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181. Patient Modesty: Volume 91

a patient enters the procedure (except in critical ER presence) with with the autonomy capacity and opportunity to express in advance their gender requirements. Yet, there are patients who ask about gender attendance in advance or set their anticipated goal as a "cure" of their illness and not any physical modesty issues they bear. Is this an example of the profession's "lack of respect" toward the elements of the patient's fundamental dignity? What I am trying to do here in this posting is to separate (...) physicians that exposed this abhorrent behavior have ever apologized. In fact, just as is happening here, physicians attempt to justify the behavior by referring to lack of training opportunities and other paternalistic fallacies. You also continue to hold the position that it is the patients' faults for NOT speaking up. This is blatant VICTIM BLAMING. Just as with Women are made to feel ashamed for not fighting hard Patients labelled mentally ill Women are threatened into silence and punished

2018 Bioethics Discussion Blog

182. Putting The Apple Watch 4 ECG To The Test In Atrial Fibrillation: An Informal Comparison To Kardia

.” and “Apple Watch never checks for heart attacks.” When finished you will see what I and my patient (who mostly stays in sinus rhythm with the aid of flecainide) saw-a declaration of normality: Later in the day I had a few patients with permanent atrial fibrillation put on my watch. This seventy-something farmer from Bowling Green, Missouri was easily able to make a very good ECG recording with minimal instruction The AW4 nailed the diagnosis as atrial fibrillation. We also recorded a Kardia device ECG (...) some yellow lines on graph. Perhaps a fit 73 year old skiing at 11,000 feet defeated their algorithm. Would recommend Qardioarm despite a few quirks, and am perplexed by Apple’s outrageously stupid claims about AW4 being first ECG. Trust is difficult to build, and easy to damage. I now have doubts about the probity of Apple. Perhaps recent fall in price of Apple stock reflects these doubts. Deja vu all over again when the marketeers run a tech company. Thanks Dr P – your posts much appreciated

2018 The Skeptical Cardiologist

183. Bruising

by, an underlying bleeding disorder or medical condition, including: Vascular disorders (for example senile or simple purpura). Platelet disorders (for example idiopathic thrombocytopenic purpura, leukaemia, or liver disease). Coagulation disorders (for example haemophilia, vitamin K deficiency, or von Willebrand disease). Drugs (such as corticosteroids, warfarin, and alcohol). The presence of a bleeding disorder or underlying medical condition does not rule out non-accidental injury as a cause of abnormal (...) disorder which leads to mucocutaneous telangiectasia of the skin, mucous membranes, and organs. There may be a positive family history, recurrent nosebleeds, fatigue, nail changes, and hair loss. Ehlers-Danlos syndrome This causes joint hypermobility and skin translucency and hyperextensibility. It may present with gingival bleeding, prolonged bleeding after surgical procedures, and menorrhagia. Abnormalities in capillary structure and deficiencies of perivascular collagen cause vascular fragility

2016 NICE Clinical Knowledge Summaries

184. Jaundice in adults

Jaundice in adults Jaundice in adults - NICE CKS Share Jaundice in adults: Summary Jaundice is a clinical sign describing yellow pigmentation of the skin, sclera, and mucous membranes due to raised plasma bilirubin. It can be caused by many disorders ranging from benign to life-threatening conditions such as Gilbert's syndrome and pancreatic cancer respectively. Jaundice is the result of dysfunction in bilirubin metabolism and its causes can be categorized as pre-hepatic, hepatic, or post (...) Background information Definition Definition Jaundice (also known as icterus) describes the yellow pigmentation of the skin, sclera, and mucous membranes resulting from raised plasma bilirubin. Normal plasma bilirubin levels range between 5 to 19 micromol/L. Clinical jaundice may not become apparent until serum bilirubin is greater than 51 micromol/L. [ ; ] Pathophysiology Pathophysiology Jaundice can be caused by a wide variety of disorders which range from benign to life-threatening conditions

