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Case Study: Stroke and Diaphragmatic Palsy leading to Pneumonia 案例研究:中风和膈肌麻痹导致肺炎
Pub Date : 2014-07-01 DOI: 10.4018/IJUDH.2014070104
A. Shrikhande, T. Galvez, Nicolas Langendorfer, K. Jain, Rakesh Biswas
The authors discuss the clinical complexities surrounding an 85-year-old male complaining of left sided weakness for one month, along with cough and fever for 20 days. Findings on non-contrast CT scan of the brain showed an acute-on-chronic infarct in the right parietal region, in the territory of the right middle cerebral artery, with lacunar infarct in the left thalamus. A chest radiograph showed a heterogeneous opacity in the right lower zone, and air bronchogram with an elevated right dome of the diaphragm. The patient was diagnosed to have suffered a stroke with a subsequent right-sided pneumonia due to diaphragmatic palsy. The patient was put on ventilator and further supportive management was instituted. This article presents the clinical course of the case and the experiential learning associated with it.
作者讨论了一名85岁男性的临床复杂性,他抱怨左侧虚弱一个月,同时咳嗽和发烧20天。脑部非对比CT扫描结果显示右顶叶区急性慢性梗死,位于大脑右中动脉区域,左侧丘脑伴有腔隙性梗死。胸片示右下区不均匀混浊,支气管气征伴膈肌右穹状突起。该患者被诊断为中风并随后因膈肌麻痹引起的右侧肺炎。给予患者呼吸机并给予进一步的支持治疗。本文介绍了该病例的临床过程和与之相关的经验学习。
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引用次数: 2
Case Study: Atypical Presentation of Orbital Hemangiopericytoma 病例分析:眼眶血管外皮细胞瘤的不典型表现
Pub Date : 2014-07-01 DOI: 10.4018/IJUDH.2014070107
V. Damle, R. Agarwal, N. Garg, H. Gulwani
Hemangiopericytoma is a slow growing, vascular mesenchymal tumor, which may behave like a malignant tumor, leading to local recurrence, or metastasis, or both. This report is about a 32-year-old lady with non-axial proptosis and diminished vision due to a mass lesion in the superomedial quadrant of the right orbit. CT scan and MRI reports showed no intracranial extension. Surgical intervention was done through the roof of the orbit keeping hemangioma, neuroma or schwannoma as the leading differential diagnoses; however, on aspiration, it was not bleeding. It was confirmed to be a hemangiopericytoma on histopathological examination. The unique presentation, where, on tapping, no blood was found, makes this case an example of diagnostic dilemma. This lack of bleeding might be due to vascular insufficiency of the mass. Proptosis disappeared the following day after the surgery and vision also showed significant improvement to 20/20 within a week after surgery. The patient has been kept on regular follow up keeping in mind the recurrent and metastatic behavior of the tumor.
血管外皮细胞瘤是一种生长缓慢的血管间质肿瘤,其表现可能与恶性肿瘤相似,可导致局部复发或转移,或两者兼而有之。本报告是一位32岁的女性,因右眼眶上内象限的肿块病变而导致非轴向性眼球突出和视力下降。CT扫描和MRI报告未见颅内扩张。通过眶顶进行手术干预,以血管瘤、神经瘤或神经鞘瘤为主要鉴别诊断;然而,经抽吸,没有出血。经组织病理学检查证实为血管外皮细胞瘤。这种独特的表现,即在敲击时没有发现血液,使这种情况成为诊断困境的一个例子。这种出血的减少可能是由于肿块的血管功能不全。术后第二天眼球突出消失,术后一周内视力也明显改善至20/20。患者一直保持定期随访,牢记肿瘤的复发和转移行为。
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引用次数: 0
Case Study: Glaucoma and Epidemic Dropsy - A Past Possible Association Revisited 案例研究:青光眼和流行性水肿-过去可能的联系
Pub Date : 2014-07-01 DOI: 10.4018/IJUDH.2014070105
S. Gupta, D. Verma, D. Singh
Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. Onset is usually subacute or insidious with watery diarrhea and vomiting. This lasts from a few days to more than a week. Bilaterally symmetrical pitting edema of the lower limbs extending from the ankles up to the scrotum and abdominal wall is a constant feature. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana (prickly yellow poppy) seeds as an adulterant of wheat flour, or more commonly, of cooking oil such as mustard oil. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil. It is a rare phenomenon for practicing ophthalmologists to observe cases of epidemic dropsy, and the possibility of glaucoma should be kept in mind in cases of epidemic dropsy, when members of same family or village report with raised IOP, pedal edema and history of use of mustard oil for cooking or massage. Glaucoma is hypersecretory in nature; prostaglandin and histamine release may have significant roles in its pathogenesis. The disease has self limiting course but needs good control of intraocular pressure (IOP) medically till it returns to normal and visual field changes have stabilized. Its early diagnosis is very important to prevent grievous complications; hence, all cases should be followed up regularly for IOP measurement and visual field analysis up to 8-12 weeks, because, if ignored, optic atrophy may develop.
