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Medical Problems (medical + problem)
Kinds of Medical Problems Selected AbstractsMedical Problems of Internationally Adopted Children Presenting to a Travel Medicine Clinic in NepalJOURNAL OF TRAVEL MEDICINE, Issue 6 2006DTM&H, Johnnie A. Yates MD Dermatologic, respiratory, and gastrointestinal infections were the most commonly diagnosed conditions among adopted Nepali children presenting to a travel medicine clinic in Kathmandu. Surveillance and early treatment of infections in international adoptees in their birth country may help prevent the importation of infectious diseases. [source] Road traffic accidents and the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Suzan Abou-Raya Aim: To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly. Methods: Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination. Results: The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims. Conclusion: The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented. [source] Medical problems in adolescents with myelomeningocele (MMC): an inventory of the Swedish MMC population born during 1986,1989ACTA PAEDIATRICA, Issue 3 2007I Olsson Abstract Aim: To describe the prevalence of myelomeningocele (MMC) and the medical needs of adolescents, 15,18 years, with MMC in Sweden, at a time when they are on the threshold of adulthood, leaving paediatrics. Methods: In a retrospective study, we identified all adolescents with MMC, born during 1986,1989 and living in Sweden on July 1, 2004. An inventory was agreed upon with questions concerning their medical problems and need for medical care. Results: There were 175 persons 15,18 years of age, born with MMC or lipoMMC (prevalence 3.8 per 10 000). Hydrocephalus was seen in 86%, 31% had been operated because of tethered cord syndrome, and 6% for Chiari malformation symptoms. The majority had motor impairments. Clean intermittent catheterisation for bladder emptying was used by 85%, and 59% used enemas on a regular basis because of the neurogenic bowel dysfunction. Renal dysfunction was seen in 1.7% of the adolescents. Conclusion: Lifelong follow-up by many specialists, among others neurologists and neurosurgeons, urotherapists and urologists, orthopaedic surgeons and orthotists, is necessary for individuals with MMC. The complex medical situation, often in combination with cognitive difficulties, makes it necessary to coordinate medical services for this increasing group of adults with multiple impairments. [source] The cause and prevention of human birth defects: What have we learned in the past 50 years?CONGENITAL ANOMALIES, Issue 1 2001Robert L. Brent ABSTRACT This review article dealig with the subject of "The Cause and Prevention of Human Birth Defects" was prepared in celebration of the 40th anniversary of the Japanese Teratology Society. It begins with recollections of some of the important contributions of Japanese scientists in the fields of teratology and embryology and a summary of the many scientific and medical accomplishments of the past 50 years in the fields of teratology, genetics, developmental biology, epidemiology and genetics. The review includes a summary of the drugs, chemicals and physical agents that have been documented to result in congenital malformations and reproductive effects when pregnant women are exposed during pregnancy. The principles of teratology were also summarized and emphasize that 1) no teratogenic agent can be described qualitatively as a teratogen, since a teratogenic exposure must include not only the agent, but also the dose and the time in pregnancy when the exposure occurs. 2) Even agents that have been demonstrated to result in malformatins cannot produce every type of malformation. 3) Known teratogens can be presumptively identified by the spectrum of malformations they produce. 4) It is easier to exclude an agent as a cause of birth defects than to definitively conclude that it was responsible for birth defects. 5) When evaluating the risk of exposures, the dose is a crucial component in determining the risk. 6) Teratogenic agents follow a toxicological dose response curve. This means that each teratogen has a threshold dose, below which, there is no risk of teratogenensis, no matter when in pregnancy the exposure occurred. 7) The evaluation of a child with congenital malformations connot be adequately performed unless it is approached with the same scholarship and detail, as is any other complicated medical problem. 