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What you need to achieve in a patient encounter or consultation
Published in Peter Tate, Francesca Frame, The Doctor's Communication Handbook, 2019
Meanwhile, a chain-smoking miner with advanced emphysema may be hoping for some more breath to allow him to walk to the club and to be able to climb the stairs to visit his disabled daughter. The fact that we may not be able to offer more breath, but we know his reasons for coming to us, may help us and him to make a realistic assessment. We can then offer the help of other agencies in providing wheelchairs, stair lifts, home oxygen, and other assistance, while not pretending that we can perform any magic.
The illness experience: eating disorders from the patient’s perspective
Published in Kathleen M Berg, Dermot J Hurley, James A McSherry, Nancy E Strange, ‘Rose’, Eating Disorders, 2018
Despite the increased media attention on eating disorders, patients and their families continue to be exasperated by family physicians and counselors who view excessive exercising, dieting and binge-eating as part of a ‘normal’ phase of adolescent development. Indeed, Hornbacher (1998) claims that this misconception of eating-disordered behavior as a passing phase was a major impetus for writing her memoirs. Rose (personal communication, 1999) also points out the dangers inherent in this kind of minimization. The misunderstanding that the disorder is a conscious choice, that it is nothing but ‘vanity in action’ and that one can simply choose to re-exercise control over it at will serves to alienate the patient and add to her feelings of hopelessness. Conversely, others (i.e. Hornbacher, 1998) are adverse to theories which tell the patient that she is powerless over her disorder. Hornbacher’s belief is that this message is dangerous because it exonerates the patient of responsibility: ‘I liked sitting back in my chair, chain-smoking, sighing with relief and thinking this is beyond my control’ (Hornbacher, 1998).
Nikos
Published in James Melson, The Golden Boy, 2013
At 9:30, not one soul had arrived. I sat on the couch, chain smoking and nail biting, wondering if we could return the food. Finally, at a quarter to ten the first guest arrived. It was José, an extremely sexy Cuban whom Nikos loathed because of his flirtations with me. Just like Nikos would do, I played it to the hilt, eating up the flattery with ravenous delight. I was the star and Nikos my accessory. Suddenly the doorbell began to ring off the wail. The thirty invited guests had nearly doubled. It became elbow to elbow and I began to fear that one of the drunken revelers would stumble into a delicate piece of folk art and turn it into kindling, or go shopping in my closet for an expensive leather jacket or cashmere sweater. Nevertheless, for the duration of the evening I was the consummate host. It was a matchmaker’s dream: loads of beautiful men cruising for partners. That included José—with me as his target.
Frontotemporal dementia as underlying cause of newly altered mental status in a 59-year-old female: a case presentation and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
At Massachusetts General Hospital, the patient had an extensive neurologic evaluation and work-up for cognitive and behavioral impairment. The earliest sign of personality change per family was about 4 years prior when the patient had a verbal altercation with one of the patients at her workplace on a psychiatric unit. Because of this episode, she was fired from her position. For the past year, the patient had exhibited memory deficits and would forget details of a recent conversation or event. She was also noted to be more irritable in her interactions. Several months prior to admission, the patient had another episode of verbal aggression towards her boss at her new job in a shelter for women and children which resulted in her suspension. She was also noted to have disinhibited behavior, such as expressing sexual comments in front of her young grandchildren or taking off her shirt in public. In addition, the patient was reported to have unstable mood. For instance, during the holidays the patient suddenly ‘started to frantically cry’ for no obvious reason. She was also reported to be irritable with family and at times yell at the grandchildren, a behavior that she had never exhibited in the past. The patient was also reported to eating more avidly than usual in the last period and asking repetitively for snacks. She had a weight gain of about 10 pounds over the previous few months. Although she had quit smoking in the past, she had started ‘chain smoking’ again. The patient was described by her family as capable of performing very basic activities of daily living such as bathing or dressing, but she had lost her ability to cook or drive.
Application of radiation omics in the development of adverse outcome pathway networks: an example of radiation-induced cardiovascular disease
Published in International Journal of Radiation Biology, 2022
Omid Azimzadeh, Simone Moertl, Raghda Ramadan, Bjorn Baselet, Evagelia C. Laiakis, Soji Sebastian, Danielle Beaton, Jaana M. Hartikainen, Jan Christian Kaiser, Afshin Beheshti, Sisko Salomaa, Vinita Chauhan, Nobuyuki Hamada
In Level II, the model included classical risk factors, such as smoking, hypertension, and dyslipidemia from the KORA cohort (Simonetto, Heier, et al. 2022). The main target of detriment in the chain of the atherogenic process was identified by goodness-of-fit. Whereas the impact of dyslipidemia was realized along the whole atherogenic chain, smoking made its strongest impact at the chain end with complicated lesions. Finally, in Level III, the KORA cohort was replaced by a Dutch cohort of breast cancer patients to obtain a risk model for ACEs after RT. Using the same method of effect identification as in Level II, therapeutic radiation released the strongest impact on complicated lesions. Due to low case numbers, the exact shape of the post-RT age-risk pattern could not be determined. However, the risk increased significantly already in the first five years after RT (Simonetto, Kaiser, et al. 2022). These findings are in line with the observation that RT doses to atherosclerotic plaques in the left anterior descending coronary artery are enhancing cardiac toxicity (van den Bogaard et al. 2021). Moreover, Simonetto et al. proposed that the dose-response for rupture of large atherosclerotic lesions might be non-linear. These studies show that susceptibility to radiation-induced ACEs depends markedly on the atherosclerotic state of a patient (Simonetto et al. 2020). Thus, for risk reduction heart sparing techniques or proton therapy has been proposed for patients burdened with plaques within the volume of high RT doses. The outlined approach of ‘Development of biologically-based models to evaluate radiation-induced disease risk’ has been added to the MEDIRAD recommendations (http://medirad-project.eu/recommendations/).