Towards a more pragmatic and wiser approach to infertility care

2019 ◽  
Vol 34 (7) ◽  
pp. 1165-1172 ◽  
Author(s):  
◽  
Siladitya Bhattacharya ◽  
J L Hans Evers ◽  
Sofia Gameiro ◽  
Eva Negri ◽  
...  
Keyword(s):  
Specific Treatment ◽  
Signs And Symptoms ◽  
Drop Out ◽  
Life Habits ◽  
Natural Conception ◽  
Challenging Situation ◽  
Work Up ◽  
Favourable Situation ◽  
Duration Of Pregnancy

Abstract Infertility represents a very peculiar area of medicine. Contrary to other areas, where signs and symptoms lead to a diagnosis, which in turn leads to a specific treatment, in reproduction the lack of signs and symptoms for more than 12 months suggests the diagnosis of ‘unexplained subfertility’, and if this condition has lasted for some years, couples qualify for IVF. Diagnosis and treatments can extend over long periods of time (even years) and the accuracy of the diagnostic armamentarium is not optimal. Uncertainty about diagnosis and the need for significant perseverance is demanding on both couples and physicians, and actually constitute a very favourable situation for overdiagnosis (‘unexplained subfertility’) and overtreatment (IVF) on one hand, and, on the other, it may also affect compliance with treatments. To improve our capacity to properly handle this challenging situation, increased attention should be given to the duration of pregnancy seeking. Initiating treatments earlier in older women is unwise because this population has a lower fecundity and, therefore, duration of pregnancy seeking is even more important to achieve a reliable diagnosis of infertility. Moreover, if the infertility work-up is unremarkable, duration of pregnancy seeking should be extended up to more than 2 years prior to making a diagnosis of unexplained infertility regardless of age. An adequate period of pregnancy seeking is also required for couples who are diagnosed with conditions that can interfere with fertility to avoid overdiagnosis and overtreatment. Indeed, most causes of infertility will reduce but not impair natural conception. Within this sometimes long-term management, physicians should also pay attention to detrimental life habits in order to optimize the chances of both natural and assisted reproduction technology -mediated pregnancy. Even if interventional studies are not conclusive, it is advisable to address the problems of obesity and smoking. Focussing on frequency of sexual intercourse may be also beneficial for natural conception. Finally, there is the need for improving our capacity to handle compliance. Providing information on the importance of persevering at the start of treatment, promoting shared decision-making and tackling patient, clinic and treatment causes of drop-out can all improve the overall chances of parenthood. Thus, we plead for a wiser and more pragmatic approach to infertility, paying more attention to these neglected, but in our opinion essential, aspects of infertility care.

scholarly journals Pheochromocytoma Presenting as Partial HELLP Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Yazan Daaboul ◽  
Serge Korjian ◽  
Lamis Khalil ◽  
Rita Nemr
Keyword(s):  
Ventricular Fibrillation ◽  
Cesarean Section ◽  
Clinical Features ◽  
Hellp Syndrome ◽  
Signs And Symptoms ◽  
Pharmacologic Therapy ◽  
Adrenal Pheochromocytoma ◽  
Work Up

Diagnosis of pheochromocytoma in partial HELLP syndrome is extremely rare. We report a case of a 25-year-old multigravida woman at 30 weeks of gestation who presented with clinical features consistent with partial HELLP syndrome. Her symptoms were not controlled by pharmacologic therapy, and the patient underwent urgent cesarean section. The patient gave birth to a viable baby, but she sustained an episode of ventricular fibrillation intraoperatively that did not result in any long-term sequelae. The patient’s symptoms persisted postoperatively and work-up for secondary etiologies of hypertension demonstrated a right adrenal pheochromocytoma. Following resection, the patient’s signs and symptoms resolved, and her lab tests normalized.