8) Each physician must recognize the consequences of providing erroneous reproductive risks to pregnant women exposed to drugs and chemicals during pregnancy or alleging that a child's malformations are due to an environmental agent without performing a complete and scholarly evaluation. [source] A cross-national meta-analysis of alcohol and injury: data from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)ADDICTION, Issue 9 2003Cheryl J. Cherpitel ABSTRACT Aims, To examine the relationship of acute alcohol consumption with an injury compared to a non-injury event in the emergency room across ERs in five countries. Design, Meta-analysis was used to evaluate the consistency and magnitude of the association of a positive blood alcohol concentration (BAC) at the time of arrival in the ER and self-reported consumption within 6 hours prior to the event with admission to the ER for an injury compared to a non-injury, and the extent to which contextual (socio-cultural and organizational) variables explain effect sizes. Findings, When controlling for age, gender and drinking five or more drinks on an occasion at least monthly, pooled effect size was significant and of a similar magnitude for both BAC and self-reported consumption, with those positive on either measure over half as likely again to be admitted to the ER with an injury compared to a medical problem. Effect sizes were found to be homogeneous across ERs for BAC, but not for self-report. Trauma center status and legal level of intoxication were positively predictive of self-reported consumption effect size on injury. Conclusions, These data suggest a moderate, but robust association of a positive BAC and self-report with admission to the ER with an injury, and that contextual variables also appear to play a role in the alcohol,injury nexus. [source] Clinical decision-making in the context of chronic illnessHEALTH EXPECTATIONS, Issue 1 2000Susan Watt DSW CSW This paper develops a framework to compare clinical decision making in relation to chronic and acute medical conditions. Much of the literature on patient-physician decision making has focused on acute and often life-threatening medical situations in which the patient is highly dependent upon the expertise of the physician in providing the therapeutic options. Decision making is often constrained and driven by the overwhelming impact of the acute medical problem on all aspects of the individual's life. With chronic conditions, patients are increasingly knowledgeable, not only about their medical conditions, but also about traditional, complementary, and alternative therapeutic options. They must make multiple and repetitive decisions, with variable outcomes, about how they will live with their chronic condition. Consequently, they often know more than attending treatment personnel about their own situations, including symptoms, responses to previous treatment, and lifestyle preferences. This paper compares the nature of the illness, the characteristics of the decisions themselves, the role of the patient, the decision-making relationship, and the decision-making environment in acute and chronic illnesses. The author argues for a different understanding of the decision-making relationships and processes characteristic in chronic conditions that take into account the role of trade-offs between medical regimens and lifestyle choices in shaping both the process and outcomes of clinical decision-making. The paper addresses the concerns of a range of professional providers and consumers. [source] The Stigma of Psychological Problems in a Work Environment: Evidence From the Screening of Service Members Returning From Bosnia,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2000Thomas W. Britt The present research examined the stigma associated with psychological problems among service members returning from the United States peacekeeping mission to Bosnia. The results show that admitting a psychological problem in the military is perceived as muchmore stigmatizing than admitting a medical problem. Service members had more concerns about stigmatization and felt more uncomfortable discussing psychological problems than medical problems, and these feelings were magnified when service members were being screened with their units rather than alone. Service members also reported a lesser likelihood of following through with a psychological referral than with a medical referral. However, participants who discussed psychological issues with a therapist felt the screening was more beneficial than those who did not discuss their responses. The results address the neglected topic of the stigma associated with psychological problems in the workplace. [source] Psoriatic arthritis of the temporomandibular joint , a surgical alternative to treating a medical problemORAL SURGERY, Issue 1-2 2010R. Popat Abstract We describe the case of a 43-year-old female who suffered pain and profound functional impairment in both tempormandibular joints (TMJ), secondary to psoriatic arthritis. The inability to eat and talk without severe pain had rendered the patient unable to seek employment and with a poor quality of life. Her symptoms had proved refractory to anti-TNF medication (Etanercept) and other treatments such as hydrocortisone injections and bilateral TMJ condylar shaves. The patient underwent bilateral total temporomandibular joint (TMJ) replacements in May 2008. Her recovery was uneventful and she is now pain-free and has a vastly improved quality of life. This case gives an overview of psoriatic arthritis, especially as it affects the TMJ and highlights