keyword
MENU ▼
Read by QxMD icon Read
search

Difficult patient

keyword
https://www.readbyqxmd.com/read/28636237/microperforate-hymen-presenting-with-incomplete-abortion-a-case-report
#1
Maya Padhi, Priyadarshini Tripathy, Asutosh Sahu
A 20-year-old patient with 3 months of amenorrhea presented in the labor room with bleeding per vaginum and having experienced lower abdominal pain for 2 h. She had a history of difficult intercourse and prolonged menstrual flow. Inspection revealed a bleeding point over an obstructing membrane at the level of the vaginal introitus. Subsequent vaginal examination confirmed the diagnosis of microperforate hymen. Her urine pregnancy test was positive and an ultrasound examination revealed the presence of retained products of conception in the endometrial cavity...
June 21, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28635573/-colonic-ischaemia-a-condition-with-an-atypical-clinical-presentation-timely-recognition-and-treatment-improve-prognosis
#2
E J A Rondagh, S A Oei, D Goudkade, A A M Masclee, J W Kruimel
The incidence of colonic ischaemia has risen in recent decades because of the ageing population. Patients with colonic ischaemia present with mild abdominal pain, rectal blood loss and/or diarrhoea. However, no pathognomonic signs have been described. Signs of peritonitis are often absent and serum lactate may be normal. This makes prompt recognition and diagnosis difficult, while early treatment with close monitoring is important to optimise prognosis. Computed tomography may have suggestive findings and exclude other causes of abdominal pain, but endoscopy remains the gold standard for confirming the diagnosis...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28635328/dietary-implications-for-patients-receiving-long-term-oral-anticoagulation-therapy-for-treatment-and-prevention-of-thromboembolic-disease
#3
Emmanouela Kampouraki, Farhad Kamali
The effectiveness of oral anticoagulation therapy with warfarin (a vitamin K antagonist) in the treatment of thromboembolic disease, including stroke prophylaxis in patients with atrial fibrillation is well recognised. However, warfarin has a narrow therapeutic window and an unpredictable anticoagulation response, which make it difficult to achieve and maintain optimal anticoagulation. Various dietary factors, including sudden changes in eating patterns, can significantly alter anticoagulation control, thereby potentially exposing patients to the risk of bleeding or thromboembolic complications...
June 21, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28634768/futile-treatment-a-review
#4
Lenko Šarić, Ivana Prkić, Marko Jukić
The main goal of intensive care medicine is helping patients survive acute threats to their lives, while preserving and restoring life quality. Because of medical advancements, it is now possible to sustain life to an extent that would previously have been difficult to imagine. However, the goals of medicine are not to preserve organ function or physiological activity but to treat and improve the health of a person as a whole. When dealing with medical futilities, physicians and other members of the care team should be aware of some ethical principles...
June 20, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28634696/prominent-midfoot-involvement-in-children-with-enthesitis-related-arthritis-category-of-juvenile-idiopathic-arthritis
#5
Sanat Phatak, Namita Mohindra, Abhishek Zanwar, Amita Aggarwal
Foot involvement is common in juvenile idiopathic arthritis (JIA) but is often unrecognized and difficult to treat. This study was done to assess clinical and radiological involvement of the feet and its impact on function in Indian children with enthesitis-related arthritis (ERA). We enrolled consecutive children with ERA with disease duration of less than 5 years. All patients underwent clinical examination of the feet and filled the juvenile arthritis foot index (JAFI) questionnaire. Ultrasound (US) of foot joints and entheses and extremity magnetic resonance imaging (MRI) scan of one foot were done...
June 20, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28634646/the-role-of-robotics-in-the-invasive-management-of-bladder-cancer
#6
REVIEW
Pramit Khetrapal, Wei Shen Tan, Benjamin Lamb, Melanie Tan, Hilary Baker, James Thompson, Ashwin Sridhar, John D Kelly, Tim Briggs
Robot-assisted radical cystectomy (RARC) has been adopted widely in many centres, owed largely to the success of robot-assisted laparoscopic prostatectomy (RALP). It aims to replicate the oncological outcomes of open radical cystectomy (ORC), while providing a shorter recovery period. Despite this, previous RCTs have failed to show a benefit for RARC over ORC. These trials have compared extracorporeal RARC (eRARC) with ORC, which requires a further incision to mobilise the bowel for urinary reconstruction with an open technique...
August 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28634526/concurrent-babesiosis-and-serological-evidence-of-lyme-disease-in-a-young-patient
#7
Mark Adler, Thein Swe, Akari Thein Naing
Human babesiosis co-infected with Lyme disease in a young patient is an important condition. Here, we describe a case of a 39-year-old male patient with concurrent babesiosis and Lyme disease. Co-infections of tick borne diseases are often difficult to diagnose and underreported, and resulting in significant morbidity and mortality to patients. While co-infections have been infrequently described, it is of paramount importance that clinicians should be able to diagnose early and treat them effectively according to the patient geographical area and history of tick bite...
