When one has nothing, a little is a lot

Volunteerism in Third World countries is a rewarding but humbling experience. Although different locations have specific issues that must be overcome, common threads are often found. Through experience, desire, and commitment, a great deal of value can be created by the work of volunteers-value for both the recipient and the giver. This article reflects some of my experiences and thoughts on this topic.     

Sometimes Less is More: Establishing the Core Symptoms of PTSD

Historically, the symptoms of posttraumatic stress disorder (PTSD) have garnered attention and controversy due to symptom overlap with other disorders. To improve diagnostic specificity, researchers have proposed to reformulate PTSD symptoms into a parsimonious set of core criteria. The core symptoms consisted of recurrent distressing dreams or flashbacks; internal or external avoidance; and hypervigilance or exaggerated startle. The purpose of this study was to examine a previously proposed set of “core” PTSD criteria in identifying cases of PTSD within a veteran sample. Veterans (N = 383) presenting to a Veterans Affairs (VA) Medical Center PTSD clinic for psychological services were assessed using the Clinician Administered PTSD Scale for DSM‐5 (CAPS‐5). A logistic regression analysis revealed that the core criteria accurately identified 79% of veterans with PTSD (OR = 11.57). Findings support a parsimonious set of core criteria in the assessment and diagnosis of PTSD. Future studies should replicate these findings in diverse, nonveteran samples.     

Unenhanced helical CT following excretory urography in the diagnosis of upper urinary tract disease: a little more cost, a lot more value

The objective of the study is to evaluate unenhanced CT following intravenous urography (IVU) for the detection of upper urinary tract (UUT) abnormalities, when IVU fails to provide the qualitative diagnosis. Helical CT scan was performed on patients with suspected disorders of UUT, after the completion of IVU for further diagnoses. In total, 124 cases of definite diagnosis and 71 cases of uncertain diagnosis via IVU were collected from 195 patients with suspected UUT disorders. Among the 71 uncertain cases, 65 patients were consent to undergo immediate or delayed CT scan. CT data were transferred to the workstation for postprocessing. Of all the 65 cases, the major CT diagnoses were the following: stone disease (n = 41), urinary tract infections (n = 4), UUT tumors (n = 7), neighboring invasion or metastasis (n = 2), congenital anomalies (n = 2), and compressed stenosis (n = 6). Among all the results, 62 cases were confirmed by surgery, pathology or clinical follow-up, while three cases (4.6%) left were still uncertain. The diagnose accordance rate of IVU + CT achieved to 95.4%. There was significant difference between IVU and IVU + CT in the determinate diagnosis of UUT diseases (χ ² = 30.4, P < 0.05). In conclusion, IVU + CT provides more valuable information for the localization and qualitative diagnosis of UUT abnormalities. It is recommended as a cost-effective and time-saving complemental means for IVU.     

Nasogastric tubes: a lot of bother

The insertion of the nasogastric tube is one of the procedure that produces the most discomfort for the patients and practitioners. The AA, with the make use of their clinical experience and the data of the literature, report some personal reflections about the management of the nasogastric tube. The AA also analyse some variables (choice of the tube, approach to the patient, insertion of the tube, examination of the position, fixation and removal) that can influence on discomfort of the patient. The choice of the most right SNG is an important moment for the correct insertion; an effect we need to adjust the material and diameter of the tube to the prearranged use. The common practice demonstrates that the collaboration with the patient, obtained by "direct" and "indirect" strategies, gives more possibilities to immediately success of this procedure. The literature explains that it is possible to decrease the discomfort with topical anesthesia; still there are some points of view to clarify. From analyse of the different methods to check the position of SNG, the pH test of the aspirating fluid is the best solution. Once examination of right placement, we need to fix in different points (at least two). From personal experience the removal of SNG is better tolerate that the insertion because the patient is more conscious to be on the mend. The principal recommendation is to abstain from insertion of SNG if it is not closely necessary!