Search

Selected Patient Cases From the APSHO Regional Lecture Series INTRODUCTION As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 3 of an accredited educational activity based on the recently concluded APSHO Regional Lecture Series. Hosted in collaboration with major cancer centers around the country, the APSHO Regional Lecture Series brought case-based didactic presentations and skills workshops to advanced practitioners. In the spirit of JADPRO, three accredited Grand Rounds articles by Beth Eaby-Sandy, MSN, CRNP, OCN® (non-small cell lung cancer) and Sandra Kurtin, PhDc, ANP-C, AOCN® (multiple myeloma and chronic lymphocytic leukemia)-program chairs for the regional lecture series-offer the same practice-changing information and strategies for advanced practitioners. In this Grand Rounds article, program chair Sandra Kurtin reviews the prognosis, risk assessment, and treatment for patients with chronic lymphocytic leukemia and assesses four case studies. You can read Parts 1 and 2 in previous issues of JADPRO or online at advancedpractitioner.com. Check out apsho.org/lectures for information on registering for upcoming JADPRO Regional Lectures this year at a location near you.

Selected Patient Cases From the APSHO Regional Lecture SeriesINTRODUCTION As the official publication of the Advanced Practitioner Society for Hematology and Oncology (APSHO), JADPRO is pleased to offer Part 2 of an accredited educational activity based on the recently concluded APSHO Regional Lecture Series. Hosted in collaboration with major cancer centers around the country, the APSHO Regional Lecture Series brought case-based didactic presentations and skills workshops to advanced practitioners. In the spirit of JADPRO, three accredited Grand Rounds articles by Beth Eaby-Sandy, MSN, CRNP, OCN® (non-small cell lung cancer) and Sandra Kurtin, PhDc, ANP-C, AOCN® (multiple myeloma and chronic lymphocytic leukemia)-program chairs for the regional lecture series-offer the same practice-changing information and strategies for advanced practitioners. In this Grand Rounds article, program chair Sandra Kurtin gives a comprehensive overview of the most recent developments in multiple myeloma research from the 2016 American Society of Hematology (ASH) Annual Meeting and clinical insight in the management of patients with this disease. You can read Part 1 in the March 2017 issue of JADPRO or online at advancedpractitioner.com, and be sure to keep an eye out for Part 3 in a future issue of JADPRO. Check out apsho.org/lectures for information on registering for upcoming JADPRO Regional Lectures this year at a location near you.

ABSTRACT Allergic bronchopulmonary aspergillosis is a pulmonary disease occurring in patients with asthma or cystic fibrosis, consequent to a dysregulated immune response to inhaled Aspergillus conidia. The usual presentation is with poorly controlled asthma. Patients may also present with expectoration of mucus plugs, hemoptysis, constitutional symptoms and radiological opacities. Patients may experience smoldering lung destruction despite well-controlled asthma. With emerging data, the diagnostic criteria transcribed by an International Expert Committee in 2013 are the latest evidence-based guidelines. Herein, we utilize a case-based approach to elaborate on the diagnosis of this disease. The review intends to provide a lucid understanding of the diagnostic process for the expert as well as the primary physician, involved in management of this enigmatic disorder.

OBJECTIVE. The objective of this article is to familiarize the reader with the most commonly used embolic agents in interventional radiology and discuss an approach for selecting among the different embolic agents. This article reviews their properties and uses a case-based approach to explain how to select one. CONCLUSION. A wide variety of embolic agents are available. Familiarity with the available embolic agents and selection of the most appropriate embolic agent is critical in interventional radiology to achieve optimum therapeutic response and avoid undesired, potentially disastrous complications such as nontarget embolization.

