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...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Education Infectious Disease Primary Care Source Type: blogs

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by Christian Sinclair (@ctsinclair)We used to publish a lot more article reviews here on Pallimed. Sometimes the analysis would be quite deep and sometimes we would just lump together a while bunch of snippets from key articles. I have been keeping an ever-growing list of articles I would love to write up for the site*, but never seemed to have the time to get to them, and then new ones would come out, that I would want to write about, but they too would just get added to the list. At the end of the year, I would look back on key articles for our field and be pretty bummed out that I never got anything published here about...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: meta sinclair Source Type: blogs
This study determined if there are observable patient-, tooth- and crack-level characteristics markedly associated with whether a tooth with an external crack also has an internal crack. METHODS: Two hundred nine dentists in The National Dental Practice-Based Research Network enrolled 2,858 adults with a vital permanent posterior tooth having at least 1 observed external crack. Presence and characteristics of internal cracks were recorded for 435 cracked teeth that were treated. Generalized estimating equations were used to identify significant (P
Source: Journal of the American Dental Association - Category: Dentistry Tags: J Am Dent Assoc Source Type: research
This study aimed to examine the prevalen...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Disaster Preparedness Source Type: news
The relative importance of nature and nurture has been debated for centuries, and has had strong — and sometimes misguided — influences on public policy.
Source: NYT Health - Category: Consumer Health News Authors: Tags: Genetics and Heredity Families and Family Life DNA (Deoxyribonucleic Acid) Pregnancy and Childbirth Anxiety and Stress Parenting Source Type: news
ConclusionOur study revealed that early and multiple doses of systemic baicalein attenuated neuropathic pain and improved sciatic nerve function by inhibiting pro-inflammatory cytokine expression and attenuating the activation of astrocytes in the spinal cord.
Source: Journal of the Chinese Medical Association - Category: General Medicine Source Type: research
AbstractPurpose of ReviewPain in rheumatoid arthritis (RA) may be due to different etiologies, ranging from peripheral inflammation to dysregulation of central nervous system (CNS) processing. This review evaluates relevant literature published on RA pain mechanisms in recent years.Recent FindingsDespite successes of disease-modifying antirheumatic drugs (DMARDs), pain persists for many RA patients. Studies involving patient-reported outcomes, quantitative sensory testing, and neuroimaging indicate that, in addition to joint inflammation, abnormalities in CNS pain processing may contribute to pain. Some DMARDs (e.g., janus...
Source: Current Osteoporosis Reports - Category: Orthopaedics Source Type: research
ConclusionsOur study confirms the feasibility and safety of our percutaneous technique for irrigation and debridement of pyogenic spondylodiscitis. Percutaneous irrigation and suction offers a truly minimally invasive option for managing recalcitrant spondylodiscitis or for diagnostic purposes. The approach used is very similar to discography and can be easily adapted to different hospital settings.Level of EvidenceLevel III
Source: Journal of Orthopaedics and Traumatology - Category: Orthopaedics Source Type: research
AbstractPurpose of ReviewSacral neuromodulation (SNM) is being used to treat lower urinary tract symptoms (LUTS) with growing popularity among clinicians in multiple specialties. As this therapy becomes more common in the USA and Europe, urologists will encounter more patients implanted with SNM generators.Recent FindingsOver time, it has recently been understood that up to 53% will develop pain at the implant site as reported by Groen et al. (J Urol 186:954,2011) and 3 –38% will lose effective stimulation as reported by Al-zahrani et al. (J Urol 185:981,2011) and White et al. (Urology 73:731,2009). There is a paucit...
Source: Current Urology Reports - Category: Urology & Nephrology Source Type: research
ConclusionsPatients with latent left ventricular outflow tract obstruction can progress to cardiogenic shock and pulseless electrical activity due to increased cardiac contraction and depletion of preload and afterload. We should consider the patient ’s underlying conditions that induced pulseless electrical activity.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
In this study, twelve test cases were presented and by applying lazy snapping algorithm, the hottest or coldest regions were extracted from the corresponding body thermographic images. The time taken to see the results varied from 7 to 30  s for these twelve cases. It was concluded that lazy snapping was much faster than other methods applied by the authors such asK-means, fuzzyc-means, level set, and mean shift algorithms for segmentation.Graphical abstractTime taken to implement lazy snapping algorithm to extract suspicious regions in different presented thermograms (in seconds). In this study, ten test cases are pr...
Source: Medical and Biological Engineering and Computing - Category: Biomedical Engineering Source Type: research
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