclusion:To the best of our knowledge, BS-80K is the first large publicly available dataset of bone scanning, which favors a wide range of research on computer-aided bone metastasis diagnosis. The full dataset is now available at https://drive.google.com/drive/folders/1DOBkLXgQeREQjF-nQIGNBBzPCb5s7RNu?usp=sharing.

Mental well-being of healthcare workers in 2 hospital districts during the first wave of the COVID-19 pandemic in Finland: a cross-sectional study.

The COVID-19 pandemic has caused unseen pressure on healthcare systems in many countries, jeopardizing the mental well-being of healthcare workers. The authors aimed to assess the mental well-being of Finnish healthcare workers from 2 hospital districts (Helsinki University Hospital [HUS] and Social and Health Services in Kymenlaakso [Kymsote]) with differing COVID-19 incidence rates during the first wave of the COVID-19 pandemic in spring 2020. A total number of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated in this prospectively conducted survey study during summer 2020. Symptom criteria of self-reported mental health symptoms followed ICD-10 classification, excluding duration criteria. Participants were divided into symptom categories "often/sometimes", and "rarely/never". These groups were compared to sociodemographic factors and factors related to work, workload, and well-being. The degree of mental health symptoms did not differ between the 2 healthcare districts despite differing COVID-19 incidences (p = 1). The authors observed a significant relationship between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort p < 0.001), insufficient recovery from work (p < 0.001), and subjective increased workload (p < 0.001). The authors' results show the importance of well-planned and sufficient instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure sufficient recovery. Sufficient control of the epidemic to keep the burden of the healthcare system low is vital for healthcare workers' well-being. Int J Occup Med Environ Health. 2022;35(6):708-18.

20 years experience in diagnostics and treatment of the ektopated pancreas in the gastroduodenal zone in children

Ectopia of the pancreas is a rare malformation that requires an individual approach to treatment. We present our experience in the diagnosis and treatment of 119 patients with EPI in the gastroduodenal zone. The main indication for surgical treatment is with a long-term intractable pain symptom. 28 (23.5%) patients were operated on, most of them from the laparoscopic approach. To determine the enzymatic activity of the gland, an assessment of the vegetative status was used. Vagotonia can be one of the causes of exocrine activity and hyperperistalsis of the stomach and duodenum. Among the operated patients, the parasympathetic type of autonomic nervous regulation was more common. Evaluation of the histostructure of the removed EPG macro- preparations indicated the predominance of type 3, indicating the presence of all components similar in structure to the tissue of a normal pancreas.

Diagnostic Reasoning Outcomes in Nurse Practitioner Education: A Scoping Review.

Diagnostic reasoning is the process of collecting, considering, and analyzing information to determine a diagnosis. Educational strategies that structure diagnostic reasoning exposure, experience, and evaluation are hypothesized to improve diagnostic safety. However, few studies measure diagnostic reasoning outcomes in nurse practitioner education. This review sought to identify the educational interventions intended to improve diagnostic reasoning competency, determine which components of reasoning are evaluated, and examine how they are measured. Four databases were searched, and 12 studies were identified that met the inclusion criteria. Simulation was the most common intervention. The most frequently measured diagnostic reasoning components were information gathering, differential diagnosis, and leading diagnosis. Checklists and patient management problems were the most used assessment method. More studies are needed to assess the reasoning processes of hypothesis generation, problem representation, and diagnostic justification. Within simulation, methods capable of capturing these components include think-aloud, global assessments, checklists, and note evaluation. [J Nurs Educ. 2022;61(10):579-586.].

How do implicit and explicit partner evaluations update in daily life? Evidence from the lab and the field.