January 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28634489/a-study-of-patients-with-primary-mediastinal-germ-cell-tumors-treated-using-multimodal-therapy
#8
Yutaro Tanaka, Takehiko Okamura, Takashi Nagai, Daichi Kobayashi, Takahiro Kobayashi, Hidetoshi Akita, Yoshinobu Moritoki, Takahiro Yasui
OBJECTIVES: Primary mediastinal germ cell tumors (PMGCTs) are rare, which often makes them difficult to treat. Herein, we examined patients with PMGCTs who underwent multimodal treatment. METHODS: We examined 6 patients (median age: 25 years, range: 19-27 years) with PMGCTs who underwent multimodal treatment between April 2001 and March 2015. Three patients had seminomas, 2 patients had yolk sac tumors, and 1 patient had choriocarcinoma. The median observation period was 32...
2017: Advances in Urology
https://www.readbyqxmd.com/read/28634455/fertilizing-a-patient-engagement-ecosystem-to-innovate-healthcare-toward-the-first-italian-consensus-conference-on-patient-engagement
#9
Guendalina Graffigna, Serena Barello, Giuseppe Riva, Mariarosaria Savarese, Julia Menichetti, Gianluca Castelnuovo, Massimo Corbo, Alessandra Tzannis, Antonio Aglione, Donato Bettega, Anna Bertoni, Sarah Bigi, Daniela Bruttomesso, Claudia Carzaniga, Laura Del Campo, Silvia Donato, Silvia Gilardi, Chiara Guglielmetti, Michele Gulizia, Mara Lastretti, Valeria Mastrilli, Antonino Mazzone, Giovanni Muttillo, Silvia Ostuzzi, Gianluca Perseghin, Natalia Piana, Giuliana Pitacco, Gianluca Polvani, Massimo Pozzi, Livio Provenzi, Giulia Quaglini, Mariagrazia Rossi, Paola Varese, Natalia Visalli, Elena Vegni, Walter Ricciardi, A Claudio Bosio
Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28634310/-a-case-of-coexistent-glossopharyngeal-neuralgia-and-hemifacial-spasm-successfully-treated-with-transposition-of-the-vertebral-artery
#10
Takashi Fujii, Naoki Otani, Yohei Otsuka, Takashi Matsumoto, Shunsuke Tanoue, Hideaki Ueno, Satoshi Tomura, Arata Tomiyama, Terushige Toyooka, Kojiro Wada, Kentaro Mori
A case of coexistent glossopharyngeal neuralgia and hemifacial spasm was treated by transposition of the vertebral artery. A 60-year-old man was referred to our hospital due to pain in the left posterior part of the tongue that was difficult to control with oral medication at a local hospital. The diagnosis was left glossopharyngeal neuralgia based on the symptoms, imaging findings, and lidocaine test results. Moreover, the patient had left hemifacial spasm. Microvascular decompression was performed, which confirmed that the vertebral artery was compressing the lower cranial nerve and the posterior inferior cerebellar artery was compressing the root exit zone of the facial nerve...
June 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28634143/pcr-based-verification-of-positive-rapid-diagnostic-tests-for-intestinal-protozoa-infections-with-variable-test-band-intensity
#11
Sören L Becker, Ivan Müller, Pascal Mertens, Mathias Herrmann, Leyli Zondie, Lindsey Beyleveld, Markus Gerber, Rosa du Randt, Uwe Pühse, Cheryl Walter, Jürg Utzinger
Stool-based rapid diagnostic tests (RDTs) for pathogenic intestinal protozoa (e.g. Cryptosporidium spp. and Giardia intestinalis) allow for prompt diagnosis and treatment in resource-constrained settings. Such RDTs can improve individual patient management and facilitate population-based screening programmes in areas without microbiological laboratories for confirmatory testing. However, RDTs are difficult to interpret in case of 'trace' results with faint test band intensities and little is known about whether such ambiguous results might indicate 'true' infections...
June 17, 2017: Acta Tropica
https://www.readbyqxmd.com/read/28634003/spasticity-video-challenge-a-look-at-methods-for-addressing-difficult-cases
#12
Katharine E Alter, Mark Gormley, Atul T Patel
As seen in this CME online activity (available at http://courses.elseviercme.com/spasticity/662e), treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy, is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. Optimal care begins with the recognition that each patient's impairments are unique and must be assessed carefully to determine the impact of muscle overactivity, loss of dexterity, and weakness on passive and active function in the context of the patients' goals...
