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Adverse Childhood Experience Scores, more commonly known as ACE scores, have provided new insight into the effects of adverse events on longstanding health and chronic illnesses in adults. Evidence shows that individuals with history of ACEs have increased risk of developing multiple chronic illnesses with or without increased exposure to activities that are detrimental to health, i.e. tobacco, alcohol, or other drug use. Additionally, a history of ACEs significantly increases an individual’s likelihood of participating in behaviors that are detrimental to long-term health, including risky behaviors and resulting addiction issues. However, in most individuals with ACEs, their childhood experiences, or the extent of the experience, is not likely to be mentioned in casual conversation. By increasing knowledge on ACE scores and implementing scoring of all individuals possible, it would improve a physician’s ability to assess risk and health screening needs for a patient on a more individualized basis. The purpose of this study is to educate Bristol Family Medicine residents on the daily uses and clinical correlations provided by ACE scoring in an attempt to increase score documentation of future patients.We will begin by providing a short knowledge assessment about ACE scores to residents in the Bristol Family Medicine residency program. We will then give a detailed presentation on the usefulness and effectiveness of using ACE scores in clinical judgement and screening. Following the presentation, we will provide a similar knowledge assessment as well as a questionnaire to assess likelihood of residents to implement ACE scores in their current practice.

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Hodgkin’s lymphoma (HL) is a disease that represents approximately 10% of lymphomas with bimodal age distribution. It is curable in approximately 75 percent of patients worldwide. ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) was originally developed for patients with disease resistant to MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), but subsequently became the gold standard initial chemotherapy for patients with HL. Anthracyclines remain as a backbone for combination regimens and in patients with systolic dysfunction MOPP regimen has been used as initial chemotherapy. In patients with relapsed or refractory HL, the goal of treatment should be to achieve long-term disease control and requires salvage regimens to reduce disease burden beforehand followed by autologous hematopoietic cell transplantation (HCT) in curative intent. There are no randomized trials that directly compare the various salvage regimens for relapsed HL. Brentuximab Vedontin (BV) and nivolumab are currently approved for the treatment of refractory disease in patients who have failed two or more first-line treatments or who have failed HCT. Little literature exists regarding the efficacy and overall survival of patients who receive BV with or without nivolumab for refractory disease in patients who are ineligible or refuse HCT. We report a case of a 24-year-old refractory nodular sclerosing Hodgkin’s disease with a lengthy progression-free survival on BV and Nivolumab and without HCT. The patient was diagnosed with stage IV HL due to bone marrow involvement and was started on the MOPP regimen due to an ejection fraction of 45-50% and given a history of transposition of great vessels. The first surveillance PET scan after 6 cycles of MOPP chemotherapy showed new hypermetabolic widespread adenopathy and new multifocal abnormal FDG uptake within the liver and spleen suggestive of early relapse. Salvage chemoimmunotherapy with RICE was then started with the intention to reduce the disease burden prior to HCT. Despite starting salvage chemoimmunotherapy, the patient’s liver function tests (LFT) continued to rise along with progressively worsening pancytopenia. Due to concern for refractoriness and worsening LFT’s, he was started on third-line single-agent nivolumab and showed tremendous response after 4 cycles. BV was added to nivolumab to further improve responses based on phase 2 data. Despite considerable efforts in counseling regarding smoking cessation, he continued to smoke and refused HCT. The patient received 4 cycles of Nivolumab every 2 weeks and then a combination of BV and Nivolumab for 17 cycles. Subsequently had progressive disease. Right, mandibular gingiva biopsy was consistent with high-grade large B cell lymphoma with concern for Richter's transformation from Hodgkin’s to non-Hodgkin’s lymphoma (NHL). He has received a course of radiation therapy to the involved facial area for symptom control and was later started on CEOP (vincristine, etoposide, cyclophosphamide, prednisone) regimen with intrathecal methotrexate. This case provides unique clinical data of durability results of a patient treated with BV in combination with nivolumab in relapsed or refractory HL patients who are ineligible or refuse HCT. Our patient likely had Richter's transformation of HL to the NHL, which has rarely been reported in the literature.

Kheirabadi Z. Patienternas upplevelser av livsstilsförändring vid typ 2 diabetes.En litteraturstudie. Examensarbete i omvårdnad (OM153B), 15 högskolepoäng.Malmöuniversitet: Fakulteten för Hälsa och Samhälle, Institutionen förvårdvetenskap, Vårtermin 2022.Bakgrund: Antalet individer som lider av typ 2 diabetes ökar varje år. Typ 2diabetes är en av de vanligaste långvariga sjukdomarna. Typ 2 diabetes kan ävenräknas som en livsstilsrelaterad sjukdom som grundar sig på ohälsosammalevnadsvanor som ökar sjukdomsrisken genom exempelvis olämplig kost, brist påfysisk aktivitet, samt tobak och alkoholkonsumtion. En av de behandlingar somkan hjälpa patienter att främja hälsan utan medicinering samt livskvalitetsutveckling är därmed livsstilsförändring.Syfte: Studien ämnar belysa patienters upplevelser av livsstilsförändring vid typ2 diabetes.Metod: Studien använder 14 vetenskapliga artiklar med kvalitativ metod.Utvalda artiklar hämtades från både CINAHL och PubMed databaser sominriktar sig på medicin och omvårdnad. Kvalitativgranskning av artiklarnagenomfördes enligt Statens beredning för medicinsk och social utvärdering(SBU:s mall) 2014.Resultat: Detta utgår ifrån 14 artiklar med kvalitativ ansats från åtta länder.Resultatet presenteras i fyra teman: 1) Motivationens roll hos patienter attgenomföra livsstilsförändring 2) Rollen av stöd och undervisning för patienter vidlivsstilsförändring 3) Patienternas upplevelser av förändringar 4) Effekter avlivsstilsförändring på individens livskvalitet. Motivation är första och främstaanledningen som kan påverka individers livsstilsförändring positivt eller negativt.Undervisning och stöd från anhöriga och hälsosjukvårdpersonal har också enviktig roll för livsstilsförändringar. Varje individ upplever livsstilsförändringar påolika sätt som utgår från individens känslor och livserfarenheter.Konklusion: Studien visar att en insikt om diabetes behövs hos individer för attdessa ska lyckas förändra sina ohälsosamma levnadsvanor till en förbättring av sinlivsstil och ökad livskvalitet.Nyckelord: diabetespatienter, typ 2 diabetes, livsstilsförändringar, patientensupplevelse, kvalitativ.