Effectiveness of Classification Measures in Predicting Achievement in the Israel Defence Forces - Fitness Instruction Trainers Courses as a Case Study

2012 ◽  
Vol 21 (5-6) ◽  
pp. 145-172
Author(s):  
Yair Galily ◽  
Orly Kayam ◽  
Michael Bar-Eli
Keyword(s):  
Training System ◽  
Drop Out ◽  
Validity And Reliability ◽  
Screening Process ◽  
Training Course ◽  
Drop Out Rate ◽  
Army Service ◽  
Israeli Army ◽  
Israel Defense Forces

Abstract Human resources are the most crucial element in the selection of suitable fitness instruction trainers (FIT) and the results of the screening process impact greatly on the entire physical training system in the Israeli army, both in the short-term and the long-term (potential officers, young officers and developing and veteran officers). The aim of the current study is to examine the effectiveness, validity and reliability of the screening process for acceptance to the female fitness instructors training course in the Israel Defense Forces (IDF). The screening process aims to identify those that are most suitable from a large pool of candidates, in order to ensure the highest possible level of candidates and the lowest possible drop-out rate from the training course and subsequent army service. The paper examines the reliability of the classification exam currently administered in the course and its validity in predicting those candidates who will succeed in the course and in their assignments afterwards. The sample is based on a data analysis of nine screening dates over three years (three each year). The evaluation of validity is based on the relationship between the course entrance exam grades (administered a year before enlistment), exam grades at the beginning of the course and additional data relating to success in the field.

scholarly journals Which triggers could support timely identification of primary antibody deficiency? A qualitative study using the patient perspective

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lisanne M. A. Janssen ◽  
Kim van den Akker ◽  
Mohamed A. Boussihmad ◽  
Esther de Vries
Keyword(s):  
Respiratory Infections ◽  
Diagnostic Delay ◽  
Signs And Symptoms ◽  
Negative Influence ◽  
Primary Antibody ◽  
Emotional Impact ◽  
Structured Interviews ◽  
Timely Treatment ◽  
The Way

Abstract Background Patients with predominantly (primary) antibody deficiencies (PADs) commonly develop recurrent respiratory infections which can lead to bronchiectasis, long-term morbidity and increased mortality. Recognizing symptoms and making a diagnosis is vital to enable timely treatment. Studies on disease presentation have mainly been conducted using medical files rather than direct contact with PAD patients. Our study aims to analyze how patients appraised their symptoms and which factors were involved in a decision to seek medical care. Methods 14 PAD-patients (11 women; median 44, range 16-68 years) were analyzed using semi-structured interviews until saturation of key emergent themes was achieved. Results Being always ill featured in all participant stories. Often from childhood onwards periods of illness were felt to be too numerous, too bad, too long-lasting, or antibiotics were always needed to get better. Recurrent or persistent respiratory infections were the main triggers for patients to seek care. All participants developed an extreme fatigue, described as a feeling of physical and mental exhaustion and thus an extreme burden on daily life that was not solved by taking rest. Despite this, participants tended to normalize their symptoms and carry on with usual activities. Non-immunologists, as well as patients, misattributed the presenting signs and symptoms to common, self-limiting illnesses or other ‘innocent’ explanations. Participants in a way understood the long diagnostic delay. They know that the disease is rare and that doctors have to cover a broad medical area. But they were more critical about the way the doctors communicate with them. They feel that doctors often don’t listen very well to their patients. The participants’ symptoms as well as the interpretation of these symptoms by their social environment and doctors had a major emotional impact on the participants and a negative influence on their future perspectives. Conclusions To timely identify PAD, ‘pattern recognition’ should not only focus on the medical ‘red flags’, but also on less differentiating symptoms, such as ‘being always ill’ and ‘worn out’ and the way patients cope with these problems. And, most important, making time to really listen to the patient remains the key.

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

scholarly journals Radiation Necrosis of the Lateral Skull Base and Temporal Bone

2020 ◽  
Vol 34 (04) ◽  
pp. 265-271
Author(s):  
Marc W. Herr ◽  
Aurora G. Vincent ◽  
Meghan A. Skotnicki ◽  
Yadranko Ducic ◽  
Spiros Manolidis
Keyword(s):  
Radiation Therapy ◽  
Temporal Bone ◽  
Radiation Necrosis ◽  
Critical Role ◽  
Therapeutic Effects ◽  
Normal Tissues ◽  
Lateral Skull Base ◽  
The Many ◽  
Work Up

AbstractRadiation therapy plays a critical role in the treatment of malignancies involving the head and neck. Although the therapeutic effects of ionizing radiation are achieved, normal tissues are also susceptible to injury and significant long-term sequelae. Osteoradionecrosis of the temporal bone (ORNTB) is among the many complications that can arise after therapy. ORNTB is a debilitating and potentially lethal condition that continues to challenge patients and treating physicians. Herein, we review the pathophysiology, presentation, work-up, and management of ORNTB.