Evidence suggesting that implicit partner evaluations (IPEs), but not explicit evaluations (EPEs), can predict later changes in satisfaction and relationship status has led researchers to postulate that IPEs must be especially sensitive to relational reward and costs. However, supporting evidence for this assumption remains scarce, and very little is known regarding how IPEs versus EPEs actually update in everyday life. Two studies (one in-lab dyadic interaction study, N = 255, and one 14-day dyadic diary study, N = 348) investigated updating in IPEs and EPEs in the context of real-life relationship experiences. Study 1 revealed that the level of positive and negative experiences that a couple encountered while discussing a divergence of interests in their relationship predicted pre-to-post changes in EPEs, but not in IPEs. Study 2 revealed that IPEs showed less sensitivity to everyday relationship experiences across multiple metrics over the course of 14 days. Specifically, compared with EPEs, IPEs fluctuated less at the within- (vs. between-) person level, showed less-abrupt changes from day-to-day, and had a substantially weaker relationship with same-day positive and negative experiences. Rather than covarying with same-day experiences, IPEs appeared sensitive to relationship experiences aggregated across multiple prior days as well as to highly diagnostic relationship experiences, such as breakup. Consistent with recent advances in social-cognitive research, these findings support a modified account of IPE sensitivity, according to which IPEs show only gradual shifts under everyday circumstances, but more-dramatic shifts under highly diagnostic circumstances. Implications of these findings for close relationships and implicit social cognition research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disruption vs. evolution in laboratory medicine. Current challenges and possible strategies, making laboratories and the laboratory specialist profession fit for the future.

Since beginning of medical diagnostics, laboratory specialists have done an amazing job, continuously improving quality, spectrum and speed of laboratory tests, currently contributing to the majority of medical decision making. These improvements are mostly of an incremental evolutionary fashion, meaning improvements of current processes. Sometimes these evolutionary innovations are of a radical fashion, such as the invention of automated analyzers replacing manual testing or the implementation of mass spectrometry, leading to one big performance leap instead of several small ones. In few cases innovations may be of disruptive nature. In laboratory medicine this would be applicable to digitalization of medicine or the decoding of the human genetic material. Currently, laboratory medicine is again facing disruptive innovations or technologies, which need to be adapted to as soon as possible. One of the major disruptive technologies is the increasing availability and medical use of artificial intelligence. It is necessary to rethink the position of the laboratory specialist within healthcare settings and the added value he or she can provide to patient care. The future of the laboratory specialist profession is bright, as it the only medical profession comprising such vast experience in patient diagnostics. However, laboratory specialists need to develop strategies to provide this expertise, by adopting to the quickly evolving technologies and demands. This opinion paper summarizes some of the disruptive technologies as well as strategies to secure and/or improve the quality of diagnostic patient care and the laboratory specialist profession.

Living With Frontotemporal Degeneration: Diagnostic Journey, Symptom Experiences, and Disease Impact.

Frontotemporal degeneration (FTD) is an umbrella term encompassing a range of rare neurodegenerative disorders that cause progressive declines in cognition, behavior, and personality. Hearing directly from individuals living with FTD and their care partners is critical in optimizing care, identifying meaningful clinical trial endpoints, and improving research recruitment and retention. The current paper presents a subset of data from the FTD Insights Survey, chronicling the diagnostic journey, symptoms, and the impact of FTD on distress, quality of life, and independence, in the mild to moderate stages of the disease. Survey respondents included 219 individuals diagnosed with FTD and 437 current care partners, representing a range of FTD diagnoses. Around half of survey respondents reported seeing three or more doctors before an FTD diagnosis was given, and a range of prior diagnoses were noted. Most frequently endorsed symptoms tended to be consistent with clinical characteristics of the specific diagnosis, though there was significant variability in symptoms reported within diagnostic categories as well as considerable overlap in symptoms between diagnostic categories. Cognitive and language symptoms of FTD were generally most distressing to the person diagnosed, and a loss of independence was endorsed as affecting quality of life. The distinct perspectives of diagnosed persons and care partners regarding disease impact differed notably for bvFTD/Pick's disease. Participating independently in a range of activities, within the home, outside the home, and with other people, were reported as challenging for people living with FTD, underscoring the degree to which the lives of these individuals are affected even at the mild and moderate stages of disease. Overall, by heeding the perspectives of those living with FTD, we can begin to design more meaningful research studies, provide better care, and develop therapies that improve quality of life.