Articles: adult.
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Mayo Clinic proceedings · Feb 2025
ReviewA Primer on Carceral Health for Clinicians: Care Delivery, Regulatory Oversight, Legal and Ethical Considerations, and Clinician Responsibilities.
The United States has one of the highest incarceration rates in the world, with approximately 1.7 million individuals detained in jails or federal or state prisons. Chronic medical conditions are more prevalent among adults in custody than among their nonincarcerated counterparts, resulting in needs that often surpass the on-site medical treatment capabilities of carceral facilities. ⋯ This special article seeks to address this knowledge gap by providing demographic and patient characteristics of this population, describing health care delivery in the criminal legal system, summarizing incarcerated patients' health care rights, conveying the current state of oversight and regulation for correctional health care, and presenting the role of health care professionals in advocating for the ethical care of incarcerated patients. By equipping themselves with this knowledge, clinicians may provide holistic and ethical care for persons involved in the criminal legal system.
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Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were "asleep-awake-asleep" protocols that relied on propofol, remifentanil, or fentanyl. ⋯ Awake craniotomies can safely be performed in the pediatric population with appropriate patient sel7ection, planning, and a multi-disciplinary approach.
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Mayo Clinic proceedings · Feb 2025
Effect of Tirzepatide on Body Weight and Diabetes Control in Adults With Type 1 Diabetes and Overweight or Obesity.
To determine the effect of tirzepatide on weight, diabetes control, and insulin requirements, and its safety profile in adults with type 1 diabetes (T1D) and overweight or obesity. ⋯ Tirzepatide for the treatment of overweight and obesity in adults with T1D leads to substantial weight loss, improved diabetes control, and decreased insulin requirements, without worsening hypoglycemia. Future studies are needed to ascertain the long-term effect of tirzepatide in this population, ideally focusing on cardiovascular outcomes.
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Menstrual pain is associated with deficits in central pain processing, yet neuroimaging studies to date have all been limited by focusing on group comparisons of adult women with vs without menstrual pain. This study aimed to investigate the role of the triple network model (TNM) of brain networks in adolescent girls with varied menstrual pain severity ratings. One hundred participants (ages 13-19 years) completed a 6-min resting state functional magnetic resonance imaging (fMRI) scan and rated menstrual pain severity, menstrual pain interference, and cumulative menstrual pain exposure. ⋯ In addition, menstrual pain interference was positively associated with connectivity within the left CEN, whereas connectivity both within the right CEN and between the right CEN and cortical areas outside the network (including the insula) were negatively associated with menstrual pain interference. Cumulative menstrual pain exposure shared a strong negative association with connectivity between the default mode network and other widespread regions associated with large-scale brain networks. These findings support a key role for the involvement of TNM brain networks in menstrual pain characteristics and suggest that alterations in pain processing exist in adolescents with varying levels of menstrual pain.
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Chronic pain is common among children and adolescents; however, the diagnoses in the newly developed 11th revision of the International Classification of Diseases (ICD-11) chronic pain chapter are based on adult criteria, overlooking pediatric neurodevelopmental differences. The chronic pain diagnoses have demonstrated good clinical applicability in adults, but to date, no field study has examined these diagnoses to the most specific diagnostic level in a pediatric sample. The current study aimed to explore pediatric representation within the ICD-11, with focus on chronic primary pain. ⋯ The latter also exhibited the lowest agreement between HCPs and algorithm. The current study underscores the need for evidence-based improvements to the ICD-11 diagnostic criteria in pediatrics. Developing pediatric coding notes could improve the visibility of patients internationally and improve the likelihood of receiving reimbursement for necessary treatments through accurate coding.