Pulmonary tuberculosis mimicking numerous lung metastases — a case study

Introduction: Tuberculosis is an infectious disease caused by tuberculosis bacilli. Presently, the incidence of tuberculosis is deemed low in Poland, i.e. less than 20 cases per 100,000 residents, even though this value still exceeds the EU average. Most often it affects the lungs, although it may also develop in other organs. The diagnosis is based on the positive test result of tuberculosis bacilli breeding on the Löwen-stein-Jensen’s egg medium. Under no circumstances may an X-ray image of the chest be construed as the ultimate diagnostic confirmation of tuberculosis, though. Case description: The case of a 68-year old woman, put under diagnostic procedure due to an abnormal X-ray image of the lungs, thereby giving rise to the suspicion of numerous metastases of unknown origin, was addressed. The initially suspected neoplastic disease with lung metastases, following comprehensive pulmonary diagnostics, ultimately turned out to be pulmonary tuberculosis, despite presenting a non-char-acteristic, radiological image. Conclusions. Completion of a comprehensive, differential diagnostics is always a prudent approach to be adopted, ultimately with a view to establishing the patient’s status beyond a reasonable doubt

Total pain in a patient with lung cancer diagnosis

Pain is experienced by most cancer patients. According to the definition of the International Society forthe Study of Pain (IASP), pain is an unpleasant sensory and emotional experience associated with, or resemblingthat associated with, actual or potential tissue damage. This very “medical” definition indicatesthat pain is a mental, subjective, sensual, emotional, and unpleasant phenomenon. In palliative care, thereis often a need for a better and deeper understanding of what “total” pain can be. The case of a youngpatient with lung cancer diagnosis presented an opportunity to describe characteristics of such pain, whichencompasses physical, mental, social and spiritual suffering

Marshall Rosenberg’s non-violent communication as the language of life in a doctor–patient relationship

The aim of the article is to present Marshall Bertrand Rosenberg’s concept of non-violent communication(NVC) and usefulness in the doctor-patient relationship. M. B. Rosenberg’s concept of NVC was basedon the assumption that a person’s natural ability is empathy directed towards other people and towardsthemselves. However, our culture suppresses these natural abilities. The language offers many expressionsthat block natural compassion because they are overfilled with moral judgments, judging comparisons,punishments, arousing feelings of guilt or shame. The author of NVC proposes a four-phase model ofempathic non-violent and non-manipulative communication, which is the basis for changes in the thoughtprocess: observing without judging, recognising, relating the feelings currently experienced to needs (values)and formulating concrete requests instead of demands

Assessment of endothelial function in relation to the presence of type 2 diabetes mellitus in patients with prior myocardial infarction: a pilot study using peripheral arterial tonometry

Background. Endothelial dysfunction represents an early stage of atherosclerosis, while hyperglycaemia remains an important cause of endothelial dysfunction. The aim of this study was to assess endothelial function in patients with prior ST-segment elevation myocardial infarction (STEMI) in relation to the presence of type 2 diabetes mellitus (DM).Materials and methods: Eighty three adults treated with primary percutaneous intervention for STEMI within the previous 12–18 months were enrolled in a case-control study. The control group consisted of 21 healthy volunteers. Endothelial function was assessed with peripheral arterial tonometry (PAT). The value of reactive hyperemia index (RHI) and the presence of endothelial dysfunction (defined as RHI ≤ 2.0) were respectively the primary and secondary study endpoints.Results. RHI was significantly lower in post-STEMI subjects with concomitant type 2 DM (n = 21) than in healthy volunteers [1.70 (1.44–1.96) vs 2.15 (1.82–2.50); p = 0.006]. On the other hand, there were no significant differences in RHI between post-STEMI patients with and without type 2 DM [n = 62; RHI: 1.87 (1.59–2.39)], nor between the latter group and the control group. In terms of the secondary study endpoint, we observed a decreasing prevalence of endothelial dysfunction across the compared groups [76.2% vs 54.8% vs 38.1% for post-STEMI diabetics, post-STEMI non-diabetics and controls, respectively; p for trend = 0.013].Conclusions. Our study indicates that endothelial function assessed with PAT is significantly worse inpost-STEMI subjects with concomitant type 2 DM compared to healthy controls, but it does not seem to be substantially different in diabetic vs. non-diabetic STEMI survivors. The clinical significance of ourfindings warrants further investigation in adequately powered, prospective studies

Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians

Background: Respiratory medicine (RM) and palliative care (PC) physicians’ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. Methods: A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. Results: 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). Conclusions: These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled

Kształcenie umiejętności komunikowania się z pacjentami na poziomie podyplomowym, ze szczególnym uwzględnieniem medycyny paliatywnej