2016 NICE Clinical Knowledge Summaries

185. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

the organs and body systems where LCH may occur are used to diagnose LCH. The following tests and procedures may be used to detect (find) and LCH or conditions caused by LCH: and health history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. : A series of questions and tests to check the brain, , and function (...) . Yellowing of the skin and whites of the eyes. Itching. Easy bruising or bleeding. Feeling very tired. Lung Signs or symptoms of LCH that affects the may include: Collapsed lung. This condition can cause chest pain or tightness, trouble breathing, feeling tired, and a bluish color to the skin. Trouble breathing, especially in adults who smoke. Dry cough. Chest pain. Bone marrow Signs or symptoms of LCH that affects the may include: Easy bruising or bleeding. . Frequent infections. Tests that examine

2015 PDQ - NCI's Comprehensive Cancer Database

186. Pityriasis versicolor

disorders that may present similarly include: Vitiligo — especially in dark-skinned people with hypopigmented lesions. For more information, see the CKS topic on . Psoriasis — particularly guttate psoriasis, a chronic inflammatory condition that usually affects children and young adults, and is characterized by small scaly skin papules, which may be pink or red, and may occur anywhere on the body. For more information, see the CKS topic on . Tinea corporis — a dermatophyte infection of the skin, usually (...) commonly occur on sebum-rich areas of the skin, particularly the back, chest, and upper arms. Macules and patches are usually asymptomatic, but mild itch sometimes occurs. The diagnosis can be confirmed by microscopy of skin scrapings, although this is not usually necessary. Disorders that may present similarly include vitiligo, pityriasis alba, psoriasis, tinea corporis, seborrhoeic dermatitis, pityriasis rosea, erythrasma, and secondary syphilis. Initial management of pityriasis versicolor is the use

2015 NICE Clinical Knowledge Summaries

187. The moment I became a passionate doctor

, and keep searching until you are confident you have the best answer. Her eyes were closed, her face calm. Her lips were dry and cracked, and her teeth yellowed with plaque. Her trach bubbled noisily with saliva. It was then that I noticed her soft blonde hair. Her mother, I presumed, had plaited it into two perfect French braids. Not a single strand was awry. They ended in delicate, lacy, pink ribbons tied into bows. Then her hands — each dainty, tapered finger — ended in a perfectly manicured nail (...) , lovingly painted a shade of girly pink. It dawned on me unexpectedly — this child means something to her mother. Despite her condition, she means the world to someone — her mother, her father, her extended family. Suddenly, I understood. My fears that had gripped me just moments before vanished. I suddenly became aware that I had no frame of reference for this. I was not yet a mother, much less a mother of a medically complex child. In that moment, I clearly saw the reality of truly caring for patients

2017 KevinMD blog

188. Patient Modesty: Volume 81

I'm hospitalized. Will my Medicare payments be given for this? Please consider what Medicare can do to prevent this from happening to me when I'm hospitalized. Will my care and safety be jeopardized because medical staff are viewing my genitals instead of caring for my injury/ illness? Creating new rules which are not respected or enforced obviously does not work. Medicare must insist that same-gender care be provided to anyone upon request. The shortage of male nurses must be addressed (...) state of affairs we are in. What I find most disgusting and distressing about the "Denver 5" episode is most people view it as being funny. What should have been a wake up call to the public is just a joke. Sad. I understand the next of kin was notified of the episode. I hope they sue the pants of the hospital & the 5 degenerates. Regards, NTT At , Anonymous said... Hello again, In my original note to Ms Jackson, I yellow highlighted the "3 weeks" and "return to work". Unfortunately, this site