First, this article explores begging and window washing as a form of radical commerce engaged in by an infamous homeless man in Auckland. Our approach brings to the fore the everyday spaces, tactics, and relationships that are central to the street life of Joshua. We consider how success as a breadwinner for Joshua’s street family not only engenders self-worth and a sense of belonging but also binds him to a street life that undermines his health. Second, we demonstrate the utility of the case as an essential tool for urban research in psychology. The case of Joshua is constructed from a series of informal, rapport-building conversations, a biographical interview through which Joshua offered an account of his life, and direct observations of Joshua window washing and begging. We also draw on a go-along interview where Joshua took us on a tour of his city, and four sets of photo-elicitation projects and corresponding follow up interviews that document key transitions for him between street and domiciled life.

INTRODUCTION It is estimated that about 90% of older adults with dementia experience neuropsychiatric symptoms. These symptoms include but are not limited to agitation, aggression, delusions, and hallucinations. Neuropsychiatric symptoms are often treated with antipsychotics. However, the use of antipsychotics in the dementia population is associated with an increased risk of death, mostly due to cerebrovascular events. All antipsychotic medications (both first generation and second generation) have a Black Box Warning for increased mortality in elderly patients with dementiarelated psychosis.

Elbow and forearm wounds range from those caused by congenital anomalies, contracture release, tumor excision, and burns, to autoimmune disease, trauma, infection, and exposed prostheses (1). Regardless of the cause, wounds about the elbow and forearm have potentially disabling effects (2), influencing both the ability to work and quality of life. An appreciation for the etiology and socioeconomic implications of upper extremity wounds is imperative for a successful outcome. Elbow and forearm wounds require a stable and durable solution. Important differences remain, however, regarding the reconstructive demands intrinsic to each anatomic area. Forearm wounds can often be closed directly or covered with skin grafts. Only large wounds or those with exposed neurovascular structures, tendon, or bone typically require flap closure. Conversely, elbow wounds have limited simple solutions for coverage as underlying structures and prostheses are easily exposed (3). Elbow wounds also have the unique requirement of a pliable, yet well-padded reconstruction. These characteristics promote early mobilization to prevent contracture and stiffness (4). As local tissues are frequently involved in the zone of injury or lack characteristics necessary to achieve an optimal outcome, the surgeon often must choose from the myriad of available flap options.

Case Oriented approach in Pharmacology will be helpful to know/study all the basic science in an integrated manner. This approach is a better approach so that the medical student will get the clinical scenario in the beginning of the topic. It will be also be effective tool for the students to solve the problem based questions and also they will learn the role of the clinical pharmacology too. Thus case oriented approach in teaching pharmacology will make Pharmacology more interesting subject. Recently based on certain evidences it was found out that basic science medical curriculum is based on clinical approach in which pharmacology is one integrated component in a holistic approach to teaching and learning methodology. One major problem of teaching pharmacology is that a student doesn’t see patients in basic science teaching and learning method. This problem can be solved to some extent by this novel case oriented approach in Pharmacology.DOI: http://dx.doi.org/10.3126/nje.v4i1.10125 Nepal Journal of Epidemiology 2014;4 (1): 301-305

This article takes a case-based approach to a scenario in veterinary practice. The actions of the registered veterinary nurse are analysed from a legal and professional perspective, with the aim to generate recommendations to improve future practice.

Fluoroquinolones (FQs) are a frequently prescribed class of antibacterial agents. FQs are widely used but may carry serious side effects particularly pronounced in older adults, and the Food and Drug Administration recently suggested FQs should not be routinely used in certain conditions if alternative options are available. Research has demonstrated that the risk of tendinitis and tendon rupture associated with FQs is one of the highest in older adults who are concurrently treated with steroids. Health care providers and pharmacists involved in the treatment of older adults should be aware of this potential drug interaction, which may lead to serious side effects and safety concerns.

The management of patients with venous thromboembolism (VTE) is a common clinical scenario that, for the most part, involves well‑established, evidence‑based treatment pathways. However, important unanswered clinical questions remain that are the focus of ongoing research. The aim of this narrative review is to provide a practical, case‑based approach to the following clinical scenarios in which therapeutic management pathways are less well established: How long to administer anticoagulation to patients with a first unprovoked VTE? How to manage complex patients with cancer‑associated VTE? When and how to treat patients with splanchnic vein thrombosis? When to use thrombolytic therapy for deep vein thrombosis?