流行性水肿是一种涉及心血管、肝、肾、眼等系统的多系统疾病。发病通常为亚急性或隐匿性腹泻和呕吐。这种情况持续几天到一个多星期。双侧下肢对称性凹陷性水肿,从脚踝向上延伸至阴囊和腹壁,是一个恒定的特征。这是一种有毒疾病,是由于无意中摄入了作为小麦面粉或更常见的食用油(如芥菜油)掺假物的墨西哥银罂粟(带刺的黄色罂粟)种子而引起的。血根碱和脱氢血根碱是银皂油中的两种主要有毒生物碱。在眼科执业医师中观察到流行性水肿病例是一种罕见的现象,当同一家庭或村庄的成员报告眼压升高、足部水肿和使用芥菜油烹饪或按摩的历史时,应注意流行性水肿患者青光眼的可能性。青光眼本质上是高分泌性的;前列腺素和组胺的释放可能在其发病机制中起重要作用。该病病程有自限性,但医学上需控制好眼压,直至恢复正常及视野变化稳定。早期诊断对预防严重并发症非常重要;因此,所有病例应定期随访,进行IOP测量和视野分析,直至8-12周,因为如果忽视,可能会发生视神经萎缩。
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引用次数: 3
Perspectives: Fourteen Aphorisms - From Problem Solving to Relationship Building 观点:十四句格言——从解决问题到建立关系
Pub Date : 2014-07-01 DOI: 10.4018/IJUDH.2014070101
P. Shankar
Dr. David Loxterkamp has been practicing as a primary care physician for over thirty years in Belfast, Maine, United States of America. He is a frequent writer on issues related to primary care and has recently published a book titled ‘What matters in medicine; Lessons from a life in primary care'. Towards the middle of the book he puts forward fourteen aphorisms for physicians with special relevance for primary care practice. In this manuscript the author briefly examines these aphorisms and describes their profound possible influence on modern medical practice, healthcare and medical education. The author is of the opinion that Dr Loxterkamp's observations and concepts born from and honed by over thirty years of practice as primary care physician in Belfast, Maine, United States should be read by all physicians and especially by medical students in training.
David Loxterkamp博士在美国缅因州贝尔法斯特担任初级保健医生30多年。他经常撰写与初级保健相关的问题,最近出版了一本名为在医学中重要的事情;初级保健生活的教训”。在书的中间部分,他为初级保健实践的医生提出了14条警句。在这篇手稿中,作者简要地检查了这些格言,并描述了它们对现代医学实践、保健和医学教育可能产生的深远影响。提交人认为,Loxterkamp医生在美国缅因州贝尔法斯特担任初级保健医生三十多年的实践中产生和磨练的观察和概念应该被所有医生,特别是正在接受培训的医科学生阅读。
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引用次数: 0
The Vascular System: Unblocking Conduits to Our Rivers Within 血管系统:畅通通往我们体内河流的管道
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040104
P. Chatterjee, A. Das, Carmel M Martin, A. Basu, R. Biswas
The motivation for this paper is based on the assumption that certain patient and health professional users' experiences can serve as a mirror or a model, whether positive or negative, for other patients and health professional users/learners. This narrative presents a patient's experience of his complicated and ad hoc journey through the diagnoses and treatment of his vascular system disorder. It then tries to connect this with health professional opinions and other patient experiences toward the collective goal of ‘getting a proper diagnosis and management of vascular disease.' Interspersed are professional narratives in the form of clinical evidence and expert comments towards clinical problem solving around vascular system disorders. User-driven health care implies shared decision making based upon collaborative partnerships between patients and health professionals. This narrative indicates that power imbalances in knowledge, particularly when the patient is ill and vulnerable, can lead to inappropriate and even harmful treatments, when profit appears to be the main driver of the medical industrial complex.