2017 Bioethics Discussion Blog

189. Briefs: Butt worms

. So reports estimate only ⅓ of patients have pruritus. There are case reports of patients who had abdominal pain but no itching. The worms may be found at the anal verge or in the vagina as well. The disease is spread amongst humans, usually by fecal-oral contact, and it can take 4 to 8 weeks for the eggs to reach the anus, for the larvae to hatch and for patients to become symptomatic. “although transmission is often attributed to the ingestion of infective eggs by nail biting and inadequate hand (...) (under a microscope – they are tiny and transparent otherwise) and/or the organism itself (see video above). The worms themselves are about 1 centimeter in length and are white/pale-yellow in color. You can “catch” eggs on transparent adhesive tape to aid in the diagnosis. So, in a patient who suspects they have pinworms but doesn’t see them the tape method can aid in identification since you’ll at least get the eggs. You may need to have a few applications of tape though… Instruct patients to apply

2017 PEM Blog

190. Votrient - pazopanib

) and for patients who have received prior cytokine therapy for advanced disease.’ The EMA has waived the obligation to submit the results of studies with Votrient in all subsets of the paediatric population in renal cell carcinoma as the condition does not normally occur in the paediatric population. The applicant has received central Protocol Assistance by the CHMP on clinical issues in December 2006. In their response to the main clinical issue the CHMP suggested the conduction of an active comparator study (...) an application for Marketing Authorisation to the European Medicines Agency (EMEA) through the centralised procedure for Votrient, which was designated as an orphan medicinal product EU/3/06/382 on 29 June 2006. Votrient was designated as an orphan medicinal product in the following indication: treatment of renal cell carcinoma (RCC). The calculated prevalence of this condition was 3.5 per 100,000 EU population. In connection with the review of the orphan designation criteria by the Committee on Orphan

2010 European Medicines Agency - EPARs

191. Efficacy, Safety and Immunogenicity of Enerceptan Compared to Enbrel in Rheumatoid Arthritis

Biotech S.A. Collaborator: QUID Quality in Drugs and Devices Latin American Consulting SRL Information provided by (Responsible Party): Gema Biotech S.A. Study Details Study Description Go to Brief Summary: The purpose of this study is to asses the compared efficacy, safety and immunogenicity of ENERCEPTAN® with ENBREL® in combination with Methotrexate for the treatment of patients with rheumatoid arthritis. Condition or disease Intervention/treatment Phase Rheumatoid Arthritis Biological: Etanercept (...) biologic treatment. Chronic antibiotic therapy, if the investigator considers this may affect the safety of the subject or the assessment of the study results. Any previous or current serious medical conditions that, in the opinion of the investigator, constitute a contraindication for the study treatment, as: Administration of vaccines: Subjects who have received a live attenuated vaccine within 3 months prior to the randomization Visit (for example, varicella-zoster, oral polio, rabies, yellow fever

2016 Clinical Trials

192. Ultrasound as Imaging Biomarker of Early Response to Tocilizumab and Methotrexate in Very Early Rheumatoid Arthritis

, with the exception of basal cell or squamous cell carcinoma of the skin or carcinoma in situ of cervix which that has been fully excised/cured with no evidence of recurrence Concomitant diagnosis or history of diverticulitis, peptic ulcer disease, diverticulosis requiring antibiotic treatment or chronic ulcerative lower GI disease such as Crohn's disease, ulcerative colitis or other symptomatic lower GI conditions that might predispose to perforations Evidence of active or latent bacterial, viral, fungal (except (...) . Identifier: NCT02837146 Recruitment Status : Recruiting First Posted : July 19, 2016 Last Update Posted : July 29, 2016 See Sponsor: Maria Stoenoiu Information provided by (Responsible Party): Maria Stoenoiu, Université Catholique de Louvain Study Details Study Description Go to Brief Summary: This study is aimed at assessing the kinetics of the ultrasound (US) response in DMARD-naive very early rheumatoid arthritis (RA) patients treated with tocilizumab (TCZ) and methotrexate (MTX). Condition

