Endometriosis Diagnosis Pathways and Disability Considerations

Endometriosis—a chronic, inflammatory, non-cancerous, gynecologic condition—is characterized by the spread of endometrial tissue exterior to the uterus. Individuals with endometriosis can experience burdensome and disabling symptoms and prolonged times to diagnosis. Extended times to diagnosis can have serious consequences on health and life trajectories. The overarching goal of this three-paper dissertation is to explore and improve understanding of pathways to diagnosis and disability considerations for those suffering from endometriosis. A life course perspective guided three analyses to achieve four aims: (1) a systematic scoping review mapping the current international, English-language, scientific peer-reviewed and gray literature investigating pathways, timing, and delays in diagnosis of endometriosis; (2) a review of federal appeals cases of disability decisions of Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) disability claims within which endometriosis appeared as an impairment; (3) a qualitative study to map participant pathways to diagnosis using qualitative interviews and analysis informed by a life course perspective; and (4) determine commonality and variation between participants in the qualitative study who perceived the time to diagnosis as timely and those who perceived the time as delayed. The scoping review reveals limited diversity among samples, little grounding in theory, and varied definitions of terms (i.e., delay, timing, and pathways). Review of the U.S. federal courts’ opinions concerning SSDI and SSI claims highlighted common themes (evidence, treatment, and time) while revealing conflicts between common characteristics of endometriosis, evidence requirements, and misconceptions. Finally, the case studies and framework matrices of the participants’ interviews showed a dynamic interplay between life courses and pathways to diagnosis of endometriosis. All but two participants perceived their time to diagnosis as prolonged (universal across SES and race/ethnicity).Future endometriosis research concentrating on pathways, timing, and delays in diagnosis of endometriosis would benefit from more diverse study samples, uniformity in definitions, and theoretical grounding. Ethnically and socioeconomically sensitive and inclusive interventions designed to improve times to diagnosis of endometriosis will help reduce uncertainty, hasten access to treatment, reduce complications from delay, and potentially improve applications for disability support.Doctor of Philosoph

What Transitional Care Interventions are Used in the Care of Burn Patients? An Integrative Review

Patients with burn wounds present complex and long-term challenges to healthcare providers. A recent study revealed burn patients experience 30-day readmission rates as high as 25% (Mandell, Pham, Klein, 2013). Readmission rates represent a costly challenge. In the recent past, transitional care has been offered as a possible solution for high readmission rates, unexpected ED visits, elevated mortality rates, and high costs. The purpose of this integrative literature review is to identify the potential need for transitional care in patients with burn injuries by pinpointing key elements of seminal works in transitional care and analyzing discharge planning in the burn patient population within this context. Cooper’s 5-stage method (1998) was used to systematically searched the literature. Search terms included transitional care, discharge planning, home care planning and burn patients/wounds/injuries. After applying exclusion criteria, 10 articles covering 8 transitional care frameworks were selected, revealing 14 common transitional care interventions. Discharge and home care planning articles were also reviewed for studies predating the body of transitional care research. Six discharge/home care planning articles also met study criteria. These works, all descriptive in nature, shared 16 common interventions. The 6 home care and discharge planning articles for burn patients represent a lineage predating the transitional care frameworks currently used in healthcare. Burn units have a strong history of preparing for patient transitions from hospital care. However, the lack of current research examining the implementation of transitional care protocols in burn units combined with high readmission rates indicate a need for further development and investigation.Bachelor of Scienc

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia

Introduction Vestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD. Methods Twenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18–51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic.ResultsOne hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups.DiscussionMucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia

IntroductionVestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD.MethodsTwenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18–51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic.ResultsOne hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups.DiscussionMucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD

June 17, 1953: a fifty-year retrospective on a German Cold War tragedy, 1953-2003.

Includes bibliographical references (p. 223-238).The failed June 17, 1953, uprising in East Berlin and elsewhere in the former German Democratic Republic (GDR) marked an early, tragic flashpoint of the Cold War. While the Federal Republic of Germany (West Germany) elevated June 17 to a "German Day of Unity" to remind people of the protestors' sacrifices and national hopes for reunification, the East German regime gained strength from crushing the revolt with Soviet help and justified its actions on ideological grounds while suppressing details of the violence and repression. The materials examined in this study span fifty years, 1953 to 2003, and focus on German, European and American perspectives gleaned from primary and secondary sources. Each chapter views the revolt's coverage through a different medium and change over time—historiography, film and television, literature and art, and newspapers. Taken together, they create a rich tableau of national remembrance and renewal before an international audience.by Martha Grace Cromeens.M.A

Exploring stress, cognitive, and affective mechanisms of the relationship between interpersonal trauma and opioid misuse.

BACKGROUND:People with a history of interpersonal trauma, including intimate partner violence, sexual assault, and adverse childhood experiences, are disproportionately affected by the current opioid epidemic. Interpersonal trauma has been shown to increase risk for chronic pain conditions, prescription opioid use, and opioid misuse. Stress, cognition, and affective function have been examined as potential mechanisms that may influence opioid misuse among individuals with a history of interpersonal trauma. However, no studies have examined these factors simultaneously, despite their interrelatedness. OBJECTIVE:The purpose of this study was to 1) examine perceived stress, perceived cognitive function, depressive symptoms, and PTSD symptoms as potential mechanisms of opioid misuse among individuals with a history of interpersonal trauma, 2) examine the types of interpersonal trauma that are associated with opioid misuse, and 3) assess the mediating role of pain and opioid prescription. METHODS:A cross-sectional, observational study design was conducted. Data were collected through a confidential self-report online survey using validated instruments (n = 230). A series of regression analyses were conducted to identify mechanistic factors and interpersonal trauma types associated with opioid misuse, opioid prescription, and pain intensity. Structural equation modeling was used to examine mediating effects of pain intensity and opioid prescription. RESULTS:Opioid prescription, depressive symptoms, and intimate partner violence increased the odds of reporting opioid misuse. Pain intensity and adverse childhood experiences increased the odds of opioid prescription. Higher levels of perceived stress and depressive symptoms were associated with increased pain intensity. Pain intensity emerged as a mediator of the relationship between depressive symptoms and opioid misuse. CONCLUSIONS:Our work shows that there are likely several pathways through which interpersonal trauma can lead to opioid misuse. Interventions aimed at improving depressive symptoms and coping with traumatizing events should be included as part of comprehensive trauma-informed pain management practices