本文的动机是基于这样的假设,即某些患者和卫生专业用户的经验可以作为镜子或模型,无论是积极的还是消极的,为其他患者和卫生专业用户/学习者。这个故事呈现了一个病人的经验,他的复杂和特殊的旅程,通过诊断和治疗他的血管系统疾病。然后,它试图将其与健康专业意见和其他患者经验联系起来,以实现“对血管疾病进行正确诊断和管理”的共同目标。穿插着以临床证据和专家评论的形式对血管系统疾病的临床问题解决的专业叙述。用户驱动的卫生保健意味着基于患者和卫生专业人员之间的协作伙伴关系共同决策。这种说法表明,知识方面的权力不平衡,特别是当病人生病和脆弱时,可能导致不适当甚至有害的治疗,而利润似乎是医疗工业综合体的主要驱动力。
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引用次数: 3
Role Plays Used During A Humanities In Medicine Module: Selected Transcripts Part 2 角色扮演中使用的人文医学模块:选定的成绩单部分2
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040103
R. Shankar, Kundan Singh, A. Shakya, A. Dhakal, R. Piryani
A medical humanities (MH) module has been conducted at KIST Medical College, Lalitpur, Nepal for the last four years. The students are divided into small groups and case scenarios, role-plays, paintings and activities are used to explore MH. The module for the fourth batch was conducted from December 2011 to March 2012. In this article the authors provide a brief overview of the MH module, Sparshanam and the learning objectives of different sessions. They provide transcripts of certain role plays conducted during the fourth, fifth and sixth sessions of the module. The role plays were conducted in Nepali with the help and guidance of the facilitators and the written transcripts in English language were provided by different student groups.
过去四年来,尼泊尔拉利特普尔KIST医学院开设了一个医学人文学科模块。学生们被分成小组,通过案例场景、角色扮演、绘画和活动来探索MH。第四批模块于2011年12月至2012年3月进行。在本文中,作者提供了MH模块,Sparshanam和不同会议的学习目标的简要概述。它们提供了模块第四、第五和第六次会议期间进行的某些角色扮演的文字记录。角色扮演在主持人的帮助和指导下以尼泊尔语进行,并由不同学生小组提供英文书面成绩单。
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引用次数: 4
Single Case Studies as Seeds: Brain Models That Matter 作为种子的单一案例研究:重要的大脑模型
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040105
A. Price
Single case studies are research studies of single participants. They explore new ideas and can suggest extensions in methods and for treatment (Yin, 1984). In this article the case study refers only to conditions observed and is limited to what was observed from these comparisons between normal function and patterns of specific conditions. This does not reflect the theory of a formal case study but rather it is an attempt to show the case study and simple computer modelling as learning tools in a complex environment. Critics of case study methodology cite small case numbers as not having grounds for establishing reliability or generalization of findings and that the intensity of exposure needed for thorough case studies could bias the research findings subtracting from researcher objectivity. Early computer models were used to simulate the function of the brain and provide partial answers. They provided insight into the understanding of complex function. In recent history, computer models and case studies have been cast aside in favor of live brain imaging and complex biochemical reactions. It is good to remember that these tools brought us to the place of knowledge we enjoy today and have enlarged diagnostic and treatment choices. They are still valuable and inexpensive methods that can impact the imaginations of neuroscientists and kindle their passions to solve the complexities of the human mind one problem at a time. Greater rigor can be easily maintained by adopting a format whereby a patient would be assessed by a fully standardized neuropsychological battery and the performance then compared to large sample of normative data. The formal study is important for generalization of findings across conditions and can be applied once normative data has been collected as a basis for comparison.