The normal radiographic appearance of implantable loop recorders has been illustrated in the radiology literature; however, their mammographic appearance has not been described. Breast imagers should become familiar with the appearance of loop recorders in order to create an accurate report. In this paper we report 3 cases of patients with implantable loop recorders who underwent mammography. We describe the types and components of implantable loop recorders, indications for their placement, and their classic appearance on mammography.

Fatigue-related crashes are one of the major threats to road safety worldwide. Despite the substantial work in the domain of transportation science by both the industry and academia, there are few studies in applying case-based reasoning (CBR) approach to modelling the risk of driver fatigue. This research explores the potential for fatigued driving using a database of 16,459 traffic crashes reported from 21 cities in Guangdong province, China from 2006 to 2010. The CBR system under development differentiates between fatigued-driving and non-fatigued-driving cases based on various personal and environmental traffic characteristics. The advantage of using CBR in modelling fatigued driving has been demonstrated through empirical evaluation.

Introduction Opioid use disorder (OUD) is characterized by a problematic pattern of opioid use leading to clinically-significant impairment or distress. Opioid agonist treatment is an integral component of OUD management, and buprenorphine is often utilized in OUD management due to strong clinical evidence for efficacy. However, interindividual genetic differences in buprenorphine metabolism may result in variable treatment response, leaving some patients undertreated and at increased risk for relapse. Clinical pharmacogenomics studies the effect that inherited genetic variations have on drug response. Our objective is to demonstrate the impact of pharmacogenetic testing on OUD management outcomes. Methods We analyzed a patient who reported discomfort at daily buprenorphine dose of 24 mg, which was a mandated daily maximum by the pharmacy benefits manager. Regular urine screenings were conducted to detect the presence of unauthorized substances, and pharmacogenetic testing was used to determine the appropriate dose of buprenorphine for OUD management. Results At the 24 mg buprenorphine daily dose, the patient had multiple relapses with unauthorized substances. Pharmacogenetic testing revealed that the patient exhibited a cytochrome P450 3A4 ultrarapid metabolizer phenotype, which necessitated a higher than recommended daily dose of buprenorphine (32 mg) for adequate OUD management. The patient exhibited a reduction in the number of relapses on the pharmacogenetic-based dose recommendation compared to standard dosing. Conclusion Pharmacogenomic testing as clinical decision support helped to individualize OUD management. Collaboration by key stakeholders is essential to establishing pharmacogenetic testing as standard of care in OUD management., Highlights • Buprenorphine is used for opioid use disorder (OUD) management and is metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme • Pharmacogenomics studies the effect of inherited genetic variation on drug response and can personalize buprenorphine dosing • Patients carrying the CYP3A4*1B allele may require higher than recommended doses of buprenorphine to optimize OUD management • Key stakeholders must be consulted when establishing pharmacogenetic testing as the standard of care in OUD management

Context.—Professionalism issues in residency training can be difficult to assess and manage. Generational or role-based differences may also exist between faculty and residents as to what constitutes unprofessional behavior and how to manage it. Objective.—To examine and compare how faculty and residents would approach the same 5 case scenarios detailing various aspects of unprofessional behavior. Design.—Five case scenarios highlighting various unprofessional behaviors were presented in a workshop at an annual meeting of pathology department chairs, residency program directors, and undergraduate pathology medical educators (ie, pathologists involved in medical student pathology education). The same cases were presented to a cohort of pathology residents currently in training. A standard set of responses were offered to the participants, polling results were collected electronically, and results were compared. Results.—Faculty and residents were fairly consistent within their respective groups. In a subset of cases, faculty were more likely to favor working with the individual in the scenario, whereas resident respondents were more likely to favor either no response or a severe response. Generational or role-based differences were also potentially evident. Conclusions.—Assessing expectations and differences around professionalism for both faculty and residents should be considered as part of any educational and management approach for professionalism. Although a level of generational differences appears to be evident in this study regarding the recognition and management of unprofessional behavior, there was also agreement in some cases. Further exploration into the discrepant responses between faculty and residents may prove useful in developing educational, assessment, and remediation resources.