scholarly journals One‐year clinically important deterioration and long‐term clinical course in Japanese patients with COPD: a multicenter observational cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuki Abe ◽  
Masaru Suzuki ◽  
Hironi Makita ◽  
Hirokazu Kimura ◽  
Kaoruko Shimizu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Progression ◽  
Clinical Outcomes ◽  
Japanese Patients ◽  
Drop Out ◽  
Chronic Obstructive ◽  
First Year ◽  
Severe Exacerbation ◽  
Clinically Important Deterioration

Abstract Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with a complex progression of many clinical presentations, and clinically important deterioration (CID) has been proposed in the Western studies as a composite endpoint of disease progression. The aim of this study was to investigate the relationships between 1-year CID and the following long-term clinical outcomes in Japanese patients with COPD who have been reported to have different characteristics compared to the Westerners. Methods Among Japanese patients with COPD enrolled in the Hokkaido COPD cohort study, 259 patients who did not drop out within the first year were analyzed in this study. Two definitions of CID were used. Definition 1 comprised ≥ 100 mL decrease in forced expiratory volume in 1 s (FEV1), ≥ 4-unit increase in St George’s Respiratory Questionnaire (SGRQ) score from baseline, or moderate or severe exacerbation. For Definition 2, the thresholds for the FEV1 and SGRQ score components were doubled. The presence of CID was evaluated within the first year from enrollment, and analyzed the association of the presence of CID with following 4-year risk of exacerbations and 9-year mortality. Results Patients with CID using Definition 1, but not any single CID component, during the first year had a significantly worse mortality compared with those without CID. Patients with CID using Definition 2 showed a similar trend on mortality, and had a shorter exacerbation-free survival compared with those without CID. Conclusions Adoption of CID is a beneficial and useful way for the assessment of long-term disease progression and clinical outcomes even in Japanese population with COPD. The definition of CID might be optimized according to the characteristics of COPD population and the observation period for CID.

Assessment of needs for care among patients with schizophrenic disorders 15 and 17 years after first onset of psychosis

1997 ◽  
Vol 6 (S1) ◽  
pp. 21-28 ◽  
Author(s):  
Durk Wiersma ◽  
Fokko J. Nienhuis ◽  
Cees J. Slooff ◽  
Robert Giel ◽  
Aant De Jong
Keyword(s):  
Mental Disorders ◽  
Empirical Studies ◽  
Signs And Symptoms ◽  
Expected Improvement ◽  
Chronic Patients ◽  
Cross Sectional ◽  
Wide Range ◽  
Social Disablement ◽  
First Onset

Severe and long term mental disorders, like schizophrenia, show in general a wide range of psychiatric signs and symptoms, psychological and physiological impairments and social disablement (Shepherd, 1994; Wing, 1982) reflecting a variety of mental health needs. Many studies provide only a cross-sectional view of the clinical and social problems of the patient population, for example at intake or admission to a mental hospital. Longitudinal studies following patients after discharge for some period of months or years show in general the expected improvement of functioning (e.g. Nienhuis et al., 1994), but as far as only chronic patients are concerned such a positive change is much less noted. The concept of chronicity of mental disorders would presume that after some time needs are fairly predictable and stable and do not change much over time. Our investigation on the long-term course of schizophrenia (Wiersma et al., 1996; 1997) enables us to study over a period of two years, from 15 to 17 years since first onset of psychosis, the stability or variability of needs in schizophrenic disorder. We are not aware of empirical studies on changes in needs among patients with long-term disorders.

CURE OF THREE PATIENTS WHO HAD SKELETAL METASTASES IN DISSEMINATED NEUROBLASTOMA

PEDIATRICS ◽  
1968 ◽  
Vol 41 (1) ◽  
pp. 47-51
Author(s):  
Douglas Reilly ◽  
Mark E. Nesbit ◽  
William Krivit
Keyword(s):  
Overall Survival ◽  
Survival Data ◽  
Specific Treatment ◽  
Skeletal Metastases ◽  
University Of Minnesota ◽  
Term Survival ◽  
Long Term Survival ◽  
Skeletal Involvement ◽  
The University

The long-term survival of three children with disseminated skeletal metastases due to neuroblastoma is reported. These three patients are added to eight other patients reported in the literature who have survived longer than 2 years after the development of their metastatic osseous lesions. A review of the cases did not reveal a specific treatment regime which provided the success in these cases. The presence of skeletal involvement, therefore, should not indicate a hopeless prognosis. A review of 33 patients with neuroblastoma at the University of Minnesota from 1956-1966 is also given to provide overall survival data.