2016 Clinical Trials

193. Warts and verrucae

salicylic acid? Topical salicylic acid therapy may cause chemical burns and irritation of the skin. [ ] Cryotherapy Cryotherapy Contraindications Who should not receive topical cryotherapy? Only practitioners who have been trained in the use of cryotherapy should carry out this treatment. Avoid using cryotherapy for: People with an uncertain diagnosis or a possible malignancy. Young children (who may find it too painful). Distal extremities in people with: Raynaud's syndrome. Peripheral vascular disease (...) , or indirectly via contact with contaminated floors or surfaces (for example in swimming pools or communal washing areas). Benign warts in immunocompetent people almost never undergo malignant change. Warts are diagnosed from their typical appearance: Common warts are firm and raised with a rough surface that resembles a cauliflower (common on knuckles, knees, and fingers). Plane warts are round, flat topped, and yellow (common on the backs of hands). Filiform warts are long and slender (common on the face

2014 NICE Clinical Knowledge Summaries

194. Evaluating the Safety, Tolerability and Preliminary Efficacy of Plasma in Improving the Appearance of Onychomycosis

dermatophytoma or "yellow spike/streak" primarily lateral or bi-lateral disease toenail thickness greater than 3 mm inability to become normal in the opinion of the investigator Subject with psoriasis, pincer nail, prior nail surgery, severe moccasin-type tinea pedis requiring treatment, symptomatic interdigital tinea pedis, lichen planus, or other abnormalities that could result in a clinically abnormal nail; Subject with peripheral vascular disease or peripheral circulatory impairment; Subject (...) . Identifier: NCT02724384 Recruitment Status : Recruiting First Posted : March 31, 2016 Last Update Posted : September 14, 2017 See Sponsor: Moe Medical Devices Information provided by (Responsible Party): Moe Medical Devices Study Details Study Description Go to Brief Summary: The purpose of this study is to evaluate the safety and preliminary efficacy of using electrical plasma to treat toenail fungus. Condition or disease Intervention/treatment Phase Onychomycosis Device: MOE Plasma Delivery

2016 Clinical Trials

195. Evaluation of the Suitability of PD P 506 A in the PDT of Distal Subungual Onychomycosis (DSO) of the Great Toenail.

: February 4, 2015 Last Update Posted : September 19, 2017 Sponsor: photonamic GmbH & Co. KG Information provided by (Responsible Party): photonamic GmbH & Co. KG Study Details Study Description Go to Brief Summary: This study evaluates the potential usefulness of photodynamic therapy with PD P 506 A in patients with distal subungual onychomycosis of the great toenail. Patients will receive four PDT treatments with PD P 506 A in weekly intervals. Condition or disease Intervention/treatment Phase (...) Dermatol. 2007 Jun;56(6):939-44): Residual changes of the nail plate compatible with dermatophyte infection White/yellow or orange brown/patches or streaks in or beneath the nail Lateral onycholysis with debris in an otherwise clear nail plate Hyperkeratoses on the lateral nail plate/nailfold edge. If the nail shows an improvement but still one of the above signs, it will be rated as "partially cleared". If the nail shows no improvement in comparison to the Screening Visit, it will be rated

2015 Clinical Trials

196. A Retrospective Analysis of the Effects of Low Level Laser Therapy on Toenail Onychomycosis

positive fungal potassium hydroxide preparation (KOH) testing results Exclusion Criteria: Spikes of disease extending to nail matrix in the great toenail Infection involving lunula of the great toenail, e.g. genetic nail disorders, primentary disorders Great toenail has less than 2mm clear (unaffected) nail plate length beyond the proximal fold Dermatophytoma or "yellow spike/streak" (defined as thick masses of fungal hyphae and necrotic keratin between the nail plate and nail bed) on the great toenail (...) : September 28, 2016 Sponsor: Erchonia Corporation Information provided by (Responsible Party): Erchonia Corporation Study Details Study Description Go to Brief Summary: The purpose of this study is to determine whether low level laser therapy (LLLT) using the Erchonia LUNULA device is effective in increasing clear nail in toenails with onychomycosis. Condition or disease Intervention/treatment Phase Onychomycosis Device: Erchonia LUNULA Not Applicable Detailed Description: Nail onychomycosis, or fungus

