INTRODUCTION:Chronic medical conditions affect approximately 129 million Americans. The complexities of chronic illness, coupled with limited health care resources and clinician time, can complicate treatment management, and contribute to poor health outcomes. The effect of group medical visits (GMVs) on patient wellness has not been well established. METHODS:Mixed-methods approach using both quantitative and qualitative data was used to evaluate wellness following completion of GMV programs. Patients completed pre- and post-GMV assessments using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. GMV programs included Yoga for Cancer, Stress Reduction and Resiliency, Mindful Eco-Wellness, and Mindfulness for Your Health from 2017 to 2024. The PROMIS-29 is a validated health questionnaire that assesses 7 domains: anxiety, depression, fatigue, sleep disturbance, participation in social roles, pain, and physical function. Clinicians and patients also participated in qualitative interviews regarding their GMV experiences. RESULTS:Among 76 participants who completed pre- and post-GMV PROMIS-29 assessments, fatigue scores improved and participation in social roles increased significantly. Improvements were also observed in anxiety, depression, sleep disturbance, and physical function, although these changes were not statistically significant. Themes identified from interviews with 15 clinicians and 10 patients included patient empowerment, sense of community, patient satisfaction, integrative care, and trust. DISCUSSION:Improvements in PROMIS-29 domains suggest that GMVs may have the potential to enhance patient health and wellness. The themes discovered portray a positive outlook on GMVs, with mindfulness practices and the sense of community that is cultivated within a group setting highlighted as especially important. CONCLUSIONS:GMVs were associated with improvements in fatigue and participation in social roles and were viewed favorably by patients and clinicians. Although additional controlled studies are needed, GMVs may represent a promising approach to supporting wellness among patients living with chronic conditions.
INTRODUCTION:The body of literature surrounding transgender health care primarily focuses on metropolitan populations and resource-rich areas. This qualitative study examines the perspectives of transgender patients in northcentral Wisconsin to identify recommendations for more comprehensive, inclusive health care practices. METHODS:A series of semistructured interviews was conducted with recipients of gender-affirming care residing in northcentral Wisconsin. A mixed deductive-inductive approach was used for qualitative thematic analysis. RESULTS:A total of 10 interviews were completed. Qualitative analysis revealed 3 key themes contributing to positive and negative experiences with health care providers: education, cultural competency, and access. DISCUSSION:Patients reported feeling supported by health care providers but not always that providers were well equipped to address their specific health needs. The attitudes of all members of the health care team contributed to participants' feelings of acceptance and comfort in the health care environment. Participants living in rural areas cited transportation challenges and provider scarcity as barriers to gender-affirming care. CONCLUSIONS:Health care providers play an important role in mitigating health disparities among transgender patients. Experience providing gender-affirming care, nonjudgmental attitudes, and visible displays of allyship are associated with positive clinician-patient relationships.
INTRODUCTION:Patients undergoing infertility evaluation and treatment frequently experience anxiety and depressive symptoms. Easily available and highly accessible online mental health tools have not previously been evaluated using validated screening measures in this population. The objective of this study was to assess whether SilverCloud, an online, self-guided mental health program, is associated with reductions in anxiety and depressive symptom scores among patients experiencing infertility. METHODS:A retrospective cohort study was conducted among female patients undergoing an initial infertility consultation at a single academic center. Patients completed Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires and were offered enrollment in SilverCloud at their initial infertility consultation. Baseline PHQ-9 and GAD-7 scores from initial consultations were compared between patients who enrolled in SilverCloud and those who did not. For patients who engaged in SilverCloud, Wilcoxon signed-rank tests were used to compare PHQ-9 and GAD-7 scores before and after completion of SilverCloud modules. RESULTS:A total of 354 patients were included in the analysis. Fifty-two patients enrolled in SilverCloud, and 32 completed at least 1 module. Baseline data demonstrated that patients who enrolled in SilverCloud had significantly higher GAD-7 scores (0.5 vs 0; P = .006). Among patients who completed at least 1 SilverCloud module, PHQ-9 and GAD-7 scores decreased significantly decreased after engagement (PHQ-9: 8.0 vs 6.5; P 7lt; .04; GAD-7: 12.5 vs 9.5; P = .02). CONCLUSIONS:Patients experiencing infertility who utilized SilverCloud experienced significant decreases in PHQ-9 and GAD-7 scores, suggesting improvement in anxiety and depression symptoms.
INTRODUCTION:An intra-right ventricular course of the left anterior descending (LAD) artery is a rare coronary anomaly with uncertain clinical and procedural significance. We describe the use of multimodality imaging to characterize this variant in a patient with ventricular tachycardia and to guide the safe performance of catheter ablation. CASE PRESENTATION:A 46-year-old White woman presented with ventricular tachycardia and was found on coronary computed tomography angiography to have an intraventricular course of the mid LAD through the right ventricular cavity. Multimodality imaging, including coronary computed tomography angiography and stress cardiac magnetic resonance imaging, demonstrated no evidence of obstructive coronary artery disease, myocardial ischemia, structural heart disease, or myocardial scar. She was ultimately diagnosed with idiopathic right ventricular outflow tract ventricular tachycardia and underwent successful catheter ablation. DISCUSSION:An intra-right ventricular course of the LAD is a rare coronary variant. In a large coronary computed tomography angiography study, this anomaly was identified in less than 1% of patients. Although its clinical significance is not well understood, this anatomic variant can have important procedural implications for ventricular tachycardia ablation. CONCLUSIONS:Multimodality imaging is vital in assessing the clinical significance of an anomalous coronary artery and ensuring the procedural safety of ventricular tachycardia ablation.