the benefits of total TMJ replacement. We recommend that consideration should be given to its use as a surgical alternative in cases which prove refractory to medical management. [source] Management of childhood diseases in the Byzantine period: VII , EpilepsyPEDIATRICS INTERNATIONAL, Issue 5 2002Ioanna A Ramoutsaki Abstract Epilepsy was referred to as a serious medical problem with poor outcome by the Byzantine physicians. For the treatment they suggested herbal or animal substances in many different forms, but they stressed the importance of a proper diet. In their efforts to elucidate the mechanisms involved in the onset as well as the course of the disease they were influenced by the Hippocratic tradition of juices. [source] ABCD position statement on screening for gestational diabetes mellitusPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2007FRCP Consultant Physician, S Robinson MD, Senior Lecturer Abstract Gestational diabetes mellitus is an increasingly common medical problem seen in pregnancy. A randomised clinical trial, published in 2005, showed improved perinatal morbidity and mortality in pregnancies of women with actively managed gestational diabetes. Prior to 2003 the evidence base for screening and treating all women with gestational diabetes was not strong enough for the National Institute for Clinical Excellence (NICE), in its 2003 antenatal guidelines, to recommend universal screening for gestational diabetes. As we await the review of these original 2003 NICE guidelines we offer a pragmatic approach for the detection of glucose intolerance in pregnancy. Copyright © 2007 John Wiley & Sons. [source] The management of cancer pain,CA: A CANCER JOURNAL FOR CLINICIANS, Issue 2 2000Dr. Nathan I. Cherny MBBS Any therapeutic strategy developed for patients experiencing cancer pain depends on the goals of care, which can be broadly categorized as prolonging survival, optimizing comfort, and optimizing function. The relative priority of these goals for any individual should direct therapeutic decision-making. By combining primary treatments, systemic analgesic agents, and other techniques, most cancer patients can achieve satisfactory relief of pain. In cases where pain appears refractory to these interventions, invasive anesthetic or neurosurgical maneuvers may be necessary, and sedation may be offered to those with unrelieved pain at the end of life. The principles of analgesic therapy are presented, as well as the practical issues involved in drug administration, ranging from calculating dosage to adverse effects, and, when necessary, how to switch and/or combine therapies. Adjuvant analgesics, which are drugs indicated for purposes other than relief of pain but which may have analgesic effects, are also listed and discussed in some detail. Surgical and neurodestructive techniques, such as rhizotomy or cordotomy, although not frequently required or performed, represent yet other options for patients with unremitting pain and diminished hope of relief. Although cancer pain can be a complex medical problem arising from multiple sources, patients should be assured that suffering is not inevitable and that relief is attainable. [source] Length of the treatment and number of doses per day as major determinants of child adherence to acute treatmentACTA PAEDIATRICA, Issue 3 2010H Chappuy Abstract Objective:, To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. Methods:, Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. Results:, One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. Conclusion:, This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments. [source] Combating resistance in a challenging, changing environmentCLINICAL MICROBIOLOGY AND INFECTION, Issue 2007F. W. Goldstein Abstract The prevalence of antimicrobial resistance for both Gram-positive and Gram-negative pathogens is escalating worldwide. Outbreaks of community- and hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) are being reported more frequently. Although antimicrobial resistance is well recognised as a global problem, decisions about appropriate intervention and treatment should be made at the level of the local hospital or healthcare system. Thus, local surveillance to identify prevalent pathogens, detect bacterial resistance and identify particular strains is necessary for selecting optimal treatment regimens. In addition, bactericidal antimicrobial agents with novel mechanisms of action and activity against multidrug-resistant bacteria, together with improved infection control measures, are needed to address this growing medical problem more effectively. [source] Why primiparous mothers do not breastfeed in the United States: a national surveyACTA PAEDIATRICA, Issue 11 2003JS Taylor Aim: To investigate primiparous women's primary reason for not breastfeeding. Methods: We used the 1995 National Survey of Family Growth to analyze the breastfeeding behaviors of a national probability sample of 6733 first-time US mothers, aged 15 to 44 y. Main outcome measures in this cross-sectional study were