Cases reported "Neoplasms"

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21/31. The treatment of the hospice patient: from occupational history to occupational role.

    The nature of hospice care, particularly from the point of view of the occupational therapist, is presented in respect to the treatment of a 26-year-old patient. This case study demonstrates the role of the occupational therapist in helping a patient deal with his feelings of isolation, in helping him cope with severe physical limitations to maintain a maximum level of independence, and in helping him to deal with relationships with his fiance, family, and friends. The reader is given a sense of the quality of communication between therapist and patient. Finally, a view of what the therapist can expect realistically when offering hospice care is considered.
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ranking = 1
keywords = communication
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22/31. Cutaneous malignant melanoma after immunosuppressive therapy.

    Malignant neoplasm after immunosuppressive therapy is a well-known entity. Though a considerable number of such lesions are cutaneous in origin, melanoma has rarely been reported. In this communication, six such melanoma cases are reported.
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ranking = 1
keywords = communication
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23/31. Manifestations of death consciousness and the fear of death in children suffering from malignant disease.

    The consciousness of death and the fear of death are analysed, and their symptoms, especially as they manifest themselves in children with chronic lethal disease, mostly tumours and leukaemia, are described. fear of death is not often expressed by direct verbal communication; sometimes it is manifest in illusions, jokes, plays, dreams, etc. Basically, it is a fear of separation. One should struggle against it until the last moment with occupational therapy, regular teaching, free visiting time, frequent permissions to go home, activity, affection and love.
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ranking = 1
keywords = communication
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24/31. Marital crises in oncology patients. An approach to initial intervention by primary clinicians.

    life-threatening illnesses such as cancer may precipitate marital crises in vulnerable relationships, and oncology clinicians often feel uncertain about how to approach them. This paper presents a framework for initial intervention based on the nature of the principal threat to the relationship. Immature relationships need distance and support for their identity as a couple; hostile dependent couples need to find consensus in order to structure communication; physically abusive relationships require monitoring in order to promote safety; and estranged couples need help in understanding their disappointment and identifying available support. Clinicians working in oncology can help couples in crisis by promoting a realistic balance of independence and dependence, clarifying the complexity of factors contributing to the crisis, considering referral for couples treatment, communicating with the team while respecting patients' confidences, and by choosing clear and compatible clinical roles. Primary clinicians can stabilize and treat marital crises, but need access to medically knowledgeable couples' therapists.
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ranking = 1
keywords = communication
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25/31. malassezia furfur folliculitis in cancer patients. The need for interaction of microbiologist, surgical pathologist, and clinician in facilitating identification by the clinical microbiology laboratory.

    malassezia furfur (MF) is a lipophilic yeast which can be found as a member of the indigenous microbiota of human skin. In immunocompromised transplant patients, MF can cause a distinctive folliculitis which is a clinical look-alike to candida folliculitis, the latter of more potentially devastating significance. Recovery of MF in culture is dependent upon the addition to culture media of an exogenous source of fatty acids, such as olive oil. The addition of an extra Sabourauds plate with an olive oil overlay to the routine set of media used to inoculate all skin biopsy specimens in order to detect MF is labor-intensive and not cost-effective. Thus, MF may not be isolated in cases of MF folliculitis unless the clinical microbiology laboratory is put on alert by the clinical suspicions of the attending physician, or by histopathologic findings suggestive of folliculitis revealed by review of surgical pathology slides. The clinical, pathological, and microbiological findings of two cases of MF folliculitis are presented where an interactive approach featuring communication between the microbiologist, the surgical pathologist, and the clinician guided the microbiology laboratory to the isolation and identification of isolates of MF that were clinically-relevant. These cases underscore how a combined approach which features communication between the laboratory and the clinical services always provides superior guidance in the diagnosis and therapy of infectious diseases.
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ranking = 2
keywords = communication
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26/31. Sedation for symptom control in japan: the importance of intermittent use and communication with family members.

    We reviewed the circumstances surrounding the use of sedation for symptom control in a Japanese hospice. Of 143 inpatients, 69 (48.3%) received sedation and died an average 3.9 days after sedation was begun. Symptoms requiring sedation included dyspnea, pain, general malaise, agitation, and nausea. In 83% of cases, those symptoms were escalating as death approached. In about one-half of the cases, sedation was carried out intermittently until the patient died. Sedation was gained by such sedatives as midazolam, morphine, and haloperidol. Side effects included suppression of the respiratory and/or circulatory system in nine cases (in four cases it caused death), and delirium in one case; tolerance and dependence were also observed in two cases. We also examined the explanation to and understanding of the patients and their family members about sedation. This experience suggested the type of communication methods that are likely to be useful in japan. It stresses the importance of intermittent use of sedation and communication with family members. We propose criteria for sedation to improve symptom control that would be acceptable in japan.
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ranking = 6
keywords = communication
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27/31. Discussing the diagnosis and prognosis with cancer patients.

    Effective doctor-patient communication is an integral part of good clinical care. Telling a patient that he/she has cancer can be a daunting task. If done with empathy and sensitivity it can create an important bond between the doctor and patient. If done brusquely and without tact it can create barriers and lasting hostility. Several key steps help make the breaking of bad news easier for doctors and patients. There is not one 'right formula' but appreciation of and responsiveness to the patient's verbal and non-verbal signals are core skills which can be developed.
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ranking = 1
keywords = communication
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28/31. The benefits of providing chemotherapy at home.

    diagnosis of cancer and subsequent treatment can result in feelings of loss of control. Home treatment services are suitable for many people receiving chemotherapy. Clients should be enabled to take as much control as they want to and are able. Effective communication within the multidisciplinary team is essential to continuity of care.
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ranking = 1
keywords = communication
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29/31. The dilemma of truth disclosure: Stoke-on-Trent, england.

    Two case studies are used to demonstrate the continuing dilemma experienced by some doctors in the United Kingdom--whether or not to disclose to cancer patients their diagnosis. The two schools of thought concerning truth disclosure are discussed, together with the ethical implications and differences in views as a result of culture. truth disclosure and associated communications skills are seen as an important area of medical education.
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ranking = 1
keywords = communication
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30/31. Pseudo-opioid-resistant pain.

    The purpose of this article is to describe and analyse factors that result in pseudo-opioid-resistant pain. This is defined as a persistent pain experience communicated by the patient or family after prescription and initiation of opioid therapy based on empirically validated criteria. Pseudo-opioid-resistant pain can be caused by inadequate self-care or family care in relation to opioid therapy. Problems can arise in relation to communication of the pain experience, acceptance of the treatment choice and correct opioid administration. These problems may result from misconceptions or knowledge deficit, lack of motivation and lack of performance capabilities. The article systematically analyses the three categories of aetiological factors and arrives at a comprehensive explanatory model. This can be used for research purposes as well as for problem detection in clinical practice. The article includes a case report.
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ranking = 1
keywords = communication
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