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"Difficult patient"

Hai-Jie Hu, Rong-Xing Zhou, Fei Liu, Jun-Ke Wang, Fu-Yu Li
RATIONALE: Pancreatic mucoepidermoid carcinoma (MEC) is a rare disease with no more than 10 cases reported in literature. The prognosis is poor and few patients can survival more than 1 year. PATIENT CONCERNS: We presented a case of patient manifested as left upper abdominal pain. Computed tomography demonstrated a low-density shadow measuring 2.1 × 2.4 cm situated at the transition area of neck and body of the pancreas with obscure boundary and irregular enhancement...
March 2018: Medicine (Baltimore)
Jasmina Starc
BACKGROUND: Working in nursing is mentally and physically demanding and is one of the most stressful professions. AIM: To determine the basic causes of stress and examine the symptoms of stress among healthcare professionals at the primary and secondary level of health care. MATERIAL AND METHODS: The research was based on the descriptive and causal non-experimental method of empirical research. The independent samples t-test was used. RESULTS: The survey results have shown that those employed in nursing are exposed to stressful situations on a daily basis, most often involving psychological or physical violence in the workplace (M = 4...
February 15, 2018: Open Access Macedonian Journal of Medical Sciences
Serkan Demirkan
Eccrine hidrocystomes (EH) are benign cystic tumors of dermal eccrine ducts. There is still no gold standard treatment option for EH because of the large number of lesions, the risk of cicatrization and the different treatment options offered. We offer combined oral isotretinoin and following erbium-yttrium aluminum garnet laser treatment as an alternative treatment option in difficult patients with EH.
February 22, 2018: Journal of Cosmetic and Laser Therapy: Official Publication of the European Society for Laser Dermatology
Hadley Burns, J Stephen Gunn, Saeed Chowdhry, Thomas Lee, Steven Schulz, Bradon J Wilhelmi
Objective: This paper discusses the various surgical techniques and outcomes associated with management of buried penis syndrome. Methods: Presented is the case of a 49-year-old man with morbid obesity, leading to massive panniculus and buried penis. We review our technique for reconstruction of the buried penis and treatment of the overlying large panniculus. Literature search was conducted to review current techniques in correcting buried penis syndrome. Results: The patient underwent a successful panniculectomy with removal of all excess skin and tissue...
2018: Eplasty
Daniel H Desmond, Mark G Carmichael
Mastocytosis is a rare process involving the activation and accumulation of clonal mast cells categorized by cutaneous or systemic involvement. Although the diagnosis of cutaneous disease can be straightforward and confirmed via skin biopsy, systemic disease mimics more common disease processes making diagnosis a challenge. The widespread physiologic distribution of mast cells causes a variety of symptoms with aberrant expression including fatigue, headache, depression, dyspnea, dyspepsia, nausea, and abdominal pain...
February 2018: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
Hitoshi Ogino
In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur...
February 5, 2018: General Thoracic and Cardiovascular Surgery
Daniela Berritto, Antonio Pinto, Anna Russo, Fabrizio Urraro, Antonella Laporta, Maria Paola Belfiore, Roberto Grassi
Scapular fractures are one of the most difficult fractures to diagnose on radiographs. Detection can be challenging because of the obscuration by the overlying structures or incomplete imaging due to difficult patient collaboration. Familiarity with imaging characteristics of these abnormalities will allow radiologists to better diagnose and characterize scapular fractures. Three-dimensional computed tomographic scans are considered the gold standard for scapular diagnoses. Treatment strategies differ depending on the type of scapular fractures, but the site and degree of displacement will determine whether surgical intervention should be considered...
January 19, 2018: Acta Bio-medica: Atenei Parmensis
Barbara Andraka-Christou, Matthew J Capone
AIM: Our aim was to compare physician-reported barriers to sublingual buprenorphine (BUP) and extended-release naltrexone (XR-NLT) prescribing in U.S. office-based practices, and to identify potential policies for minimizing these barriers. Only one previous qualitative study has examined physician-reported barriers to prescribing XR-NLT and no qualitative study has compared physician-reported barriers between the two medications. METHODS: Researchers conducted individual semi-structured and in-depth interviews with 20 licensed physicians in four U...
January 8, 2018: International Journal on Drug Policy
Phi Anh Phan, Cathy Zhang, Daniel Geer, Federico Formenti, Clive E W Hahn, Andrew D Farmery
The inspired sinewave technique is a noninvasive method to measure airway dead space, functional residual capacity, pulmonary blood flow, and lung inhomogeneity simultaneously. The purpose of this paper was to assess the repeatability and accuracy of the current device prototype in measuring functional residual capacity, and also participant comfort when using such a device. To assess within-session repeatability, six sinewave measurements were taken over two-hour period in 17 healthy volunteers. To assess day-to-day repeatability, measurements were taken over 16 days in 3 volunteers...
2017: IEEE Journal of Translational Engineering in Health and Medicine
Kaja Heidenreich, Anders Bremer, Lars Johan Materstvedt, Ulf Tidefelt, Mia Svantesson
In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis...
December 14, 2017: Medicine, Health Care, and Philosophy
Ruqiya Shama Tareen, Kinza Tareen
Diabetes mellitus (DM) is a debilitating chronic illness with complex pathophysiological, psychological, and quality of life (QoL) implications creating a constant state of turbulence. Some of these interconnections are apparent to healthcare providers and are easily addressed in a routine diabetic clinical care. However, a large number of these hidden factors that interplay with each other and impact on the physical outcomes of DM goes unnoticed by health care providers. This is a frustrating and lonely predicament for DM patients making it very difficult for them to manage their illness well...