the reasons for never breastfeeding and reasons for stopping breastfeeding using closed-ended, multiple choice questions. Results: Most commonly, women did not breastfeed because they "preferred to bottle feed" (66.3%). The most common reason for stopping breastfeeding was that the child was "old enough to wean" (35.7%), although 15%, 34%, 54%, and 78% of those women had stopped breastfeeding by 3, 6, 9, and 12 mo, respectively. "Physical or medical problem" was reported by 14.9% of women who did not breastfeed and 26.9% of women who had stopped breastfeeding, making it the second most common reason for not breastfeeding in each group. There were significant differences across racial and ethnic groups. Conclusion: Additional studies are needed to better understand why women "prefer to bottle feed", especially black women. Increasingly effective programs and policies to promote breastfeeding will logically follow. Since physical and medical problems are such common reasons both for never breastfeeding and for stopping breastfeeding, individual healthcare providers can have a significant impact on breastfeeding rates and duration. [source] Abductive Diagnosis Using Time-Objects: Criteria for the Evaluation of SolutionsCOMPUTATIONAL INTELLIGENCE, Issue 1 2001Elpida T. Keravnou Diagnostic problem solving aims to account for, or explain, a malfunction of a system (human or other). Any plausible potential diagnostic solution must satisfy some minimum criteria relevant to the application. Often there will be several plausible solutions, and further criteria will be required to select the "best" explanation. Expert diagnosticians may employ different, complex criteria at different stages of their reasoning. These criteria may be combinations of some more primitive criteria, which therefore should be represented separately and explicitly to permit their flexible and transparent combined usage. In diagnostic reasoning there is a tight coupling between the formation of potential solutions and their evaluation. This is the essence of abductive reasoning. This article presents an abductive framework for diagnostic problem solving. Time-objects, an association of a property and an existence, are used as the representation formalism and a number of primitive, general evaluation criteria into which time has been integrated are defined. Each criterion provides an intuitive yardstick for evaluating the space of potential solutions. The criteria can be combined as appropriate for particular applications to define plausible and best explanations. The central principle is that when time is diagnostically significant, it should be modeled explicitly to enable a more accurate formulation and evaluation of diagnostic solutions. The integration of time and primitive evaluation criteria is illustrated through the Skeletal Dysplasias Diagnostician (SDD) system, a diagnostic expert system for a real-life medical domain. SDD's notions of plausible and best explanation are reviewed so as to show the difficulties in formalizing such notions. Although we illustrate our work by medical problems, it has been motivated by consideration of problems in a number of other domains (fermentation monitoring, air and ground traffic control, power distribution) and is intended to be of wide applicability. [source] Striae Distensae (Stretch Marks) and Different Modalities of Therapy: An UpdateDERMATOLOGIC SURGERY, Issue 4 2009MOHAMED L. ELSAIE MD BACKGROUND Striae distensea (SD; stretch marks) are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The origins of SD are poorly understood, and a number of treatment modalities are available for their treatment, yet none of them is consistently effective, and no single therapy is considered to be pivotal for this problem. With a high incidence and unsatisfactory treatments, stretch marks remain an important target of research for an optimum consensus of treatment. OBJECTIVE To identify the current treatment modalities and their effectiveness in the treatment of stretch marks. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of stretch marks with emphasis on the safety and efficacy of the newer optical devices and laser applications. RESULTS No current therapeutic option offers complete treatment, although there are a number of emerging new modalities that are encouraging. CONCLUSION The therapeutic strategies are numerous, and no single modality has been far more consistent than the rest. The long-term future of treatment strategies is encouraging with the advance in laser technologies. [source] Surgical Management of Pyoderma Gangrenosum: Case Report and ReviewDERMATOLOGIC SURGERY, Issue 11 2000Murad Alam MD Background. Commonly used treatments for pyoderma gangrenosum are medical, with immunosuppressive agents employed most often. Objective. To report a case and discuss the indications for radical surgical treatment of pyoderma gangrenosum. Methods. Analysis of a case of Crohn's disease-associated pyoderma gangrenosum treated with immunosuppression followed by amputation, and a review of