scholarly journals Strategies for Managing Difficult Cases

2018 ◽  
Author(s):  
Baris Komur
Keyword(s):  
Difficult Cases

Modified Earpieces and CROS for High Frequency Hearing Losses

1968 ◽  
Vol 11 (1) ◽  
pp. 204-218 ◽  
Author(s):  
Elizabeth Dodds ◽  
Earl Harford
Keyword(s):  
Hearing Loss ◽  
Hearing Aids ◽  
High Frequency ◽  
Hearing Aid ◽  
Sound Field ◽  
Intensity Level ◽  
Test Results ◽  
High Frequency Hearing Loss ◽  
Increased Sensitivity ◽  
Difficult Cases

Persons with a high frequency hearing loss are difficult cases for whom to find suitable amplification. We have experienced some success with this problem in our Hearing Clinics using a specially designed earmold with a hearing aid. Thirty-five cases with high frequency hearing losses were selected from our clinical files for analysis of test results using standard, vented, and open earpieces. A statistical analysis of test results revealed that PB scores in sound field, using an average conversational intensity level (70 dB SPL), were enhanced when utilizing any one of the three earmolds. This result was due undoubtedly to increased sensitivity provided by the hearing aid. Only the open earmold used with a CROS hearing aid resulted in a significant improvement in discrimination when compared with the group’s unaided PB score under earphones or when comparing inter-earmold scores. These findings suggest that the inclusion of the open earmold with a CROS aid in the audiologist’s armamentarium should increase his flexibility in selecting hearing aids for persons with a high frequency hearing loss.

Indian Dermoscopic Study of One Thirty Eight Cases of Alopecia Areata

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Rahul Kumar Sharma, Divya Sharma, Rajendra Kumar Sharma
Keyword(s):  
Alopecia Areata ◽  
Smart Phone ◽  
Cotton Wool ◽  
Exclusion Criteria ◽  
Dermatology Clinic ◽  
Exclamation Mark ◽  
Single Feature ◽  
Males And Females ◽  
Vellus Hairs ◽  
Difficult Cases

Alopecia areata (AA) is a type of non-scarring alopecia first described by Cornelius Celsus, characterized by hair loss without any clinical inflammatory signs and affecting both males and females equally. The activity of AA is by the presence of black dots, broken hair, and tapering, furthermore black dots and yellow dots are equated to severity of AA. Aim - To study dermoscopic features of untreated cases of alopecia areata. Study subjects-All the patients who attended the dermatology clinic from March 2015 to March 2017 with the clinical diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria. Study period - Two year (from March 2015 to March 2017). Methodology - All the patients who attended the dermatology clinic from March 2015 to March 2017 with the diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria were recruited for the study. Trichoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - We got various dermoscopic signs in different combinations in our study. Yellow dots were seen in 10 cases, White dots in cotton wool pattern were seen in 3 cases, Black dots were seen in 25 cases, Dermoscopic coudability sign was demonstrated in 38 cases, Pigtail hairs were present in 2 cases, five cases showed short vellus hairs, Short broken hairs were found in 18 cases, Exclamation mark hairs were very common and were detected in 131 patients out of 138. Discussion - Single feature is not leading to the diagnosis so we should use combination of features which will help in difficult cases like AA incognito. Dermatoscope is an indispensible valuable tool in trichology practice which helps in prognosticating and making early diagnosis of AA. It also helps to differentiate it from trichotillomania and other causes of alopecia. In our study the incidence of AA was almost similar in both sexes. Our study revealed that exclamation mark hair is very common and sensitive dermoscopic marker of AA.

