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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In this report, we looked at opioid medication use following discharge after radical prostatectomy. We found that 77% of opioid pain medication prescribed was unused, with 84% of patients using less than half of their prescription. Prescribing more opioids was associated with greater use; only 9% of patients appropriately disposed of leftover medication.
Source: European Urology - Category: Urology & Nephrology Source Type: research
Publication date: Available online 21 October 2018Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Ali Zarezadeh, Kelly Mamelson, W. Christian Thomas, Bradley S. Schoch, Thomas W. Wright, Joseph J. KingAbstractIntroductionWe evaluate the most common outcome measures used in distal humerus fracture studies in order to suggest standardization for future research.Materials and methodsA systematic review identified articles assessing the outcomes of acute distal humerus fractures from 2006 to 2016 from PubMed and Web of Science databases. The inclusion criterion was studies reporting on the outcomes of t...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
CONCLUSIONS: Prenatal exercise reduced the odds and severity of prenatal depression. PMID: 30337464 [PubMed - in process]
Source: British Journal of Sports Medicine - Category: Sports Medicine Authors: Tags: Br J Sports Med Source Type: research
The Impact of Livestrong® at the YMCA for Cancer Survivors. Oncol Nurs Forum. 2018 Nov 01;45(6):717-725 Authors: Schumacher MM, McNiel P Abstract OBJECTIVES: To determine the clinical significance of pre- and post-exercise rehabilitation physical and psychosocial outcomes of the Livestrong® at the YMCA program. SAMPLE & SETTING: 158 participants at the YMCA of the Fox Cities in Appleton, Wisconsin, were analyzed for pre- and postparticipation physical outcomes, 68 participants were analyzed for pre- and postparticipation psychosocial outcomes, and 11 participants were interviewed abou...
Source: Oncology Nursing Forum - Category: Nursing Authors: Tags: Oncol Nurs Forum Source Type: research
Abstract PROBLEM IDENTIFICATION: Fear of cancer recurrence (FCR) is prevalent among people with cancer; therefore, it is important to determine whether interventions offered to this population are effective in alleviating FCR. This review summarizes randomized, controlled trials in the literature about the effect of psychosocial interventions on FCR in people with cancer. LITERATURE SEARCH: A systematic review of the literature was conducted using PubMed, Web of Science, EMBASE, and Cochrane Library. DATA EVALUATION: Extracted data included cancer type, number of participants, intervention type and durat...
Source: Oncology Nursing Forum - Category: Nursing Authors: Tags: Oncol Nurs Forum Source Type: research
CONCLUSION: Day-surgery is nowadays a concrete reality, made possible by an attentive selection of patients, an accurate surgical technique, an attentive patient monitoring in the postoperative period and a continuous monitoring of the effectiveness of pain medications. Over the last decades our surgical team has developed modified techniques of loco-regional anesthesia that allow us to perform even complex procedures and discharge the patient within 24 hours. KEY WORDS: Day-surgery, Haemorrhoids, Proctological procedures. PMID: 30337511 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain. PMID: 30337510 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
ConclusionsOur NLP system performed well in identifying the 26 lumbar spine findings, as benchmarked by reference-standard annotation by medical experts. Machine-learned models provided substantial gains in model sensitivity with slight loss of specificity, and overall higher AUC.
Source: Academic Radiology - Category: Radiology Source Type: research
Conclusion: This study reveals noteworthy health risks in a rural uninsured population, including a higher rate of gonorrhea compared with national rates and a higher RR for STDs in certain demographic groups. These findings form a foundation for improvements in care through earlier STD diagnoses, effective treatment, and enhanced patient education. PMID: 30335878 [PubMed - in process]
Source: Journal of the American Osteopathic Association - Category: Complementary Medicine Tags: J Am Osteopath Assoc Source Type: research
In this study, eutectic mixtures, as binary pharmaceutical compositions of CEL with adipic acid (ADI) and saccharin (SAC), were identified through a phase diagram and Tammann’s triangle intended to improve the wettability and dissolution rate of poorly water-soluble CEL. The contact angles at 0s in the liquid-solid interface were approximately θs (theta) 79.7° ± 0.50° and 86.65° ± 0.45° for CEL-ADI and CEL-SAC, respectively, which were much lower than the value obtained for CEL (92.05° ± 0.75° θ). Moreover, a comparison of the disk intrinsic dissolution rate an...
Source: International Journal of Pharmaceutics - Category: Drugs & Pharmacology Source Type: research
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