the literature on surgical management of pyoderma gangrenosum. Results. In unstable patients with intractable multiple medical problems, surgical treatment of pyoderma gangrenosum may be indicated by the existence of these life-threatening comorbidities. The recent literature suggests that surgical management of pyoderma gangrenosum may also be appropriate in other special circumstances. Conclusions. Surgical management, including amputation, may have a role in the management of pyoderma gangrenosum. Further research is needed to delineate precisely the circumstances and patient factors that are appropriate indications for such surgery. [source] Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlatesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009A. O. Adewuya Objective:, Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Method:, Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results:, Overall, 21 patients (21.2%) were categorised as having ,good' and 36 (36.4%) as having ,poor' subjective QOL. ,Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93,11.48), comorbid medical problems (OR 4.75, 95% CI 1.43,16.33), unemployment (OR 3.75, 95% CI 1.25,11.72) and poor social support (OR 4.60, 95% CI 1.49,14.28). Conclusion:, Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment. [source] The nervous system and gastrointestinal functionDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 2 2008Muhammad A. Altaf Abstract The enteric nervous system is an integrative brain with collection of neurons in the gastrointestinal tract which is capable of functioning independently of the central nervous system (CNS). The enteric nervous system modulates motility, secretions, microcirculation, immune and inflammatory responses of the gastrointestinal tract. Dysphagia, feeding intolerance, gastroesophageal reflux, abdominal pain, and constipation are few of the medical problems frequently encountered in children with developmental disabilities. Alteration in bowel motility have been described in most of these disorders and can results from a primary defect in the enteric neurons or central modulation. The development and physiology of the enteric nervous system is discussed along with the basic mechanisms involved in controlling various functions of the gastrointestinal tract. The intestinal motility, neurogastric reflexes, and brain perception of visceral hyperalgesia are also discussed. This will help better understand the pathophysiology of these disorders in children with developmental disabilities. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:87,95. [source] Torsade de pointes in a patient with complex medical and psychiatric conditions receiving low-dose quetiapineACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2005W. V. R. Vieweg Objective:, Describe potential cardiac complications of low-dose quetiapine and other atypical antipsychotic drugs. Method:, We present a case report of a 45-year-old Black woman with multiple medical and psychiatric problems taking low-dose quetiapine. Results:, Coincident with a generalized seizure, the patient developed ,ventricular fibrillation'. She was countershocked with restoration of normal sinus rhythm. The initial electrocardiogram showed QT interval prolongation. Shortly thereafter, classical torsade de pointes appeared, lasted 10 min, and resolved spontaneously. Hypomagnesemia was present. A cardiac electrophysiologist was concerned that the very slow shortening of the prolonged QTc interval after magnesium replacement implicated quetiapine as a risk factor for QTc interval prolongation and torsade de pointes. A psychosomatic medicine consultant asserted that the fragmented medical and psychiatric care almost certainly contributed to the patient's medical problems. We discuss other cases of QT interval prolongation by newer antipsychotic drugs and previous reports by our group concerning the association of psychotropic drugs, QT interval prolongation, and torsade de pointes. Conclusion:, Atypical antipsychotic drug administration, when accompanied by risk factors, may contribute to cardiac arrhythmias including torsade de pointes. [source] Can we predict future improvement in glycaemic control?DIABETIC MEDICINE, Issue 2 2008R. Singh Abstract Aims To determine the factors responsible for poor glycaemic control in diabetes and whether any such factors are associated with likely improvement in glycaemic control. Methods A prospective cohort study of 130 diabetic patients with poor glycaemic control (HbA1c , 10.0%) with 1-year follow-up in a teaching hospital Diabetes Clinic. Changes in HbA1c were measured after 1 year. Results Poor glycaemic control was attributed to one of 15 possible causes. Those cases due to recent diagnosis of diabetes, inadequate treatment with diet, oral glucose-lowering agents or insulin, exacerbation of co-existent medical problems, recent stressful life-events and missed clinic appointments were all associated with significant improvement in HbA1c at 12 months. Patients with low mood or alcohol excess, inadequate