Modern forms of assistance to solve families difficult cases and their adolescent children

2014 ◽  
Vol 4 (1) ◽  
pp. 123-133
Author(s):  
Marzena Możdżyńska
Keyword(s):  
Adverse Event ◽  
Young People ◽  
Social Exclusion ◽  
Family Life ◽  
Social Group ◽  
Social Hierarchy ◽  
Educational Work ◽  
The Social ◽  
Difficult Cases ◽  
Complex Activities

Abstract In recent decades, we observe a significant disorganization of family life, especially in the sphere of parental functions performed by unprepared for the role emotional, socially and economically young people. Lack of education, difficulties in finding work, and the lack of prospects for positive change are the main causes of their impoverishment and progressive degradation in the social hierarchy. Reaching young people at risk of social exclusion and provide them with comprehensive care, should be a priority of modern social work and educational work. In order to provide help this social group and cope with the adverse event created a lot of programs to support systemically start in life. An example would be presented in the article KARnet 15+ program as a form of complex activities of a person stimulating subjectivity, and allows you to modify support in individual cases

HISTOPATHOLOGY OF THE PIGMENTED TUMORAL-LIKE LESIONS OF THE SKIN AT HUE HOSPITAL OF MEDICINE AND PHARMACY UNIVERSITY

2018 ◽  
Vol 8 (4) ◽  
pp. 65-69
Author(s):  
Mao Nguyen Van ◽  
Dong Tran Nam
Keyword(s):  
Key Words ◽  
Definitive Diagnosis ◽  
The Other ◽  
Cell Tumour ◽  
Cross Sectional ◽  
Skin Tumour ◽  
Clinical Appearance ◽  
The Face ◽  
The Common ◽  
Difficult Cases

Background: Pigmented tumour of the skin is one of the common tumour in human including the benign pigmented tumours (more common) called Nevi tumours and the malignant one called melanoma which was less frequent but the most poor in prognosis. In addition, the others not belonging to these group had the same clinical appearance, so the application of histopathology and immunohistochemistry for the definitive diagnosis was indespensible. Objectives: 1. To describe the macroscopic features of the pigmented tumoral-like lesions; 2. To classify the histopathologic types of the pigmented cell tumours and the other pigmented tumours of the skin. Materials and Method: Cross-sectional research on 55 patients diagnosed as pigmented tumoral lesions by clinician, then all definitively diagnosed by histopathology combining the immunohistochemistry in difficult cases. Results: There was no difference in gender, the disease was discovered most common in adult, especially with the age over 51 years old (58.1%). the most region located was in the face accounting for 60%, following the trunk and limbs (14.6%, 12.8% respectively). All 3 malignant melanomas happened in foot. The most common color of the lesions was black (65.4%), the other ones were rose, grey and blue. Histopathology and immunohisthochemistry showed that the true pigmented cell tumours were 52.6% encompassing benign ones (Nevi tumour) (41.8%), melanoma (5.4%) and lentigo (5.4%). 47.4% was not the true pigmented cell tumour including pigmented basocellular carcinoma (36.4%) and the others less common as histiofibromas, acanthoma and papilloma. Conclusion: the pigmented tumoral-like lesions of the skin could be the true pigmented cell tumours and the others, so the application of the histopathology and the immunohistochemistry after the clinical discovery helps to determine and classify the disease definitely and for the best orientation of treatment as well. Key words: skin tumour, benign pigmented tumour (Nevi), malignant pigmented tumour (melanoma), pigmented basocellular carcinoma

INSULATION AGAINST ICE AT MEASURING WEIRS

1974 ◽  
Vol 5 (1) ◽  
pp. 32-49 ◽  
Author(s):  
JOHN TVEIT
Keyword(s):  
Hydraulic Engineering ◽  
Simple Method ◽  
Institute Of Technology ◽  
The University ◽  
Difficult Cases

This article deals with the problem of insulating measuring weirs to avoid ice disturbances. The development of a simple method for insulating a conventional V-weir is described. This method will serve its purpose in many cases. For more difficult cases a special type of a fully insulated weir is described. The experiments described were carried out by The Division of Hydraulic Engineering, The University of Trondheim, The Norwegian Institute of Technology, at the River and Harbour Laboratory of the University, and at the IHD representative basin Sagelva.

