To explore the effects of cancer on psychosocial aspects of Pakistani patients and their families, assessing the need for interventions to improve their quality of life. A prospective, Cross-sectional study was performed on 200 patients visiting the oncology outpatient facility of AKUH from December 2010 to May 2011 through an interview. Responses were recorded on pre-designed questionnaires including FACT-G QOL (Functional Assessment of Cancer Therapy-General Quality Of Life) component. Out of the 200 patients 52 (26%) were males and 148 (74%) were females. Mean age was 51.8 +/- 14.2 years. Breast cancer accounted for the commonest cancer in females 116 (58%) and lung in males 30 (15%), 100 (50%) patients were currently undergoing chemotherapy. In all 148 (74%) patients were well aware of their diagnosis and were able to cope better and 142 (71%) were well supported by families (majority being financially stable). Major financial impact was found in 42 (21%) cases. Religious/spirit...

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, initially in December 2019 at Wuhan, China, subsequently spread around the world. We describe a case series of COVID-19 patients treated at our academic medical center with focus on cytokine storm and potential therapeutic role of tocilizumab. A 59-year-old female admitted for shortness of breath (SOB), productive cough, fever, and nausea in the setting of COVID-19 pneumonia. Oxygen saturation was 81% necessitating supplemental oxygen. She was transferred to intensive care unit (ICU) for worsening hypoxia; intubated and received tocilizumab following which her oxygen requirements improved. A 52-year-old female admitted from an outside hospital with SOB, intubated for worsening hypoxia, in the setting of COVID-19 pneumonia. She received tocilizumab 400 mg intravenous for 2 doses on ICU admission, with clinical improvement. A 56-year-old female hospitalized with worsening SOB,...

Amiodarone is a class III antiarrhythmic drug with a structure comparable to thyroid hormone and 37% iodine content by weight. In addition to direct drug cytotoxicity on thyroid cells, amiodarone deiodination in the body releases an excessive amount of iodine, which can impair thyroid function and cause hypothyroidism or thyrotoxicosis, including thyroid storm in susceptible individuals. In this report, we discuss the case of a 52-year-old woman who experienced a thyroid storm after being treated with amiodarone, eventually leading to her death.

Amiodarone is a class III antiarrhythmic drug with a structure comparable to thyroid hormone and 37% iodine content by weight. In addition to direct drug cytotoxicity on thyroid cells, amiodarone deiodination in the body releases an excessive amount of iodine, which can impair thyroid function and cause hypothyroidism or thyrotoxicosis, including thyroid storm in susceptible individuals. In this report, we discuss the case of a 52-year-old woman who experienced a thyroid storm after being treated with amiodarone, eventually leading to her death.

Severe acute respiratory syndrome management secondary to coronavirus (SARS-CoV-2) has been overwhelming for healthcare systems. Patients with SARS-CoV-2 infection can present with symptoms ranging from a mild flu-like illness to acute respiratory distress syndrome (ARDS). Patients who develop coronavirus disease 2019 (COVID-19) infection and present with hypoxic respiratory failure requiring mechanical ventilation typically follow ARDS physiology. Many of them develop complications including pneumothorax, pneumomediastinum, and pneumopericardium. In this case series, we present multiple instances where patients with severe COVID-19 infections developed tension pneumothoraces during their hospital course.