Clinical communication skills have been taught and researched for more than 40 years. This set of processes and communication skills with patients and/or their family, and other healthcare professionals, improves the quality of healthcare services, increases patient involvement in the treatment process and improves job satisfaction. It seems particularly important for physicians working in palliative care to have these skills. The process of pre-graduate and post-graduate training was analysed in terms of teaching clinical communication and the expectations of healthcare professionals, with a particular focus on palliative medicine. The results were compared with those of a survey of 123 physicians who identified their training needs in clinical communication. The results show that there is a significant gap between physicians' expectations of their clinical communication skills training and the requirements of the curricula. It is therefore reasonable to modify the existing clinical communication curricula.Komunikacja kliniczna to dziedzina, której naucza się i którą bada się od ponad 40 lat. Ten zbiór procesów i umiejętności, które stosowane są podczas komunikowania się lekarza z pacjentem i/lub jego rodziną, w trakcie pracy w zespole interdyscyplinarnym czy podczas komunikowania się pracowników ochrony zdrowia między sobą, poprawia jakość świadczonych usług medycznych, zwiększa zaangażowanie pacjenta w proces leczenia oraz poprawia satysfakcję z wykonywanej pracy. Szczególnie ważne wydaje się posiadanie tych umiejętności przez lekarzy pracujących w opiece paliatywnej. Przeanalizowano proces szkolenia przeddyplomowego oraz podyplomowego pod kątem nauczania oraz oczekiwań wobec pracowników ochrony zdrowia, ze szczególnym uwzględnieniem medycyny paliatywnej. Uzyskane wyniki porównano z wynikami badania przeprowadzonego na próbie 123 lekarzy, którzy określali swoje potrzeby kształcenia w zakresie komunikacji klinicznej. Uzyskane wyniki wskazują na istnienie znaczącej różnicy pomiędzy oczekiwaniami lekarzy dotyczącymi ich kształcenia w tej dziecinie a wymaganiami programów nauczania. W pełni zasadne jest zatem wprowadzenie modyfikacji dotychczasowych programów nauczania komunikacji klinicznej

Artykuł oryginalnyWpływ płci na śmiertelność wewnątrzszpitalną osób poddanych przezskórnej angioplastyce wieńcowej

Background: Many observational and randomised studies have suggested that women are referred for invasive diagnostics and treatment of coronary artery disease (CAD) less frequently than men, and the effects of percutaneous coronary intervention (PCI) among women are worse than in men. Aim: To compare direct results of PCI in men and women. Methods: The study was a retrospective assessment of case records of one thousand consecutive patients treated with PCI because of acute myocardial infarction (AMI) (344 patients), unstable angina (UA) (164 patients) and stable angina (SA) (492 patients). We examined the effects of demographic, angiographic and clinical variables on the duration of hospitalisation and in-hospital mortality separately in men and in women. Results: Women constituted 30.7% of patients treated with PCI because of AMI, 39.6% of those with UA and just 25.8% of those with SA. Women were significantly older than men, had a higher BMI, and more often suffered from hypertension and diabetes. The duration of hospitalisation was the same in men and women if the reason for PCI was SA or UA, however, in case of AMI women were hospitalised significantly longer than men. In the univariate analysis gender had no influence on in-hospital mortality regardless of the reason for PCI treatment. Among the variables subjected to multivariate analysis female gender, age, BMI, diabetes, hypercholesterolaemia, indication for PCI, final TIMI flow in the target vessel and cardiogenic shock as a complication of AMI were shown to affect mortality. Significant effects on in-hospital mortality for women were exhibited only by cardiogenic shock. Among men, indication for PCI, age, diabetes and final TIMI flow in the target vessel also had a significant influence on in-hospital mortality. Conclusions: Stable angina is a reason for performing PCI more rarely in women than in men. Women with CAD are older than men and have more risk factors. The in-hospital mortality among patients treated with PCI because of SA is independent of gender. Cardiogenic shock appeared to be the only factor that influences in-hospital mortality in women. In the case of men such an influence is also observed for indication for PCI (AMI, UA or SA), diabetes and final TIMI flow in the target vessel.Wstęp: Wiele obserwacji i wyników badań wskazuje, że kobiety z chorobą niedokrwienną serca (IHD) rzadziej od mężczyzn są diagnozowane i leczone inwazyjnie, a wyniki przezskórnych interwencji wieńcowych (PCI) u kobiet są gorsze niż u mężczyzn. Cel: Porównanie wyników bezpośrednich PCI wykonywanych u kobiet i mężczyzn z różnych wskazań. Metodyka: Badanie było retrospektywną oceną historii chorób kolejnych 1000 pacjentów (299 kobiet i 701 mężczyzn) poddawanych PCI z powodu zawału serca (MI) (342 chorych &#8211; 30,7% kobiety, 69,3% mężczyźni), z powodu niestabilnej dusznicy bolesnej (UA) (164 chorych &#8211; 39,6% kobiety, 60,4% mężczyźni) oraz z powodu stabilnej dusznicy bolesnej (SA) (492 chorych &#8211; 25,8% kobiety, 74,2% mężczyźni). Porównywano zmienne demograficzne, zmienne angiograficzne (lokalizacja i rozległość zmian miażdżycowych, przepływ TIMI w naczyniu docelowym przed i po zabiegu, średnica balonu/stentu, maksymalne ciśnienie inflacji balonu, częstość stentowania bezpośredniego, czas trwania zabiegu, ilość zużytego środka cieniującego) oraz zmienne kliniczne (czas trwania hospitalizacji, śmiertelność wewnątrzszpitalna). Wyniki: Stabilna dusznica bolesna była powodem wykonywania PCI znamiennie rzadziej u kobiet (42,5%) niż u mężczyzn (52,1%). Kobiety były znamiennie starsze od mężczyzn (63,7&#177;11,2 vs 58,5&#177;10,4 roku,