We proposed the case-based approach to obtaining blurred boundaries for safety assessment where rough sets was used in uncertainty situations for describing spatial configurations. Due to using the rough sets for determine dynamic safety domains this approach is not sensitive to imprecise and incomplete observations. The main condition of proper implementation of this approach is the presence of a sufficient number of accumulated cases in case base.

Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident

The continually changing learner's mobile environment gives rise to many learning context. This paper describes a model of a case-based approach to context-aware content sequencing in mobile learning environments. The design of mobile learning teaching systems with adaptive content sequencing requires significant effort, since dependencies between educational characteristics of learning resources, learning context and learner characteristics are too complex. According to the proposed approach, an prototype of Mobile Finite Automata Tutoring (MoFAT) system using a context-aware case-based content sequencing is presented. The MoFAT's learning material organization has a hierarchical structure with four levels. A new content sequencing problem (a new case) is solved by finding a similar past case, and reusing it in the new content sequencing problem context.

An increasing number of Cyber Physical Systems is used in different areas of applications like smart grid, smart factory or smart home. This paper demonstrates a first approach for an integrated consideration of safety and security for Cyber Physical Systems in a System of Systems by a use case based model for smart home applications. To realize a safe and secure operation of Cyber Physical Systems in System of Systems a high number of elements, relations and functions have to be taken into account. A Systems Engineering based approach will be introduced in this paper to deal with this complexity. The approach consists of a SysML based model which is associated with a procedure to ensure the safe and secure design of Cyber Physical Systems. Defined safety use cases will be used in a following security analysis and assessment. By harmonizing security assessment and safety use cases the integrated consideration is accomplished. The results can be used for an early technically solution neutral design planning.

This is a concise, practical, case-based book documenting examples and scenarios that will help you manage challenging clinical issues for patients with myeloproliferative neoplasms. The editors and authors have strived to distil the very latest information in this rapidly advancing field in a way that will help you to update your practice and manage your patients. The key focuses are: diagnosis, both standard and challenging; both day-to-day management as well as special situations such as surgery, thrombotic events and pregnancy; and finally, managing evolving situations with MPN such as progression to acute myeloid leukemia. This book is an outstanding resource that includes a discussion of both classical myeloproliferative neoplasms, such as essential thrombocythemia, polycythemia vera and myelofibrosis, and also less common disorders such as systemic mast cell disease, hypereosinophilia, MPN/MBS overlap syndromes and atypical CML, amongst others. This book is a practical reference for practitioners, hematologists, medical oncologists and trainees.

Coronary artery disease remains the leading cause of mortality worldwide, and the identification of at-risk individuals represents a significant clinical challenge. In this review, a typical clinical case is presented, followed by a discussion of the cardiovascular risk assessment of such individuals. Specifically, the role of imaging modalities such as carotid intima-media thickness measurements and coronary artery calcium scoring is explored. Case resolution and recommendations are subsequently suggested.

The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3) describe a simplified 5-step approach to facilitate the evaluation of diarrhea.

The management of work-related asthma has some differences from management of other asthma. Components of management include not only making as accurate a diagnosis as possible, identifying the causative agent or triggers at work, and managing the asthma with pharmacologic treatment as for other patients with asthma, but also advising on the appropriate work changes that may be needed, assisting the worker with appropriate compensation claims, and supporting protective measures for coworkers. This article discusses the approaches that may be taken for patients with different forms of work-related asthma.

