The article explores the various approaches a doctor can use in managing and upset patient. These approaches include BATHE (Background-Affect-Troubles-Handling-Empathy), LEARN (Listen-Explain-Acknowledge-Recommend and Negotiate) and LEAP (Listen-Empathise-Agree-Partnership). We include a case study of a 16 year old patient who presented with a sore throat. She subsequently developed a rash after starting Amoxicillin, which was later changed to Augmentin. The doctor utilised the BATHE approach in managing the patient’s unhappiness.

Introduction: Human papilloma virus (HPV)-related genital warts and cancers can lead to significant morbidity. The ACIP 2011 from the United States recommends routine quadrivalent HPV vaccination for both males and females for primary prevention.1 This study reviews current evidence on vaccinating males routinely, and determines if it can be applied to Singapore. Methods: Relevant articles from PubMed were obtained by searches using the search words “quadrivalent HPV vaccination”, “males”, “cancer” and “prevention”. Three retrieved articles are included in this review and 3 additional articles are included from the references of the selected articles. Results: Quadrivalent HPV vaccination is effective in the primary prevention of HPV-related genital warts and cancers in both genders. Effectiveness in the secondary prevention of HPV-related recurrent high-grade intra-epithelial neoplasia(HGAIN) was suggested in a cohort study among men. The vaccine is safe with minor side effects of localised injection site pain. Conclusion: Given the efficacy and safety of quadrivalent HPV vaccination in both males and females, local studies should be done to confirm the benefits of routine vaccination.

PURPOSE: To review the clinical outcomes of patients with voiding dysfunction who have detrusor overactivity with impaired contractility (DOIC) diagnosed with urodynamic studies. METHODS: Urodynamic reports from 2005 to 2009 were reviewed, and 54 male patients had findings consistent with DOIC. Patients with acontractile or neuropathic bladders were excluded. Clinical outcomes were obtained from patient records. RESULTS: Of 54 men, 8 presented with voiding symptoms, 17 had storage symptoms, and 29 had mixed symptoms. Twenty-two had a previous transurethral resection of the prostate. The median follow-up was 12 months. Four patients received no intervention. Two patients were taught intermittent self-catheterization. Five patients underwent surgery to reduce outlet resistance and all reported improvement. Forty-three patients were started on pharmacotherapy; symptomatic improvement was reported by 9 of 16 patients commenced on anticholinergics alone, 6 of 16 on alpha-blockers alone, and 4 of 5 treated with a combination of alpha-blockers and anticholinergics. Eleven patients experienced no difference on pharmacotherapy and 2 reported deterioration. One patient developed acute urinary retention (18 months after commencing treatment with alpha-blockers). No patient had urosepsis. CONCLUSIONS: Anticholinergics and alpha-blockers appear to be safe in patients with DOIC. The risk of urinary retention and sepsis is low. The majority of patients report symptomatic benefit from either drugs or surgical treatment.
Adrenergic alpha-Antagonists ; Cholinergic Antagonists ; Drug Therapy ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Sepsis ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Retention ; Urodynamics

Background: While the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics correlated with better rehabilitation status among hemodialysis patients. Methods: A total of 29,865 hemodialysis patients who were registered with rehabilitation status information in the Korean Society of Nephrology end-stage renal disease registration program from January 2017 to April 2019 were included and divided into five groups according to their rehabilitation status. Results: About half (47%) of enrolled patients belonged to the “independent but without a job” group and 21% of patients belonged to the “employed with a full-time job” group. Analysis revealed significantly younger mean age, longer mean hemodialysis duration, a higher proportion of male sex, and a lower proportion of diabetic nephropathy cases in the full-time job group than in the other hemodialysis patient groups. Also, hemoglobin, albumin, and phosphorus levels were higher but the urea reduction ratio was lower in the full-time job group. Conclusion A better rehabilitation and employment state of hemodialysis patients was associated with younger age, male sex, and underlying chronic glomerulonephritis. Patients with full-time jobs generally have better laboratory data but lower dialysis efficacy.