blood glucose monitoring, poor exercise/sedentary lifestyle, refusal to take tablets or underdosing and refusal to take insulin at all or to increase the dose were all associated with continuing poor glycaemic control at 12 months. The patients were divided almost equally between the two groups. Conclusions In patients with poor glycaemic control, it is possible by simple features identified at clinic to predict which individuals are likely to show improvement in control and which will not. These findings have not been reported previously and suggest that about half of individuals with poor control will improve within our current diabetes clinic practice. Additional strategies will be required to address those individuals who are not likely to respond. [source] Aortic Tumor or Mobile Thrombus?ECHOCARDIOGRAPHY, Issue 2 2010Andrea Loiselle M.D., M.P.H. Isolated large mobile mass in the thoracic aorta can be due to thrombus or, rarely, aortic tumor. We report the case of a 61-year-old man with no history of medical problems presenting with neurologic deficits and in whom a large mobile echogenic mass in the distal aortic arch was found with transesophageal echocardiography. Given his few cardiovascular risk factors and absence of other systemic symptoms, he received anticoagulant therapy. Subsequent resolution of the aortic mass suggested a diagnosis of thrombus. This case illustrates an unusual manifestation of aortic arch atherosclerosis and underscores the utility of transesophogeal echocardiography for patients with ischemic stroke. (Echocardiography 2010;27:E21-E22) [source] Non-urgent presentations to a paediatric emergency department: Parental behaviours, expectations and outcomesEMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2005Mary Ryan Abstract Objectives:, To identify factors that influence the attendance of children with non-urgent medical problems to a tertiary paediatric ED and to define parental expectations of the hospital visit. Methods:, A questionnaire administered to a convenience sample of 200 parents/carers who attended the paediatric ED and whose children were categorized as having non-urgent problems that had been present for at least 4 weeks. Subsequent outpatient attendances were then analysed retrospectively. Results:, Most patients had visited a general practitioner but remained unhappy with the outcome of the consultation. The hospital was expected to provide immediate diagnosis and initiate appropriate treatment by the vast majority of parent. Only four patients required admission. Conclusions:, The expectations of parents who attend the paediatric ED with children who have non-urgent chronic complaints are high. Rapid access to outpatient clinics might provide an acceptable alternative for these patients, and free valuable ED resources. [source] Co-morbidity in the ageing haemophilia patient: the down side of increased life expectancyHAEMOPHILIA, Issue 4 2009E. P. MAUSER-BUNSCHOTEN Summary., Because of an increased life expectancy, (age-related) co-morbidity is becoming a common occurrence in haemophilia patients. In this review, haemophilia-related and non-haemophilia-related medical problems, treatment recommendations and psychosocial consequences in ageing haemophilia patients are discussed. Haemophilic arthropathy is an important cause of pain and disability, and a frequent indication for surgery in haemophilia patients. In addition, many adult patients are infected with hepatitis C or HIV, the consequences and treatment of which can add to physical and mental discomfort. Moreover, inhibitors against factor VIII can also develop in adulthood, especially in patients with mild haemophilia. Hypertension is reported to occur more often in haemophilia patients than in the general population. Other internal problems, like renal abnormalities, overweight, diabetes mellitus and hypercholesterolemia are discussed. Haemophilia seems to protect against cardiovascular disease, although the incidence is increasing. Recommendations are given on dealing with tooth extractions, surgical interventions and sexuality problems in patients with haemophilia. In addition to haemophilia in itself, co-morbidity has a major psychological impact, and an important effect on quality of life. It can also result in complex treatment regimens, in which coordination between health care workers is essential. [source] Health profiles and quality of life of 518 survivors of thyroid cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003Pamela N. Schultz RN Abstract Background. Available literature describes the long-term outcome of thyroid cancer survivors with respect to thyroid cancer but not their overall medical and social well-being. Methods. Five hundred eighteen thyroid cancer survivors responded to a survey regarding medical and social impacts of their cancer experience. Results. All had surgery, and 417 (80.5%) also had some radiation. Two thirds (64.5%) reported that cancer created health effects varying by gender and passage of time; neurologic, musculoskeletal, and psychologic problems seemed most prominent. They reported more memory loss and psychologic problems than other cancer survivors and more migraine headaches than both other cancer survivors and the general population. Regarding family and work, they integrated well in society overall. However, unsolicited comments by 24.5% of responders disclosed symptoms reminiscent of thyroid hormone imbalance. Conclusion. Thyroid cancer survivors generally report good health long term but describe distinct, lasting medical problems including symptoms of thyroid dysregulation. The extent and manner in which cancer therapy contributes to the health profile of the group merits further inquiry. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happinessINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2009Jameson K. Hirsch Abstract Objective Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. We tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. Methods A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. Results Chronic medical problems are associated with suicide ideation and, as hypothesized, happiness attenuates the relationship between self-reported diseases and suicidal distress. Conclusions Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. Our results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk. Copyright © 2009 John Wiley & Sons, Ltd. [source] Therapy of metastasized Merkel cell carcinoma with liposomal doxorubicin in combination with radiotherapyJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 6 2009Marion Wobser Summary Background: Merkel cell carcinoma is a rare skin cancer of neuroendocrine origin, which is characterized by a high rate of recurrence, metastatic spread and mortality. Because of its rarity, evidence-based therapeutic regimens are difficult to establish. Merkel cell carcinoma is known to be both radio- and chemosensitive. Toxicity is a key factor in assessing any regimen, as the patients are usually elderly and likely to have other significant medical problems. Patients and Methods: We retrospectively evaluated five patients with metastatic Merkel cell carcinoma to see if liposomal doxorubicin (Caelyx® or Myocet®) in combination with radiotherapy exhibited clinical anti-tumoral effects accompanied by acceptable side effects. Results: The outpatient chemotherapy regimen was tolerated without major side effects and produced good response rates. All patients achieved at least tumor stabilization; four of five had a partial remission. Effects of therapy were usually seen in the first cycle of therapy but the responses were of short duration with an average interval of two months until progression. Conclusions: As combined radiochemotherapy with liposomal doxorubicin is well tolerated even in older patients with other illnesses and can be given on an outpatient basis, it is an attractive option for metastatic Merkel cell carcinoma. Based on response rate or overall survival, it offers no advantages compared to polychemotherapy. [source] Nursing Interventions for a Chronically Ill, Nonadherent Teenager With a Psychiatric DiagnosisJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2003Diane Sieben BSN ISSUES AND PURPOSE To describe the complex care of an adolescent with chronic psychiatric and medical problems. CONCLUSIONS The nonadherent, self-abusing, adolescent was empowered to progress developmentally, as well as medically. PRACTICE IMPLICATIONS A planned team approach helped the adolescent become more developmentally appropriate and independent in self-care. The care plan designed by nursing staff included a change in nursing focus, creative problem solving, team nursing, and utilization of multidisciplinary resources. [source] Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009AGSF, Harrison G. Bloom MD Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. [source] The Stigma of Psychological Problems in a Work Environment: Evidence From the Screening of Service Members Returning From Bosnia,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2000Thomas W. Britt The present research examined the stigma associated with psychological problems among service members returning from the United States peacekeeping mission to Bosnia. The results show that admitting a psychological problem in the military is perceived as muchmore stigmatizing than admitting a medical problem. Service members had more concerns about stigmatization and felt more uncomfortable discussing psychological problems than medical problems, and these feelings were magnified when service members were being screened with their units rather than alone. Service members also reported a lesser likelihood of following through with a psychological referral than with a medical referral. However, participants who discussed psychological issues with a therapist felt the screening was more beneficial than those who did not discuss their responses. The results address the neglected topic of the stigma associated with psychological problems in the workplace. [source] | |||||||||||||||||||||||||||||||||||||||||||