Several forces impinge upon the way we see the world of teaching and learning, as well as on the way we shape our lives and the lives of our students in schools. To understand and explore the pedagogy for autonomy puzzle, teachers may need to uncover those forces, look at their ideas and action from new perspectives, and discover unconventional routes to follow. Teacher education for pedagogy for autonomy needs to embark teachers and teachers-to-be on a journey of self-discovery and self-reconstruction. Taking as a starting point the view of pedagogy for autonomy as a flexible approach where teachers play a decisive role in creating learning opportunities that promote learners’ reflectivity and self-regulation, the EuroPAL team has developed an interactive, multimedia DVD-ROM for teacher development for learner autonomy that highlights the interconnectedness of teaching, learning, and contexts of practice. The innovative aspects of this teacher development package are: (1) the use of pedagogical ...

Russell L. Ackoff developed the Interactive Planning (IP) methodology as a conceptual tool to guide systematic and systemic development of organizations. One of its unique features is that such development should be ideal-oriented. IP has been well-received within the Systems Thinking community in particular; where more than 300 applications of IP are mentioned. However, it has not been easy to answer the question: “does the use of IP enable that which it is proposing to enable?” as there have been no systematic, empirically grounded, and critically oriented, evaluations of IP. This study attempts to offer such an evaluation. In this case, IP was employed to support a comprehensive development of a Department within a company. This IP application was evaluated using a set of predefined evaluation criteria derived from the IP as such and also from its critique. The results suggest that IP is indeed a powerful methodology to guide organizational development. While IP has several positive merits, a set of limitations were identified and serve here as a basis for deriving recommendations for the practitioners of IP and also suggestions of areas that merit further IP research.

Many neuro-ophthalmic conditions are associated with head or ocular pain; some are benign and others are potentially life-threatening. Rather than listing and describing numerous conditions, this article presents three cases interfacing neuro-ophthalmology and headache, with a discussion of the differential diagnosis, approach to obtaining the proper diagnosis, and management. The discussions are not intended to be exhaustive, but include conditions encountered in practice that present a diagnostic challenge. The main issues are highlighted for each clinical scenario.

In this paper, we discuss how the societal context of sub-Saharan Africa is related to the innovative performance of project teams. We developed propositions based on previous literature while also using insights from experts from the sub-Saharan section of Africa. We then tested these propositions using a case based approach. Specifically, we examined the propositions through interviews with team leaders in three companies located in sub-Saharan Africa (two located in Nigeria and one located in South Africa). This empirical examination of real-life project teams in sub-Saharan Africa led us to an improved understanding concerning the consequences of African societal characteristics for the innovative performance of teams. Essentially, our findings suggest that managers of African projects need to adapt their methods (1) to incorporate and utilize the diversity inherent in society, (2) to (re)direct the focus of entire projects towards creating value for human beings, and (3) to maintain acceptable and security-giving hierarchies. We discuss the theoretical and practical implications of our findings.

R. Gupta, R. Matthews, L. Bangiyev, D. Franceschi, and M. Schweitzer, Eds. New York, NY: Springer, 2018, 351 pages, $179.99 PET/MRI is an exciting novel diagnostic imaging modality that combines the precise anatomic and functional information provided by MRI with the molecular data obtained with

On the basis of an interesting case of a 40-year-old lady with an atrial septal defect, we describe a simple approach for complex shunt volume calculations based on the Fick principle using hemodynamic data obtained in the catheterization laboratory. Understanding Fick's principle allows determination of all relevant flows, flow ratio, and resistances without having to resort to memorization of complex formulae. Those findings significantly impact the managements of patients like ours with hemodynamically and clinically relevant shunting.

We describe an approach to integrate dialogue management, machine-learning and action planning in a system for dialogue between a human and a robot. Case-based techniques are used because they permit life-long learning from experience and demand little prior knowledge and few static hand-written structures. This approach has been developed through the work on an experimental dialogue system, called CEDERIC, that is connected to an unmanned aerial vehicle (UAV). A single case base and case-based reasoning engine is used both for understanding and for planning actions by the UAV. Dialogue experiments both with experienced and novice users, where the users have solved tasks by dialogue with this system, showed very adequate success rates.