Selenium in Pediatric Nutrition

PEDIATRICS ◽  
1991 ◽  
Vol 87 (3) ◽  
pp. 339-351
Author(s):  
Richard E. Litov ◽  
Gerald F. Combs
Keyword(s):  
Age Groups ◽  
Signs And Symptoms ◽  
Infants And Children ◽  
Keshan Disease ◽  
National Academy Of Sciences ◽  
Maple Syrup ◽  
Clinical Impairment ◽  
Se Deficiency ◽  
Se Status

Se is an essential nutrient that provides antioxidant protection in concert with vitamin E. Several selenoproteins have been identified, but only one, SeGSHpx, has a known function, that of neutralizing toxic hydroperoxides. Plasma Se concentration, being responsive to changes in Se intake, is the most practical and widely used measure of nutritional Se status. The plasma Se concentrations of the majority of healthy infants and children fall within the range of 50 to 150 µg/L. Although SeGSHpx activity measures the metabolically functional form of Se, the lack of a standardized analytical method has limited its usefulness as an index of nutritional Se status. Se deficiency was first observed in animals, but it is now recognized to occur in humans. Two human diseases associated with severe nutritional Se deficiency have been reported from China: a juvenile cardiomyopathy named Keshan disease and a chondrodystrophy named Kaschin-Beck disease. Long-term TPN, which provides negligible amounts of intrinsic Se, has been demonstrated in some cases to result in biochemical and clinical impairment. Although there are no consistent signs and symptoms characteristic of TPN-associated Se deficiency, in addition to the low blood selenium levels, some patients will experience leg muscle pain and altered serum transaminase and creatine kinase activities. These manifestations of Se deficiency usually take years to develop. Recent information about the amount of dietary Se needed to maximize plasma SeGSHpx activity in adult men has allowed for better estimates of the Se requirement for humans. Recommended daily dietary allowances published recently by the National Academy of Sciences have been revised for infants and children in this paper by making appropriate adjustments for the protein requirements of these age-groups. These recommended intakes for Se can generally be met by consuming adequate amounts of cereals, meat, eggs, dairy products, human milk, and infant formula, which are good sources of highly available Se and are of low risk of providing excess amounts of Se. Suboptimal Se intakes by pregnant women may predispose their infants to low Se status at birth, which in turn may affect the infants' ability to maintain adequate Se status during the first few months of life. In those situations where protein intake is restricted, such as in phenylketonuria and maple syrup urine disease, Se-supplemented formulas should be used. The most critical situation for Se supplementation is in pediatric patients receiving long-term TPN therapy. When supplementing with Se, consideration must be given to the amount and form of Se to be used; with long-term TPN therapy, plasma Se levels should be monitored.

Therapeutic Dynamics of Aggression, Readiness to Change, and Recidivism in a Partner Violent Men Typology

2021 ◽  
pp. 001112872110364
Author(s):  
Natalia Redondo ◽  
Marina J. Muñoz-Rivas ◽  
Arthur L. Cantos ◽  
Jose Luis Graña
Keyword(s):  
Stages Of Change ◽  
Transtheoretical Model ◽  
Partner Violence ◽  
Behavioral Interventions ◽  
Readiness To Change ◽  
Drop Out ◽  
Short Term ◽  
Violent Men ◽  
Partner Violent Men

The Transtheoretical Model (TTM) of behavior change predicts that patients go through different stages of change prior to changing their problematic behavior. This study aims to evaluate the utility and validity of this model in a sample of 549 court-ordered partner violent men. Three types of perpetrators with respect to their readiness to change were revealed. Those in more advantage stage of change use more processes to change their problem and present with higher levels of intimate partner violence (IPV). Low readiness to change levels and treatment drop-out predict short-term criminal justice recidivism, while treatment drop-out predicts medium and long-term recidivism. Results highlight the applicability of the TTM in IPV and its usefulness in designing behavioral interventions with this population.

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