OBJECTIVE: To evaluate the association of LRP5 gene polymorphisms with bone mineral density (BMD) and bone responsiveness to hormone therapy (HT) in postmenopausal women. DESIGN AND METHODS: The LRP5 gene polymorphisms were analyzed by restriction fragment length polymorphism (RFLP) in 229 postmenopausal women receiving HT for 1 year. The BMD before HT was check using dual-energy x-ray absorptiometer (DEXA) at lumar spine, femur neck, Ward's triangle, and greater trochanter of femur, and women in the study were classificed into 3 group, normal, osteopenia and osteroporosis according to their BMD. RESULTS: The frequency of genotype C/C of C1677A was significanty high in osteoporosis group, and that of C/A was much low in osteoporosis group. The frequency of genotype T/C of T2268C was high in osteoporosis group, while that of C/C was low in the same group. There was no significant relationship between LRP5 polymorphisms and BMD before HT. In patients whose genotype was A/A of C3405G, C/C of T2268C, or C/C of T4037C had meaningful responsiveness to HT at the lumbar spine, regardless of their initial BMD. The Genotype C/A of C1677A also had great responsiveness to HT at the greater trochanter of femur in both osteopenia and osteoporis group. CONCLUSION: The LRP5 gene polymorphisms were not associated with the BMD before HT, but there were some reponsiveness to HT at specific site according to genotypes of the gene.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Femur ; Femur Neck ; Genotype ; Humans ; Osteoporosis ; Polymorphism, Restriction Fragment Length ; Spine

Although most cases of C2 traumatic spondylolisthesis, a so called Hangman's fracture, can be managed by a closed reduction and immobilization, surgery should be considered in the cases of non-reducible fractures or a recurrent subluxation. This report details our recent experience with the surgical treatment of a Type II Hangman's fracture after an unsuccessful closed reduction. Advantage and the technique of the posterior short segment fixation are discussed.
Immobilization ; Spondylolisthesis

The authors report a symptomatic intramedullary spinal cord astrocytoma in the thoracolumbar area associated with neurofibromatosis type 1(NF-1). A 38-year-old woman presented with paraparesis. Magnetic resonance imaging revealed an intramedullary lesion within the lower thoracic spinal cord and conus medullaris, which was removed surgically. Pathological investigation showed anaplastic astrocytoma. This case confirms that the diagnosis criteria set by the National Institute of Health Consensus Development Conference can be useful to differentiate ependymoma from astrocytoma when making a preoperative diagnosis of intramedullary spinal cord tumor in patients of NF-1.
Adult ; Astrocytoma* ; Conus Snail ; Diagnosis ; Ependymoma ; Female ; Humans ; Magnetic Resonance Imaging ; Neurofibromatoses* ; Neurofibromatosis 1* ; Paraparesis ; Spinal Cord Neoplasms ; Spinal Cord*

Approximately 5% of breast cancer patients develop leptomeningeal metastases over the course of their disease. Though several treatments options are available for these patients, their prognosis is typically considered to be poor. We report a case of leptomeningeal failure after a patient underwent prior radiotherapy, radiosurgery, surgery, chemotherapy, and biologic therapy. This patient experienced a prolonged response after receiving bevacizumab and capecitabine. The literature currently contains several reports regarding the use of systemic therapy to manage leptomeningeal metastases from breast cancer, which we summarize. Finally, we review the relevant effects of the patient's treatment modalities and provide a rationale for the mechanism that led to her prolonged response.
Antibodies, Monoclonal, Humanized ; Biological Therapy ; Breast ; Breast Neoplasms ; Deoxycytidine ; Fluorouracil ; Humans ; Meningeal Neoplasms ; Neoplasm Metastasis ; Prognosis ; Radiosurgery ; Bevacizumab ; Capecitabine

PURPOSE: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drug-refractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. METHODS: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson's chi-square tests. RESULTS: Fifty-two patients with a mean age of 67.4 years (range, 26-93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9-101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts. CONCLUSIONS: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.
Aged ; Antibiotic Prophylaxis ; Botulinum Toxins* ; Cohort Studies ; Compliance ; Female ; Follow-Up Studies ; Humans ; Male ; Treatment Outcome ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Retention ; Urinary Tract Infections ; Urodynamics

INTRODUCTIONDyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients' perceptions of statin therapy.

METHODSWe searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as 'patient', 'views', 'perceptions', 'adherence', 'statin' and 'dyslipidaemia'. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model.

RESULTSPatients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient's adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality.

CONCLUSIONExisting evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.

Attitude to Health ; Cardiovascular Diseases ; drug therapy ; Diet ; Dyslipidemias ; drug therapy ; Health Education ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Medication Adherence ; Myocardial Infarction ; drug therapy ; Patient Acceptance of Health Care ; Physician-Patient Relations ; Risk Factors ; Singapore ; Stroke ; drug therapy