单一案例研究是针对单一参与者的研究。他们探索新的想法,并可以提出方法和治疗的扩展建议(Yin, 1984)。在本文中,案例研究仅涉及观察到的条件,并且仅限于从正常功能和特定条件模式之间的这些比较中观察到的情况。这并不反映正式案例研究的理论,而是试图将案例研究和简单的计算机建模作为复杂环境中的学习工具。案例研究方法的批评者认为,小的案例数量没有建立可靠性或结果泛化的依据,并且彻底的案例研究所需的暴露强度可能会使研究结果产生偏差,从而降低研究人员的客观性。早期的计算机模型被用来模拟大脑的功能,并提供部分答案。它们为理解复杂函数提供了洞见。在最近的历史中,计算机模型和案例研究已经被抛弃,取而代之的是实时脑成像和复杂的生化反应。值得记住的是,这些工具使我们获得了今天所享有的知识,并扩大了诊断和治疗的选择。它们仍然是有价值且廉价的方法,可以影响神经科学家的想象力,点燃他们的激情,一次解决一个人类思维的复杂性问题。通过采用一种格式,通过完全标准化的神经心理学电池对患者进行评估,然后将其表现与大样本的规范数据进行比较,可以很容易地保持更大的严密性。正式的研究对于在不同条件下推广发现是很重要的,一旦收集到规范性数据作为比较的基础,就可以应用。
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引用次数: 6
eICU STUDY: A Proof of Concept eICU研究:概念验证
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040101
A. Dhakal, B. Dhakal, L. Pathak, Shadi Marina, V. Vijayaraghavan
The authors' objective is to study the effect of eICU (electronic ICU) as a supplementary remote intensive care program on improvement in clinical outcomes. The experiment is designed to determine the clinical usefulness before and after evaluation of the effects of eICU program. The setting is two adult ICU of a large 375 bed teaching community hospital in US. The study was undertaken by group of resident physicians after eICU was started to study the impact on few selected parameters in a teaching hospital. A total of 2537Patients admitted to ICU between June 2006 to June 2008 (n= 1310 before and n= 1227 after implementation of the eICU) The eICU Program used intensivists and other healthcare providers to give 24x7 supplemental monitoring and management from a remote location. Supporting software and computer based decision support tool were available. The outcome is to study and compare rate of falls, mortalities, incidence of code blues and length of stay between the two periods before and after the implementation of eICU. In the results no statistical difference was observed in the studied parameters thus showing contrary results to other previous studies. The incidence of code blue (39 vs. 54 with P value of 0.36), length of stay (3.0 vs. 3.1 P value 0.36), mortality rates (77 vs. 90 P value 0.28) and incidence of fall (0 vs. 1 P value 0.28) all show no improve outcomes before and after the implementation of eICU.
作者的目的是研究eICU(电子ICU)作为一种辅助远程重症监护方案对改善临床结果的影响。本实验旨在确定eICU方案效果评估前后的临床有效性。本研究的背景是美国一家拥有375张床位的大型教学社区医院的两个成人重症监护室。本研究是在某教学医院开展eICU后,由一组住院医师进行的,目的是研究对部分选定参数的影响。2006年6月至2008年6月期间,共有2537例患者入住ICU(实施eICU前1310例,实施eICU后1227例)。eICU项目利用重症监护医师和其他医疗保健提供者从远程位置进行24x7的补充监测和管理。配套软件和基于计算机的决策支持工具可用。结果是研究和比较实施eICU前后的跌倒率、死亡率、蓝码发生率和住院时间。结果中所研究的参数无统计学差异,与前人研究结果相反。蓝码发生率(39 vs. 54, P值0.36)、住院时间(3.0 vs. 3.1 P值0.36)、死亡率(77 vs. 90 P值0.28)和跌倒发生率(0 vs. 1 P值0.28)在实施eICU前后均无改善。
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引用次数: 10
“Paper Teachers:”: Towards a True Postgraduate Education “纸质教师”:走向真正的研究生教育
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040106
D. Elpern
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引用次数: 1
A Self-Management System for Chronically Ill Patients 慢性病患者自我管理系统
Pub Date : 2014-04-01 DOI: 10.4018/IJUDH.2014040102
Silvia Torsi
This article describes the User Centered Design Process for providing chronically ill patients tools to better self-manage their conditions. Stroke, congestive heart failure and chronic pain are complex conditions in which regulated physical activity can provide real improvement of symptoms and health conditions. In particular the work is focused on how the authors gathered the guidelines from the patients, how they translated them into interface design and how did the patients react to the paper prototypes. Paper prototyping is a quick, inexpensive and easily modifiable way to create intermediate artifacts that can be iteratively modified by early evaluation with intended users.
本文描述了以用户为中心的设计过程,为慢性病患者提供工具,以更好地自我管理他们的病情。中风、充血性心力衰竭和慢性疼痛是复杂的疾病,在这些疾病中,有规律的身体活动可以真正改善症状和健康状况。特别地,这项工作集中在作者如何从患者那里收集指导方针,他们如何将其转化为界面设计,以及患者对纸上原型的反应。纸上原型是一种快速、廉价且易于修改的方法,用于创建中间工件,可以通过与预期用户的早期评估进行迭代修改。
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引用次数: 2
期刊
International Journal of User-Driven Healthcare
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