Everything and Nothing

2018 ◽  
Author(s):  
Mark Jago
Keyword(s):  
States Of Affairs ◽  
Difficult Cases

What should we say about the ‘difficult’ cases of truthmaking, involving general and negative existential truths, modal truths, counterfactual truths, analytic truths, and temporal truths? The toughest cases are the general and negative existential truths. I’ll argue that we can’t account for them without introducing new bits of ontology (§5.2 and §5.3). Armstrong’s totality states of affairs are not the best option (§5.4). Negative states of affairs are a better bet (§5.5), although their metaphysical analysis is difficult (§5.6). I’ll discuss the remaining cases – modal truths, counterfactual truths, analytic truths, and temporal truths – in §5.7.

scholarly journals Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy

2021 ◽  
Author(s):  
Jacob Indu ◽  
Vikrama Amitha Kheda ◽  
Deepak Bolbandi ◽  
Sanjay Govil ◽  
Ravisankar Bhat
Keyword(s):  
Bile Duct ◽  
Current Treatment ◽  
Laser Lithotripsy ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Difficult Cases ◽  
Transhepatic Biliary Drainage ◽  
Variant Anatomy

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the current treatment of choice in bile duct stones. Several factors such as variant anatomy of ampulla and surgical procedures like hepaticojejunostomy limit the success of ERCP in treating bile duct stones. Percutaneous transhepatic laser lithotripsy using interventional radiologic and endourologic techniques, which is uncommon, is a reasonable treatment option in such difficult cases. It is a minimally invasive, safe procedure accompanied by a high success rate, minimal morbidity, and a short hospital stay. We report our technique and experience in a series of three patients who underwent percutaneous transhepatic biliary drainage (PTBD) followed by percutaneous transhepatic laser lithotripsy in an attempt to avoid open surgery when ERCP was technically difficult.

scholarly journals Templated Text Synthesis for Expert-Guided Multi-Label Extraction from Radiology Reports

2021 ◽  
Vol 3 (2) ◽  
pp. 299-317
Author(s):  
Patrick Schrempf ◽  
Hannah Watson ◽  
Eunsoo Park ◽  
Maciej Pajak ◽  
Hamish MacKinnon ◽  
...  
Keyword(s):  
Domain Knowledge ◽  
Expert Knowledge ◽  
Medical Image Analysis ◽  
Imaging Data ◽  
Data Synthesis ◽  
Domain Specific ◽  
Radiology Reports ◽  
Training Examples ◽  
Analysis Models ◽  
Difficult Cases

Training medical image analysis models traditionally requires large amounts of expertly annotated imaging data which is time-consuming and expensive to obtain. One solution is to automatically extract scan-level labels from radiology reports. Previously, we showed that, by extending BERT with a per-label attention mechanism, we can train a single model to perform automatic extraction of many labels in parallel. However, if we rely on pure data-driven learning, the model sometimes fails to learn critical features or learns the correct answer via simplistic heuristics (e.g., that “likely” indicates positivity), and thus fails to generalise to rarer cases which have not been learned or where the heuristics break down (e.g., “likely represents prominent VR space or lacunar infarct” which indicates uncertainty over two differential diagnoses). In this work, we propose template creation for data synthesis, which enables us to inject expert knowledge about unseen entities from medical ontologies, and to teach the model rules on how to label difficult cases, by producing relevant training examples. Using this technique alongside domain-specific pre-training for our underlying BERT architecture i.e., PubMedBERT, we improve F1 micro from 0.903 to 0.939 and F1 macro from 0.512 to 0.737 on an independent test set for 33 labels in head CT reports for stroke patients. Our methodology offers a practical way to combine domain knowledge with machine learning for text classification tasks.

scholarly journals The Role of the Abdominal Vessels for Vascular Access in Difficult Cases

EJVES Extra ◽  
2003 ◽  
Vol 6 (5) ◽  
pp. 85-87
Author(s):  
J Barbosa ◽  
M.J Ferreira Barbas ◽  
R Esteves ◽  
P Lopes ◽  
A Oliveira ◽  
...  
Keyword(s):  
Vascular Access ◽  
Abdominal Vessels ◽  
Difficult Cases
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