Evaluation of Disparities in Healthcare Experiences Between Racial Identities and Age Cohorts

Background: Healthcare consumers have their own perspectives and expectations of what should occur during an encounter of care; these unmet expectations create healthcare disparities. However, there is limited data regarding healthcare experiences among racial and aging groups. Objectives: To compare the physical and emotional responses of healthcare experiences among racial/ethnic and aged cohorts in the United States. Methods: Applying a descriptive-correlational design, secondary data from the 2014 Behavioral Risk Factor Surveillance System related to healthcare experiences among racial groups (White, Black, Hispanic, and Asian) and aged cohorts (18-39, 40-54, and 55- 69 years) were assessed. Results: In the sample, there were 78.3% Whites, 7.9% Blacks, 12.4% Hispanics and 1.4% Asians; 42.9% were 55-69, 30.1% were 40-54, and 27% were 18-39 years. Blacks reported the greatest disparity with 8.5% reporting being treated worse than other races, experienced physical (8.5%) or emotional (16.2%) symptoms due to race during their healthcare encounters. For Hispanics, 4.9% reported being treated worse; 6.4% experienced physical and 8.8% experienced emotional symptoms due to race. For Asians, ratings for the three categories were 3.2%, 6.2%, and 9.8% respectively. White respondents reported the least disparity; the ratings for their three categories were 2.0%, 1.4%, and 2.8% respectively (analysis related to race, p\u3c0.001). The age group representing the largest disparity was 40-54 for all categories; while 55-69 ranked highest for best healthcare experiences. Conclusion: Prevailing disparities among all racial and age groups exist; minorities and middleaged Americans are at greater risk for not receiving optimal healthcare treatment due to industry biases and perception of treatment

Characteristics and treatment strategies of mitral regurgitation associated with undifferentiated papillary muscle

Purpose: In this report we review our experience of operations on mitral regurgitation associated with abnormal papillary muscles/chordae tendineae of the mitral valves and discussed the clinical characteristics, operative findings, and treatment strategies. Methods: Undifferentiated papillary muscle was defined as a hypoplastic chordae tendineae with anomalous formation of papillary muscles attached to the mitral valves directly. Consecutive 87 patients undergoing surgery for mitral regurgitation at our institution were reviewed and 6 of them had undifferentiated papillary muscle. Results: The underlying mechanism of regurgitation was prolapse at the center of the anterior leaflet in 3 cases and tethering, a wide area of myxomatous degeneration, and annular dilatation in one case, respectively. Five patients underwent mitral valve plasty and 1 patient received replacement. Anomalous formation of chordae tendineae was corrected by resection and suture with transplantation at the tip of the leaflet to which abnormal chordae were attached in 2 cases, while resection and suture with chordal shortening was performed in 1 case, and chordal reconstruction using artificial chordae was employed in 2 cases. There was no operative death, and postoperative echocardiography showed no residual regurgitation in any of the cases. Conclusions: Mitral regurgitation associated with undifferentiated papillary muscle resulted from prolapse or tethering and impaired flexibility of leaflets. It was possible to successfully treat the patients by mitral valve plasty unless complex congenital cardiac malformation coexisted. Detailed examinations of attached papillary muscle by echocardiography and intraoperative inspection are necessary and surgical techniques should be selected appropriately in each case

Anti-angiogenic alternatives to VEGF blockade

Angiogenesis is a major requirement for tumour formation and development. Anti-angiogenic treatments aim to starve the tumour of nutrients and oxygen and also guard against metastasis. The main anti-angiogenic agents to date have focused on blocking the pro-angiogenic vascular endothelial growth factors (VEGFs). While this approach has seen some success and has provided a proof of principle that such anti-angiogenic agents can be used as treatment, the overall outcome of VEGF blockade has been somewhat disappointing. There is a current need for new strategies in inhibiting tumour angiogenesis; this article will review current and historical examples in blocking various membrane receptors and components of the extracellular matrix important in angiogenesis. Targeting these newly discovered pro-angiogenic proteins could provide novel strategies for cancer therapy