June 17, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28633904/clinical-characteristics-of-type-a-acute-aortic-dissection-with-symptom-of-the-central-nervous-system
#13
Yuji Shono, Tomohiko Akahoshi, Satomi Mezuki, Kenta Momii, Noriyuki Kaku, Jun Maki, Kentaro Tokuda, Tetsuro Ago, Takanari Kitazono, Yoshihiko Maehara
BACKGROUND AND PURPOSE: Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms. METHODS: We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014. RESULTS: We identified 59 TAAAD patients for the analysis (mean age, 67...
June 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28633723/validated-measures-of-insomnia-function-sleepiness-and-nasal-obstruction-in-a-cpap-alternatives-clinic-population
#14
Austin S Lam, Nancy A Collop, Donald L Bliwise, Raj C Dedhia
STUDY OBJECTIVES: Although efficacious in the treatment of obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) can be difficult to tolerate, with long-term adherence rates approaching 50%. CPAP alternatives clinics specialize in the evaluation and treatment of CPAP-intolerant patients; yet this population has not been studied in the literature. To better understand these patients, we sought to assess insomnia, sleep-related functional status, sleepiness, and nasal obstruction, utilizing data from validated instruments...
June 16, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/28633696/cross-border-collaboration-for-improved-tuberculosis-prevention-and-care-policies-tools-and-experiences
#15
M Dara, G Sulis, R Centis, L D'Ambrosio, G de Vries, P Douglas, D Garcia, N Jansen, E Zuroweste, G B Migliori
As tuberculosis (TB) spreads beyond borders with people movements, several interventions ensuring the continuity of care are essential, although difficult to put in place in the absence of well-defined agreements allowing data sharing and easy referral of patients to appropriate health facilities. This article first sets out general principles for cross-border collaboration and continuity of care. It then presents a series of case studies. Policies and practices on cross-border collaboration in selected low-incidence countries (Australia, Italy, Norway, The Netherlands, the United Kingdom and the United States) are described and critically appraised...
July 1, 2017: International Journal of Tuberculosis and Lung Disease
https://www.readbyqxmd.com/read/28633490/isolated-fourth-ventricle-to-shunt-or-stent
#16
Aaron Mohanty, Kim Manwaring
BACKGROUND: Of the various management options for isolated fourth ventricle (IFV), fourth ventriculoperitoneal shunts (FVPS) and aqueductal stents (AST) have been the most favored. Though effective, FVPS are often difficult to place and have higher complication rates than conventional ventricular shunts. OBJECTIVE: To assess the efficacy of AST in IFV and compare the outcome with FVPS. METHODS: Twenty-five patients surgically treated for IFV were analyzed...
June 17, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28633464/hyposmia-and-disgust-gender-specific-effects
#17
Rottraut Ille, Axel Wolf, Peter Valentin Tomazic, Anne Schienle
Reduced olfactory function is associated with altered trait disgust in men. This study sought to determine whether hyposmic women show similar changes in disgust responsiveness. We compared patients with hyposmia (25 men, 23 women) and 50 normosmic individuals (25 men, 25 women) with regard to their tendency to experience disgust across different disgust domains (disgust proneness), their self-disgust and their tendency to perceive their own disgust feelings as difficult to control and embarrassing (disgust sensitivity)...
July 1, 2017: Chemical Senses
https://www.readbyqxmd.com/read/28633279/off-pump-semicircular-annuloplasty-effective-treatment-of-concurrent-moderate-aortic-regurgitation
#18
Haiming Li, Chengxiong Gu
The treatment of aortic regurgitation (AR) in patients undergoing off-pump coronary artery bypass grafting (CABG) is a difficult problem. Aortic valve repair has become a promising therapy for AR. Various annuloplasty approaches have been used and have gained satisfactory results. Thus we adopted off-pump semicircular annuloplasty to treat concurrent moderate AR in 12 high-risk patients. Early follow-up results showed that this way is simple, safe, and effective.
July 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28633151/age-based-normative-measurements-of-the-pediatric-pelvis
#19
Matthew E Oetgen, Steven Andelman, Benjamin D Martin
OBJECTIVES: Pediatric pelvic trauma is associated with high rates of morbidity and mortality. Current classifications do not take into account age-dependent quantitative differences of the pediatric pelvis making accurate diagnosis of pathologic diastasis of the pubic symphysis, sacroiliac (SI) joints, and triradiate cartilage difficult. The purpose of this study was to establish age-based normative values for the width of the pubic symphysis, SI joints, and the triradiate cartilage of the pediatric pelvis...
July 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28633150/hexapod-frame-stacked-transport-for-tibial-infected-nonunions-with-bone-loss-analysis-of-use-of-adjunctive-stability
#20
Joshua K Napora, Douglas S Weinberg, Blake A Eagle, Bram R Kaufman, John K Sontich
OBJECTIVES: The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization. DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Seventy-five patients with infected posttraumatic nonunions of the tibia. INTERVENTION: Resection of nonunion with application of stacked hexapod frame for bone transport...
July 2017: Journal of Orthopaedic Trauma
keyword
keyword
58066
1
2
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"