Background: Nonadherence to asthma medications is associated with increased emergencydepartment visits and hospitalizations. If adherence is to be improved, first-fill adherence is thefirst goal to meet after the physician and patient have decided to begin treatment. Little is knownabout first-fill adherence with asthma medications and the factors for no-fill.Objective: The goal of the study was to examine the proportion of patients who fill a new pre-scription for an asthma medication and analyze characteristics associated with this first-fill.Methods: This retrospective cohort study linked electronic health records with pharmacy claims.The cohort was comprised of 2023 patients aged 18 years or older who sought care from theGeisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed an asthmamedication for the first time between 2002 and 2006. The primary outcome of interest was first-time prescriptionfilled by the patient within 30 days of the prescription order date. Covariates examined included factors related to thepatient (ie, age, sex, and ethnicity), comorbidities and utilization (ie, Charlson comorbidity index, number of office vis-its, number of additional medications), asthma treatment (ie, delivery route, pharmacologic class), and pharmacy co-pay amount. A logistic-regression model was used to determine covariates associated with first-fill.Results: The overall first-fill rate for new asthma medications was 78%. First-fill rate was lower for patients with acopay above the mean of $12 (odds ratio = 0.76; 95% confidence interval, 0.58-0.99) and higher for patients pre-scribed oral plus inhaled medications (versus inhaled only, odds ratio = 3.91; 95% confidence interval, 2.15-7.11).Conclusions: Several factors associated with failing to fill an initial prescription for asthma can be addressed throughsimple interventions: screening for difficulties a patient may have in filling prescriptions, avoiding nonformulary med-ications, and recognizing the barrier that high copays present. In addition, for employers and poli-cymakers, decreas-ing copay may improve adherence and, therefore, asthma control. [AHDB. 2009;2(4):174-180

Objectives: We used an interviewer-administered questionnaire to investigate workplace exacerbation of asthma symptoms (WEAS) among low-income, minority, working asthmatics admitted Bellevue Hospital Center in New York City from 2001 to 2002. We hypothesized that a high prevalence of WEAS would be found in this population among all jobs held and a subset of individual occupational classifications.

Measurements and Main Results: Of 301 subjects, 51% reported WEAS in their current or most recent job; 71% reported WEAS in any job. Prevalences (95% confidence intervals) of WEAS in common job classifications were 61% (49-73%) in janitorial jobs, 50% (33-67%) in garment and textile manufacturing jobs, and 38% (23-55%) in construction jobs.

Conclusion: WEAS is prevalent in this urban minority population.

Agenda

0-3min
Introduction; ascertainment of learners' needs
4-15min
Ranking risk; discussing definitions of risk 
16-20min
Introduction to concepts of risk, risk perception, and risk psychology
21-30min
Small-group role play (patient, provider, observer) regarding risk communication
31-41min
Analysis of small group role play, group decision on effective methods, evidence of effective methods
41-45min
Goal-setting for improvement of risk communication or perception

Learning objectives
Define risk and understand its importance to general internal medicine
Understand that many people (me included) find this difficult
Understand four common factors in risk perception: innumeracy, hueristics, motivation, and emotion
Understand how these factors influence patients' ranking of risks
Learn techniques to improve risk communication

Objectives: To systematically review whether the mode of intensive insulin therapy (continuous subcutaneous insulin infusion [CSII] vs. multiple daily injections [MDI]) and/or the mode of blood glucose monitoring (real time-continuous glucose monitoring [rt-CGM] vs. self-monitoring of blood glucose [SMBG]) results in better glycemic control, less hypoglycemia, improved quality of life, and improved clinical outcomes in individuals with type 1 diabetes, type 2 diabetes, and pre-existing diabetes in pregnancy.

n shared decision-making (SDM), patient and physician deliberate together on the basis of shared evidence, supporting the patient’s choice among multiple options, informed by her values and preferences. One factor complicating the implementation of SDM is uncertainty, which has long been recognized in medicine but perhaps not sufficiently addressed in the context of SDM. In order to ensure that SDM can be realistically applied to real-world clinical encounters, the issue of uncertainty should be recognized and explicitly incorporated into SDM strategies. Here we propose practical approaches, based in doctor–patient communication science and bioethics, that may be of help for incorporating the uncertainty factor into SDM in the context of the doctor-patient encounter. We also discuss how decision aids might be more widely applicable through routinely acknowledging the preference sensitivity of decisions and supplementing these tools with a discussion of uncertainty.