Articles: patients.
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Ankylosing spondylitis (AS) is a systemic disorder occurring in genetically predisposed individuals. The disease course appears to be characterized by bouts of partial remission and flares. However, we have little understanding of what is a flare, why they occur, and what lasting effects they have on the patient. We examine the patient's perception of the factors important in defining flare. ⋯ There are 2 forms of flare: (1) localized to one area or (2) throughout the entire body. Examining the differences between these types of flares may aid our understanding of the biological mechanism of the disease process of AS and allow us to help relieve the symptoms of flare, a highly painful and often depressing phenomenon.
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Patients' perceptions of do not resuscitate (DNR) orders and how and when to present the information were sought to aid in framing DNR policy. Semi-structured interviews of 23 patients being treated for cancer, were conducted by a clinical psychologist. The interviews were transcribed and analysed with the aid of a qualitative software package. ⋯ Most advocated written DNR orders but few had them. Families were construed as advocates but also seen as constraining individual autonomy. When considering DNR orders, patients recognise the diversity of preferences likely to exist that belie a one policy fits all approach.
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Patients with large hemispheric strokes frequently develop neurologic deterioration secondary to cerebral edema. Despite supportive care in the intensive care unit and traditional forms of therapy for cerebral edema, they have a high morbidity and mortality. New forms of therapy are being investigated to improve outcome in these patients. ⋯ Neurologic deterioration in patients with large hemispheric strokes necessitates admission to the intensive care unit for management of the airway, blood pressure, and cerebral edema. New promising therapies, such as hemicraniectomy and hypothermia, need to be further evaluated to define their role in the management of these patients.
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The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. ⋯ Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease.
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Intensive care medicine · May 2002
Effects of acid-base abnormalities on blood capacity of transporting CO2: adverse effect of metabolic acidosis.
Objective. To investigate the effects of some acid-base abnormalities on blood capacity of transporting CO2. Design. ⋯ Conclusions. Our findings suggest that acid-base abnormalities, particularly metabolic acidosis, markedly affect blood capacity of transporting CO2 and may worsen tissue hypercarbia associated with hypoperfusion. However, because of possible errors due to small measurements and the assumptions of the method, in the future definitive clarification will require the construction of original CO2 dissociation curves for each acid-base abnormality.