2015 Clinical Trials

197. Study to Compare the Efficacy of Tocilizumab With or Without Glucocorticoid Discontinuation in Rheumatoid Arthritis Participants

-Barr virus, cytomegalovirus and herpes zoster, but excluding fungal infections of nail beds) Neuropathies or other conditions that might interfere with pain evaluation unless related to primary disease under investigation Any major episode of infection requiring hospitalization or treatment with intravenous antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks prior to screening Active TB requiring treatment within the previous 3 years (participants previously treated for TB (...) randomization to Week 24 post-randomization, in participants with stable low disease activity [LDA] (DAS28 ESR score less than or equal to [<=] 3.2) who receive tocilizumab, and have been randomized to either continue or taper prednisone in a double-blinded fashion. Condition or disease Intervention/treatment Phase Rheumatoid Arthritis Drug: Placebo matched to prednisone Drug: Prednisone Biological: Tocilizumab Phase 4 Study Design Go to Layout table for study information Study Type : Interventional

2015 Clinical Trials

198. Quackery expands in the Dana Farber Cancer Institute and Children’s Hospital of Philadelphia

efforts fail, they come back again. And again. And again. They do not give up until they get what they want. So it is with quackademic medicine. CHOP was hostile to unscientific medicine: In the past, alternative options were not welcome at Children's Hospital. The institution removed most dietary supplements from its list of approved medications in 2013 because it could not guarantee their safety and effectiveness. Paul Offit, chief of infectious diseases, said the hospital's stance on supplements (...) integrating quackery with real medicine without concern for such niceties. It’s also depressing that this could happen at the institution where Dr. Offit is faculty. I’d be shocked if he didn’t fight this tooth and nail; indeed, you can tell from his quotes in this story that he’s probably holding back because it’s never a good idea to outright badmouth your employer in a news story. If acupuncture and a little woo are where CHOP is now, to see where CHOP could be in a few years: Massage therapist Maria

2016 Respectful Insolence

199. Study of Erchonia Low Level Laser Light Therapy to Treat Toenail Fungus

pedis. History of current or past psoriasis of the skin and/or nails. Concurrent lichen planus. Onychogryphosis. Any of the following conditions of the affected great toenail(s) is present: proximal subungual onychomycosis; white superficial onychomycosis; dermatophytoma or "yellow spike/streak"; exclusively lateral disease Confounding problems/abnormalities of the great toenail(s). Any abnormality of the affected great toenail(s) that could prevent a normal appearing nail if clearing of infection (...) provided by (Responsible Party): Erchonia Corporation Study Details Study Description Go to Brief Summary: The purpose of this study is to determine whether low level laser light therapy is effective in the treatment of toenail onychomycosis. Condition or disease Intervention/treatment Phase Onychomycosis Device: Erchonia LUNULA Not Applicable Detailed Description: An infection of toenail fungus, or onychomycosis, typically occurs when fungi (most commonly dermatophytes) infect the nail, but may also

2014 Clinical Trials

200. Dermoscopic features in fungal melanonychia. (Abstract)

was observed in 19 of the nails. The main dermoscopic pattern was homogeneous pigmentation; however, black pigmented aggregates, presenting as either coarse granules or pigmented clumps, accompanied this homogeneous pigmentation in 16 lesions. Matt black pigmentation, matt white pigmentation, yellow to brown pigmentation, black reverse triangle (wider at the distal than the proximal end), superficial transverse striation and blurred appearance were the other features.We have identified a number (...) Dermoscopic features in fungal melanonychia. Data on the dermoscopic features of fungal melanonychia are limited.To identify the dermoscopic features of fungal melanonychia.We reviewed patient files, clinical history and dermoscopic images of all cases with a diagnosis of fungal melanonychia seen at our dermoscopy unit within the past year.In total, 14 cases with 20 involved nails were reviewed. The most common type of melanonychia was melanonychia striata (7/20). Multicoloured pigmentation

2014 Clinical & Experimental Dermatology

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