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"Difficult patient"

Lorenzo Corbetta, Ariela Tofani, Flavio Montinaro, Lucio Michieletto, Loris Ceron, Chiara Moroni, Pier Giorgio Rogasi
BACKGROUND: The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches. OBJECTIVES: We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment...
October 12, 2016: Respiration; International Review of Thoracic Diseases
Richard W Siy, Rachel E Pferdehirt, Shayan A Izaddoost
INTRODUCTION: The use of biologic mesh where native tissue deficiencies limit reconstructive options has been well documented in the adult population, with increasing use to address the special requirements of complex abdominal wall reconstruction. There is, however, little documented evidence as to the safety and efficacy of these products in the pediatric population. METHODS: This retrospective case series details 5 pediatric cases of complicated abdominal hernia repair with Strattice®, a non-crosslinked porcine acellular dermal matrix...
September 23, 2016: Journal of Pediatric Surgery
Brett Cronin, Robin Robbins, Timothy Maus
OBJECTIVE: To assess the feasibility of pulmonary artery catheter placement using transesophageal echocardiography inclusive of a description of the technique. DESIGN: A prospective, proof-of-concept study. SETTING: Single university hospital. PARTICIPANTS: Twenty patients with chronic thromboembolic pulmonary hypertension scheduled for pulmonary thromboendarterectomy. INTERVENTIONS: Pulmonary artery catheters were placed in 20 patients solely by transesophageal echocardiographic guidance...
July 12, 2016: Journal of Cardiothoracic and Vascular Anesthesia
G Di Nardo, C Di Lorenzo, A Lauro, V Stanghellini, N Thapar, T B Karunaratne, U Volta, R De Giorgio
BACKGROUND: Chronic intestinal pseudo-obstruction (CIPO) represents the most severe form of gastrointestinal dysmotility with debilitating and potentially lethal consequences. Symptoms can be non-specific, and result in this condition being diagnosed incorrectly or too late with consequences for morbidity and even mortality. PURPOSE: The present article aims to provide pediatric and adult gastroenterologists with an up to date review about clinical features, diagnosis and therapeutic options for CIPO...
September 29, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Tirsa Colmenares-Roa, Gabriela Huerta-Sil, Claudia Infante-Castañeda, Leticia Lino-Pérez, Everardo Alvarez-Hernández, Ingris Peláez-Ballestas
The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors...
October 2016: Qualitative Health Research
Kiran Beneng, Tara Renton
Burning mouth syndrome (BMS) is a rare but impactful condition affecting mainly post-menopausal women resulting in constant pain and significant difficulty with eating, drinking and daily function. The aetiology of BMS remains an enigma. Recent evidence suggests it likely to be neuropathic in origin, the cause of which remains unknown. There is no cure for this condition and the unfortunate patients remain managed on a variety of neuropathic pain medication, salivary substitutes and other non-medical interventions that help the patient 'get through the day'...
April 2016: Dental Update
M S Kristensen, W H Teoh, S S Rudolph
Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review summarizes the current evidence for application of airway ultrasonography for identification of the cricothyroid membrane compared with the clinical techniques. We identified the best-documented techniques for bedside use, their success rates, and the necessary training for airway-ultrasound-naïve clinicians. After a short but structured training, the cricothyroid membrane can be identified using ultrasound in difficult patients by previously airway-ultrasound naïve anaesthetists with double the success rate of palpation...
September 2016: British Journal of Anaesthesia
Bo Qiu, Pei-Rong Ding, Ling Cai, Wei-Wei Xiao, Zhi-Fan Zeng, Gong Chen, Zhen-Hai Lu, Li-Ren Li, Xiao-Jun Wu, Rene-Olivier Mirimanoff, Zhi-Zhong Pan, Rui-Hua Xu, Yuan-Hong Gao
BACKGROUND: Complete resection of locally advanced sigmoid colon cancer (LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemoradiotherapy (neoCRT) followed by surgery as treatment of selected patients with unresectable LASCC. METHODS: We studied the patients with unresectable LASCC who received neoCRT followed by surgery between October 2010 and December 2012...
2016: Chinese Journal of Cancer
Ajay Gopalakrishna, Thomas A Longo, Joseph J Fantony, Richmond Owusu, Wen-Chi Foo, Rajesh Dash, Brant A Inman
BACKGROUND: Spectrum effects refer to the phenomenon that test performance varies across subgroups of a population. When spectrum effects occur during diagnostic testing for cancer, difficult patient misdiagnoses can occur. Our objective was to evaluate the effect of test indication, age, gender, race, and smoking status on the performance characteristics of two commonly used diagnostic tests for bladder cancer, urine cytology and fluorescence in situ hybridization (FISH). METHODS: We assessed all subjects who underwent cystoscopy, cytology, and FISH at our institution from 2003 to 2012...
2016: BMC Urology
Alan N Queen
Evidence-based dentistry is a concept ideally suited and applicable to special needs dentistry. As the special needs of patients varies according to the individual, so should the way we evaluate our patient, prescribe a course of treatment, and implement that treatment plan. Future generations of dental students and residents should be trained in these concepts not just for patients with special needs, but also for the general patient population. It is imperative that the dental community not retreat in the face of what many deem to be "difficult" patients with special needs...
