Diagnosis and treatment of depression in adults with comorbid medical conditions: a 52-year-old man with depression

Approximately 1 in 10 primary care patients has major depressive disorder, and its presence is associated with poor health outcomes in numerous medical conditions. Using the case of Mr J, a 52-year-old man with depressive symptoms and several comorbid medical conditions, diagnosis and treatment of depression are discussed. Specific topics include evidence regarding appropriate depression screening and diagnosis, the importance of team-based care, patient self-management, exercise, structured psychotherapy, pharmacotherapy, monitoring of therapy, and indications for referral.     

A 70-year-old man with a transient ischemic attack: review of internal carotid artery stenosis

Mr V, a man with severe coronary, aortic, and peripheral artery disease, had an episode of brain ischemia caused by severe preocclusive carotid artery disease in the neck. The major treatment options for his symptomatic carotid artery disease are optimizing medical treatment, carotid endarterectomy, and carotid artery stenting. Selection of treatment must take into consideration his severe symptomatic coronary artery disease as well as Mr V's concerns about surgery. Carotid endarterectomy presents a risk of myocardial infarction unless his coronary disease is treated effectively before surgery. Carotid stenting is problematic because the severity of the preocclusive arterial narrowing makes passing a protective device beyond the stenosis difficult without first performing potentially hazardous angioplasty. Optimizing medical treatment may be the best option for his severe systemic atherosclerosis. Treatment decisions in complex patients like Mr V require weighing the particular risks and benefits of available options, and the patient's own wishes and fears. These decisions, in this and other complex patients, often cannot be directly informed by results from randomized trials.      

Caring for patients with limited health literacy: a 76-year-old man with multiple medical problems

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand health information, skills, and services needed to make informed health decisions and take informed actions. Narratives from Mr J, a 76-year-old man with multiple medical problems and limited health literacy, and his physician exhibit some of the difficulties experienced by patients with limited health literacy. Clinicians can help patients with limited health literacy by removing unneeded complexity in their treatment regimens and in the health care system and by using teach-back methods to assess and improve understanding. Rather than a selective screening approach for limited health literacy, a patient-based universal precaution approach for confirming patient comprehension of critical self-care activities helps ensure that all patients have their health literacy needs identified.     

Finding a faster route to practice: from medical student to board certified physician

An examination of two types of educational tracks used by medical students seeking a faster route to practice: 1) "3+3" programs that combined the final year of medical school with the first year of a primary care residency, and 2) graduating from medical school after only three years. The "3+3" programs were discontinued despite reports indicating their success. Three year medical school options are still available at a handful of medical schools. Finally, the paper will explore why and how medical schools might wish to enact a three year curricular option.     

从临床医学馆员到信息专家：医学学科馆员的发展与启示

从临床医学馆员项目的目的、服务方式和评价以及临床医学馆员的角色与作用等方面介绍了国外临床医学馆员项目及服务的发展,"信息专家"概念的提出,并以美国国立卫生研究院图书馆等为例,介绍了国外"信息专家"服务实践情况,最后深入阐述了开展医学学科馆员服务的必要性和医学学科馆员应该扮好的5种角色.     

Pediatric burns due to hot water from water dispenser: a neglected issue that should be highly concerned

Background  More and more Chinese drink hot water from water dispensers while many children were scalded due to this change. The present study aimed to propose a feasible strategy for prevention.

Methods  A retrospective study was conducted for all water dispensers related pediatric burns admitted to Changhai Hospital from January 2005 to December 2009.

Results  The number of new cases and incidences of pediatric burns due to hot water from water dispensers was significantly increasing year after year. In the total 238 involved cases, 175 cases happened on males and 78.9% were at the age of 1–4 years. The burn areas were mainly located in upper extremities. All water dispensers in the surveyed families had no isolate protection devices and 85.2% of their locations were easy for children to reach. Nearly half of the children were in the same room with their guardians when injured. Total 196 burned children were playing the taps of water dispensers before injured, unfortunately, 80.6% of them have not been stopped until burned.

Conclusion  As the kind of burns is quite serious and with bad outcome, some recommendations should be followed, such as buying water dispensers with protection devices, keeping children from touching them and so on.