We must ask patients obvious questions
Four o’clock on a Friday afternoon is an anxiety-inducing time to be running behind in clinic as patients and staff both begin to show signs of wanting to leave. After finishing with a particularly complicated case involving chronic pain with multiple spinal and abdominal surgeries, I rushed into the room of the patient scheduled for 3 p.m. frazzled. The patient was an elderly man, seated with arms folded, looking sternly down a knobby nose at me. I couldn’t help feeling guilty as he stared at me as if I’d done something to unforgivably wrong him. Trying to appear less disconcerted than I was, I started taking a history for his complaint of back pain. He was extremely defensive to my every question, giving curt answers or throwing questions back at me. I got the impression that he loathed having to share personal information with me. I noticed throughout the course of history and physical examination that not only was his nose knobby, covered with two large bulbar outgrowths; his entire body was spattered with growths of varying sizes. They were skin-colored, apparently not painful and firm. I frowned as I took stock of a particularly large one on his forehead, about 2-inches across, trying hard to ignore the patient’s steady glare. “Neurofibromas?” I thought to myself, but I wasn’t sure. Perhaps they were just warts (viral?), or some other infection or unusual presentation (dermatitis herpetiformis?) that was unfamiliar to me. When I...
Charity Tourettes Action has discovered that patients are facing long delays in diagnosis.
Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization. PMID: 30658276 [PubMed - as supplied by publisher]
CONCLUSION: Older adults who receive rehabilitation services are at risk of having depressive and anxiety symptoms after these services have terminated. As mental illness is associated with considerable morbidity and may affect rehabilitation outcomes, additional efforts to identify and treat depression and anxiety in these older adults may be warranted. PMID: 30655031 [PubMed - as supplied by publisher]
CONCLUSIONS: localized or diffused hard-ligneous vaginal areas with Cork Wall sign represent the typical sign of disease presentation. PeNHVL is characterized by a very high sensitivity to chemotherapy and very favourable prognosis; therefore, radical surgery is not indicated. Histotype characterization is crucial to identify those uncommon variants associated with a less favorable clinical outcome. PMID: 30656635 [PubMed - as supplied by publisher]
Teens are known to have a penchant for impulsivity and instant gratification. Even scientists have studied these habits and come to the conclusion that teen brains are simply wired for risk. But just what kind of at-risk or high-risk behaviors should parents be on the lookout for? To start with, at-risk behaviors are defined as anything that puts adolescents on the path to future negative consequences such as injury, poor health, incarceration and even death. Since most teens rarely think ahead to the consequences of their actions, it’s up to parents to recognize some of these dangerous behaviors and caution the...
This study applies biomechanical tests (a flexion-relaxation test and a functional movement evaluation test) to analyse the effectiveness of flexible lumbar supports in functionality and disability versus placebo intervention, consisting of kinesiotape placed on the low back without any stress. 28 workers participated in the study, randomised in control and intervention groups with a two months' intervention. None of the biomechanical tests showed statistical differences in between-groups pre-post changes. No benefits of wearing a flexible lumbar support during the workday have been found in these assembly-line workers ver...
ARTHRITIS of the hands can be an extremely uncomfortable and debilitating condition that gets in the way of completing simple activities and tasks. Fight pain and symptoms of arthritis with these four hand exercises.
CONCLUSIONS: The decrease in scapular posterior tilt, along with increased scapular internal rotation and glenohumeral horizontal abduction, was associated with shoulder pain in university volleyball players. These changes should be addressed in the training and treatment of young volleyball players. PMID: 30657718 [PubMed - as supplied by publisher]
CONCLUSIONS: Small bowel location and longer abdominal pain duration may help distinguish vasculitis-induced bowel perforation from other etiologies. Overall mortality in patients with vasculitis and bowel perforation is increased, highlighting the importance of prompt diagnosis and management. PMID: 30652682 [PubMed - as supplied by publisher]
CONCLUSIONS: Consistent with previous findings, healthy participants displayed stronger alpha desynchronisation for pain pictures, indicating automatic disinhibition of the sensorimotor cortices in response to the observation of pain in others. We found evidence for a deficient modulation of sensorimotor cortex in FM patients. The lack of differential response suggests that they perceived relatively neutral pictures as potentially painful, at least in this setting. Our findings suggest that defective top-down regulation may play a role in the pathogenesis of FM. PMID: 30652680 [PubMed - as supplied by publisher]