July 2016: Dental Clinics of North America
Brendan T Wanta, Harmony L Tyner, John K Bohman, Larry M Baddour
Refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membraneoxygenation (ECMO) is an accepted strategy for treating refractory hypoxemia in patients with ARDS but is relatively contraindicated in the setting of systemic infections. We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient.
June 1, 2016: A & A Case Reports
Jorg Kleeff, Murray Korc, Minoti Apte, Carlo La Vecchia, Colin D Johnson, Andrew V Biankin, Rachel E Neale, Margaret Tempero, David A Tuveson, Ralph H Hruban, John P Neoptolemos
Pancreatic cancer is a major cause of cancer-associated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades. Currently, prevention or early diagnosis at a curable stage is exceedingly difficult; patients rarely exhibit symptoms and tumours do not display sensitive and specific markers to aid detection. Pancreatic cancers also have few prevalent genetic mutations; the most commonly mutated genes are KRAS, CDKN2A (encoding p16), TP53 and SMAD4 - none of which are currently druggable...
2016: Nature Reviews. Disease Primers
M S Kristensen, W H Teoh, S S Rudolph, R Hesselfeldt, J Børglum, M F Tvede
We compared the transverse and longitudinal approaches to ultrasound-guided identification of the cricothyroid membrane, to determine which was faster and more successful. Forty-two anaesthetists received a one-hour structured training programme consisting of e-learning, a lecture and hands-on training, and then applied both techniques in a randomised, cross-over sequence to obese females with body mass index 39.0 - 43.9 kg.m(-2) . The mean (SD) time to identify the cricothyroid membrane was 24.0 (12.4) s using the transverse technique compared with 37...
June 2016: Anaesthesia
(no author information available yet)
Patients regarded as 'difficult' by doctors are more likely to have conditions misdiagnosed, irrespective of the time spent or the complexity of the case, a new study suggests.
March 30, 2016: Nursing Standard
Jesus Rivera-Nieves, Giorgos Bamias
No abstract text is available yet for this article.
May 2016: Gastroenterology
Jarrad W Rowse, Lee Kirksey
With the increasing incidence of end-stage renal disease, hemodialysis vascular access presents an ongoing struggle, and a multidisciplinary approach must be considered to provide long-term durable access for patients on chronic hemodialysis. Surgeons must be very thoughtful in planning the steps of access for these patients and consider fistula first and catheter last, without forgetting that prosthetic grafts may be a legitimate first option for patients. This article provides a review of surgical management of dialysis access, including primary access options and follow-up of this difficult patient population...
March 2016: Seminars in Interventional Radiology
Leeat Granek, Merav Ben-David, Shahar Shapira, Gil Bar-Sela, Samuel Ariad
OBJECTIVE: The study aimed to explore oncologist's grief symptoms over patient death and to identify why and which losses are particularly challenging when patients die. METHODS: The grounded theory method was used to collect and analyze the data. Twenty-two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers in the north, center, and south of Israel. Oncologists were at different stages of their careers and varied in their sub-specialties, gender, and personal and professional backgrounds...
March 14, 2016: Psycho-oncology
Massimiliano Bissolati, Elena Orsenigo, Carlo Staudacher
Minimally invasive surgery (MIS) was initially used for the treatment of colorectal benign disease. However, the indications for MIS techniques have progressively been expanded to include cancers. Nowadays, the indications for MIS are almost the same as those for open surgery. The scientific validation of MIS for colorectal cancer has favorably evolved. The advantages awaited for the short-term outcome were confirmed, although at the cost of longer operating time and higher costs. In parallel, tangible evidence of oncologic safety was demonstrated, and long-term results of MIS have been found comparable to those of open surgery...
March 2016: Updates in Surgery
Mercedes Rubio, Quique Bassat, Xavier Estivill, Alfredo Mayor
Symptoms caused by bacterial, viral and malarial infections usually overlap and aetiologic diagnosis is difficult. Patient management in low-resource countries with limited laboratory services has been based predominantly on clinical evaluation and syndromic approaches. However, such clinical assessment has limited accuracy both for identifying the likely aetiological cause and for the early recognition of patients who will progress to serious or fatal disease. Plasma-detectable biomarkers that rapidly and accurately diagnose severe infectious diseases could reduce morbidity and decrease the unnecessary use of usually scarce therapeutic drugs...
2016: Malaria Journal
Sílvia Mamede, Tamara Van Gog, Stephanie C E Schuit, Kees Van den Berge, Paul L A Van Daele, Herman Bueving, Tim Van der Zee, Walter W Van den Broek, Jan L C M Van Saase, H G Schmidt
BACKGROUND: Patients who display disruptive behaviours in the clinical encounter (the so-called 'difficult patients') may negatively affect doctors' diagnostic reasoning, thereby causing diagnostic errors. The present study aimed at investigating the mechanisms underlying the negative influence of difficult patients' behaviours on doctors' diagnostic performance. METHODS: A randomised experiment with 74 internal medicine residents. Doctors diagnosed eight written clinical vignettes that were exactly the same except for the patients' behaviours (either difficult or neutral)...
March 7, 2016: BMJ Quality & Safety
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