More Than a Rash

Skin disorders are one of the most common complaints seen in primary care offices. This can be intimidating and frustrating for providers due to the wide variety of possibilities. Skin lesions that are difficult to manage or concerning are often referred to dermatology to determine the potential etiology. The following is a case study of an elderly woman who presented with a persistent rash for the past 6 months despite clinically appropriate treatment. This case study describes the interdisciplinary care implemented for diagnosis, treatment, and follow up-care.     

Tinnitus patients lost to follow-up

Abstract

Tinnitus patients without hearing loss or hyperacusis often start tinnitus retraining therapy but do not return to the tinnitus clinic for follow-up visits. The aim of this study was to evaluate how these ‘missing patients’ feel and whether they still use their sound generators after they discontinue retraining therapy. We interviewed 269 tinnitus patients by phone who never returned to the clinic after receiving initial counseling and a generator for sound enrichment. Twenty-six percent did not have tinnitus anymore, 30.5% still used the sound generator to treat their tinnitus, and 43.5% did not use their sound generator but still suffered from tinnitus. This study suggests that therapists need to contact missing patients periodically to follow their improvement, encourage them, and decide on new therapeutic approaches as necessary.

Sumario

Los pacientes con acúfeno, sin hipoacusia ni hiperacusia, a menudo inician terapia de re-entrenamiento para el acúfeno pero no regresen a la clínica de acúfenos para citas de seguimiento. El objetivo de este estudio fue evaluar cómo se sienten estos “pacientes perdidos” de la consulta y si aún utilizan sus generadores de sonido luego de que suspenden la terapia de re-entrenamiento. Entrevistamos por teléfono a 269 pacientes que nunca retornaron a la clínica, luego de recibir una sesión de orientación inicial y un generador de enriquecimiento sonoro. Veintiséis por ciento no volvieron a tener acúfeno, 30.5% aún usaban el generador de sonido para tratar su acúfeno, y 43.5% no usaron su generador de sonido y aún sufren del acúfeno. Este estudio sugiere que los terapeutas necesitan contactar periódicamente a sus pacientes perdidos de la consulta, para dar seguimiento a su evolución, estimularlos, y para tomar decisiones sobre nuevos enfoques terapéuticos conforme sea necesario.     

Antenatal dexamethasone has no adverse effects on child physical and cognitive development: a long-term cohort follow-up investigation

Objective: Antenatal corticosteroids are extensively given in pregnancies with threatened preterm labour as a prophylactic method to reduce some kinds of neonatal diseases. Dexamethasone is one kind of commonly used corticosteroid, but controversies still remain whether it leads to adverse effects on neonatal long-term development or not. The purpose of this study was to investigate the influence of prenatal exposure to one or two dosages of dexamethasone on neonatal physical and cognitive development of children at 1, 3 and 6 years of age. Methods: This was a retrospective cohort study. The body length, head circumference and body weight were measured in every infant and child to evaluate physical development. The mental development index (MDI) and a psychomotor development index (PDI) were used to evaluate mental and cognitive development in children of ages 1 year and 3 years while verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ) scores were used to evaluate mental and cognitive development in children of age of 6 years. There were 1554 infants at 1 year, 1328 children at 3 years and 1297 preschool children at 6 years followed. Results: There were no significant differences between antenatal dexamethasone exposure groups and antenatal dexamethasone non-exposure groups on physical development index and MDI, PDI, VIQ and PIQ. Conclusions: The results of this investigation suggested that one or two dosages of antenatal dexamethasone is safe for the use of inevitable preterm birth.     

ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors

Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, ¹⁸F-2-fluoro-2-deoxy-D-glucose PET/CT, ^99mTc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

护理随访干预对哮喘患儿预后的影响

目的探讨护理干预对小儿支气管哮喘的干预效果和临床疗效的影响。方法对我院2009年1月～2010年12月住院治疗的120例小儿哮喘住院患者随机分为对照组和观察组,对照组给予常规基础护理,观察组在常规护理的基础上延伸到家庭及社区护理干预,具体方式为指导患儿父母保持适宜的家庭生活环境、衣着方式,通过测定呼气峰流速监测病情并调整药物剂量、正确使用吸入式工具、鼓励患儿合理饮食并适度运动等。观察对比两组护理干预后1年内哮喘的复发次数与住院次数。结果干预组患儿1年内的哮喘复发次数和住院次数均少于对照组,二者差异具有统计学意义(p<0.05)。结论延伸的护理干预可以明显减少小儿哮喘的复发次数和住院次数,提高其生活质量。     

Late Follow-up Studies after Operation for Congenital Pyloric Stenosis

Follow-up studies were made of 14 congenital pyloric stenosis patients between 21 and 27 years after Fredet-Ramstedt pylorotomy. Minor dyspeptic discomfort was common, but only two had symptoms of any severity. Acid secretion studies showed generally high fasting and basal secretion, both acid and volume. Following pentapeptide stimulation, volume secretion was about 40% higher than in normal individuals, but peak acid output was within normal limits. Barium meal studies showed no gastric, pyloric or duodenal abnormality. Two patients had retention. No patient had symptoms of dumping.