ResearchPad - case-studies https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Case Series of Bedside Renal Cell Carcinoma Detected by Point-of-Care Ultrasound in the Ambulatory Setting]]> https://www.researchpad.co/article/elastic_article_14019 Background: Kidney and renal pelvic cancer was the sixth most common cancer in men and 10th most common in women in the United States in 2018. Renal cell carcinoma (RCC), accounts for 86% of malignancies of the kidney. RCC patients are often asymptomatic; up to 25-30% have metastases at diagnosis. Few present with the triad of gross hematuria, flank pain, and abdominal mass. In RCC patients, 36% had 2 symptoms of the triad, and 60% had gross hematuria as 1 symptom. Point-of-care ultrasound (POCUS) offers a way to identify clinically meaningful anatomic abnormalities. This case series presents 3 patients in whom routine POCUS examination performed in an outpatient cardiology clinic found asymptomatic renal masses, resulting in surgical resection and cure of early-stage RCCs. Case Presentation: Patient 1: 54-year-old female with hypertension (HTN). Two solid masses were identified with POCUS in the right kidney. Patient 2: 63-year-old male with coronary artery disease (CAD) and HTN was seen at an 8-month follow-up visit. A 6-cm mass was identified in the left kidney. Patient 3: 69-year-old male with CAD, HTN, and smoking history seen at 5-month follow-up visit. A 3-cm mass in the right kidney was identified. Conclusions: Incorporating POCUS into the routine physical examination in the ambulatory care setting may improve rates of detection and increase the pretest probability of identifying renal pathology with formal imaging studies. With minimal clinician training, earlier and increased detection of asymptomatic RCC may result in improved patient survival.

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<![CDATA[Facilitating Guideline Implementation in Primary Health Care Practices]]> https://www.researchpad.co/article/elastic_article_13941 Introduction: Many patients continue to receive suboptimal services, inappropriate, unsafe, and costly care. Underutilization of research by health professionals is a common problem in the primary care setting. Although many theoretical frameworks can be used to help address such evidence-practice gaps, health care professionals may not be aware of the benefits of frameworks or of the most appropriate ones for their context and thus, may be faced with the challenge of selecting and using the most relevant one. Aim: The aim of this article was to describe the process used to adapt a knowledge translation framework to meet the local needs of health professionals working in one large primary care setting. Methods: The authors developed a 5-step approach for guideline implementation. This approach was informed by prior research and the authors’ experiences in supporting multidisciplinary teams of health care professionals during the implementation of evidence-based clinical guidelines into primary care practices. To ensure that the 5-step approach was practical and suitable for the context of guideline implementation by multidisciplinary teams in primary health care, the implementation team adapted the “knowledge-to-action” framework using a multistep process. Results: The implementation approach consisted of the following 5 steps: identification, context analysis, development of implementation plan, evaluation, and sustainability. All 5 steps were described alongside details about a national low back pain project. Discussion: This article describes a collaborative, grassroots process that addressed an identified need in one complex context by adapting a knowledge translation framework to meet the local needs of health professionals working in primary care settings. Existing implementation frameworks may be too complex or abstract for use in busy clinical contexts. The 5-step approach presented in this paper resulted in practical steps that are more readily understood by health care professionals and staff on “the ground.”

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<![CDATA[Leukemic Transdifferentiation of Follicular Lymphoma Into an Acute Histiocytic Leukemia in a 52-Year-Old Caucasian Woman]]> https://www.researchpad.co/article/elastic_article_10147 We report an instructive case of acute myeloid leukemia with histiocytic differentiation (acute histiocytic leukemia) arising in a patient, a 52-year-old woman with a history of follicular lymphoma. The results of genetic studies proved a clonal relationship between the lymphoma and the leukemic cells. To our knowledge, this is the first report of leukemic transdifferentiation of follicular lymphoma into modified base 5-methylcytosine (M5c)–like acute histiocytic leukemia and the first reported karyotype on a transdifferentiated neoplasm.

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<![CDATA[HNF1β Diabetes or Maturity-Onset Diabetes of the Young Type 5 With Rare HNF1β Mutation: A Case Report]]> https://www.researchpad.co/article/N545aedd6-23e8-49e4-87bb-73e3cfd586c0 ]]> <![CDATA[Insulin Resistance and Portal Vein Thrombosis]]> https://www.researchpad.co/article/N89efb324-6d45-44aa-b562-e15b10153c79 ]]> <![CDATA[Drug-Induced Falsely Low A1C: Report of a Case Series From a Diabetes Clinic]]> https://www.researchpad.co/article/5c35468dd5eed0c484d9c27f ]]> <![CDATA[Delayed Response to U-500 Regular Insulin]]> https://www.researchpad.co/article/5c354687d5eed0c484d9bfe5 ]]> <![CDATA[Prolonged Severe Hypoglycemia in a Pediatric Patient With Type 1 Diabetes]]> https://www.researchpad.co/article/5c354689d5eed0c484d9c0bc ]]> <![CDATA[Euglycemic Diabetic Ketoacidosis Accompanied by Severe Hypophosphatemia During Recovery in a Patient With Type 2 Diabetes Being Treated With Canagliflozin/Metformin Combination Therapy]]> https://www.researchpad.co/article/5c0e101ed5eed0c484dd6108 ]]> <![CDATA[Mysterious Hyperglycemia: Disease Versus Device]]> https://www.researchpad.co/article/5c0e1026d5eed0c484dd6247 ]]> <![CDATA[Nonobese, Nonketotic Childhood-Onset Diabetes: Look for Lipodystrophies]]> https://www.researchpad.co/article/5c0e1029d5eed0c484dd62f4 ]]> <![CDATA[A Case of Recurrent Hepatocellular Carcinoma Acquiring Complete Remission of Target Lesion With Treatment With Traditional Chinese Medicine]]> https://www.researchpad.co/article/5bf27921d5eed0c484fc0a35

Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies worldwide. Although surgery is known as the most promising radical treatment, a high recurrent or metastatic rate after surgery has limited its clinical efficacy. Sorafenib, a target agent, has seemed to be the only option for metastatic HCC patients to date, but none of clinical trials showed it could prolong the overall survival (OS) of advanced HCC to 1 year. How to prolong the OS and improve cure rate of HCC patients is still beset with difficulties. This report presents a rare case of recurrent HCC patient with complete regression of target lesion with 2 years of Chinese herbal treatment. A 64-year-old Chinese man with hepatitis B virus–associated chronic hepatitis presented HCC has been clinically diagnosed tumor relapse and omentum metastasis with computed tomography and α-fetoprotein blood test 4 months after surgery. It was decided the patient would receive traditional Chinese medicine treatment because of poor prognosis. After approximately 2 years of treatment, recurrent hepatic tumor and omentum metastasis have been found in complete regression. The patient remains alive over 31 months after relapse.

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<![CDATA[Rapid Improvement in Blood Glucose Control in a Patient With Type 1 Diabetes and Complete Blindness Using a Continuous Glucose Monitor]]> https://www.researchpad.co/article/5bc2719f40307c2017bbd70e ]]> <![CDATA[Rare Presentations of Ketoacidosis: Diabetic Ketoalkalosis and Ketoacidosis Secondary to Fasting and Muscular Dystrophy]]> https://www.researchpad.co/article/5bc5cdf740307c51dd5acceb ]]> <![CDATA[Supraventricular Tachycardia With Underlying Atrial Flutter in a Diabetic Ketoacidosis Patient]]> https://www.researchpad.co/article/5aff76e5463d7e25ff66a814 ]]>