October 2017: Translational pediatrics
Niklas Rommel, Marco Rainer Kesting, Nils Hagen Rohleder, Klaus-Dietrich Wolff, Jochen Weitz
PURPOSE: Osteoradionecrosis (ORN) of the jaws represents one of the most severe complications after primary or adjuvant radiation therapy (RT) of large head and neck tumors. In advanced ORN cases, surgical management is generally considered the therapy of choice. However, in several severe ORN patients with extensive bone and soft tissue defects, functional and aesthetic reconstruction represents a huge challenge for any surgeon, with an increased risk of post-operative wound healing disorders...
January 2018: Journal of Cranio-maxillo-facial Surgery
Szymon Pawlak, Roman Przybylski, Janusz Skalski, Joanna Śliwka, Andrzej Kansy, Adam Grzybowski, Arkadiusz Wierzyk, Jacek Białkowski, Bohdan Maruszewski, Marian Zembala
BACKGROUND: The treatment of advanced heart failure (HF) in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital aetiology. The treatment schedules for paediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the paediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance of surviving the period of waiting for a heart donor...
2018: Kardiologia Polska
Elizabeth Hulen, Somnath Saha, Benjamin J Morasco, Claire Zeigler, Katherine Mackey, Samuel T Edwards
Objective: The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers. Setting: A Veterans Health Administration primary care clinic in Portland, Oregon. Participants: 12 members of primary care clinic staff representing multiple disciplines with recent participation in the Controlled Substance Review Group...
November 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Zhuoqi Cheng, Brian L Davies, Darwin G Caldwell, Giacinto Barresi, Qinqi Xu, Leonardo S Mattos
Intravenous catheterization is frequently required for numerous medical treatments. However, this process is characterized by a high failure rate, especially when performed on difficult patients such as newborns and infants. Very young patients have small veins, and that increases the chances of accidentally puncturing the catheterization needle directly through them. In this article, we present the design, development and experimental evaluation of a novel hand-held robotic device for improving the process of peripheral intravenous catheterization by facilitating the needle insertion procedure...
October 1, 2017: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
Bernhard Moser, Peter Jaksch, Shahrokh Taghavi, Gabriella Muraközy, Georg Lang, Helmut Hager, Claus Krenn, Georg Roth, Peter Faybik, Andreas Bacher, Clemens Aigner, José R Matilla, Konrad Hoetzenecker, Philipp Hacker, Irene Lang, Walter Klepetko
OBJECTIVES: Lung transplantation for idiopathic pulmonary arterial hypertension has the highest reported postoperative mortality of all indications. Reasons lie in the complexity of treatment of these patients and the frequent occurrence of postoperative left ventricular failure. Transplantation on intraoperative extracorporeal membrane oxygenation support instead of cardiopulmonary bypass and even more the prolongation of extracorporeal membrane oxygenation into the postoperative period helps to overcome these problems...
July 27, 2017: European Journal of Cardio-thoracic Surgery
Christopher Raio, Robert Elspermann, Natwalee Kittisarapong, Brendon Stankard, Tanya Bajaj, Veena Modayil, Mathew Nelson, Gerardo Chiricolo, Benjamin Wie, Alexandra Snock, Michael Mackay, Adam Ash
The primary study objective was to evaluate insertion success rates. Secondary objectives included patient satisfaction, procedure time, complication rates, completion of therapy and dwell time of the novel AccuCath(®) 2.25″ Blood Control (BC) Catheter System (FDA approved) placed in difficult-access patients. This was a single-arm feasibility trial evaluating the AccuCath(®) 2.25″ BC Catheter System in a convenience sample of DIVA patients defined as at least two failed initial attempts or a history of difficult access plus the inability to directly visualize or palpate a target vein...
September 14, 2017: Internal and Emergency Medicine
L Granek, L Barbera, O Nakash, M Cohen, M K Krzyzanowska
OBJECTIVES: We aimed to explore and identify what makes patient death more emotionally difficult for oncologists and how oncologists cope with patient death. METHODS: A convenience sample of 98 Canadian oncologists (50 men, 48 women) completed an online survey that included a demographics section and a section about patient death. RESULTS: More than 80% of oncologists reported that patient age, long-term management of a patient, and unexpected disease outcomes contributed to difficult patient loss...
August 2017: Current Oncology
Payam Zarrintaj, Abolfazl Salehi Moghaddam, Saeed Manouchehri, Zhaleh Atoufi, Anahita Amiri, Mohammad Amir Amirkhani, Mohammad Ali Nilforoushzadeh, Mohammad Reza Saeb, Michael R Hamblin, Masoud Mozafari
Skin is the outermost covering of the human body and at the same time the largest organ comprising 15% of body weight and 2 m2 surface area. Skin plays a key role as a barrier against the outer environment depending on its thickness, color and structure, which differ from one site to another. The four major types of problematic wounds include ulcers (diabetic, venous, pressure) and burn wounds. Developing novel dressings helps us to improve the wound healing process in difficult patients. Recent advances in regenerative medicine and nanotechnology are revolutionizing the field of wound healing...
October 2017: Nanomedicine
James D Livingston, Erica Adams, Marlee Jordan, Zachary MacMillan, Ramm Hering
BACKGROUND: Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices. OBJECTIVES: This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder...
August 30, 2017: Substance Use & Misuse
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