Complaints from patients

Aside from consideration of the relatively uncommon but serious GI adverse effects described above, fewer overall GI complaints from patients are found for COX-2 inhibitors compared to nonspecific NSAIDs. Moreover, celecoxib use was associated with decreased outpatient physician claims for upper GI symptoms compared with other prescription nonspecific NSAIDs. Finally, celecoxib was comparable to a combination of diclofenac and misoprostol in reducing the risk of recurrent GI bleeding in patients who had a prior GI bleed. ... 

The most frequent complaints of patients taking theophylline are nausea and vomiting, which occur most frequently in patients receiving theophylline for the first time and when the plasma level approaches 20 pg/mL but rarely occur at plasma concentrations below 15 pg/mL. The fact that patients who receive the drug intravenously also have the same complaint suggests that the nausea and vomiting result from an action in the CNS. 

Most patients tend to respond in a positive way to any therapeutic intervention by interested, caring, and enthusiastic medical personnel. The manifestation of this phenomenon in the subject is the placebo response (Latin, "I shall please") and may involve objective physiologic and biochemical changes as well as changes in subjective complaints associated with the disease. The placebo response is usually quantitated by administration of an inert material, with exactly the same physical appearance, odor, consistency, etc, as the active dosage form. The magnitude of the response varies considerably from patient to patient and may also be influenced by the duration of the study. Placebo adverse effects and "toxicity" also occur but usually involve subjective effects stomach upset, insomnia, sedation, and so on. 

It is difficult for us now to appreciate the naive fervour and trust in doctors that allowed them almost unlimited rights to prescribe (in the early years of the UK National Health Service founded in 1948). Beer was a prescription item in hospitals until, decades later, an audit revealed that only 1 in 10 bottles reached a patient. Mote recently (1992) There could be fewer Christmas puddings consumed this year. The puddings were recently struck off a bizarre list of items that doctors were able to prescribe for their patients. They were removed by Health Department officials without complaint from the medics, on the grounds they had "no therapeutic or clinical value". (Lancet 1992 340 1531). 

Another group of anamnestic findings is based on the patient s subjective complaints. However, patients suffering from liver disorders frequently fail to recognize symptoms. 

Answer A. The symptoms are those of a mild case of hemorrhagic cystitis. Bladder irritation with hematuria is a fairly common complaint of patients treated with cyclophosphamide, It appears to be due to acrolein, a product formed when cyclophosphamide is bioactivated by liver P450 to form cytotoxic metabolites. Urinary tract problems may also occur with methotrexate from crystalluria due to its low water solubility. 

The major risk associated with use of ibuprofen is stomach irritation. The inventors of ibuprofen had hoped to find a substance that causes less stomach irritation than aspirin. Ibuprofen does seem to cause fewer gastrointestinal problems than does aspirin. Nevertheless, it can still cause severe problems in some patients, especially those who take large doses. Common complaints from the use of ibuprofen include nausea, stomach pain, and diarrhea. Patients who are especially sensitive or who take high doses of ibuprofen for long periods may experience damage to the stomach lining. 

University Hospital Zurich has been conducting patient surveys for more than 10 years now. In addition, its patient advice service deals directly with complaints and praise from patients and, where appropriate, makes contact with the patients concerned. The data acquired via the surveys and also via this direct patient feedback are made available to the various specialist units. This feedback makes clinical staff more aware of patients problems and expectations and also of what procedures and stractures are proving to be effective. It can also be used to plug and eliminate deficits in patient care as perceived by patients. 

Back claims and complaints are widespread among people and occupations. They often occur in industrial or construction activities. They are common among hospital employees, often resulting from patient lifting and handling. Even office workers report back complaints quite frequently. Results of one national survey estimated that over half of all office workers have back complaints at some time. Another study notes that four out of every five Americans will suffer at least one episode of lower back pain between the ages of 20 and 60. 

Complaints are non-conformities as well. Complaints may originate from patients but may also be brought by one department to another. The pharmacy or company will also bring complaints to suppliers or starting materials, for instance. 

MAD deficiencies were detected (patient 2,4). Among 12 patients with these complaints, one showed decreased NH formation during ischaemic exercise. MAD subsequently was found decreased in muscle biopsy (patient 3). MAD deficiency so could be found in these patients in a frequency of about 10%. In consecutive biopsy series from literature, a frequency of about 1,8% can be estimated. Half of the cases in these series display exercise intolerance. However, it is very probable that much less than half of the biopsies in these series come from patients with exercise intolerance. Therefore the available evidence from our study and from literature suggests that myoadenylate deaminase is possibly a rather frequent cause of exercise intolerance. Further research is needed to decide if the occurrence of MAD deficiency together with other often well defined neuromuscular diseases is determined by chance, or if there exists a rather varying clinical expression of the deficiency. 

Generally, arblockers are considered as second-line agents to be added on to most other agents when hypertension is not adequately controlled. They may have a specific role in the antihypertensive regimen for elderly males with prostatism however, their use is often curtailed by complaints of syncope, dizziness, or palpitations following the first dose and orthostatic hypotension with chronic use. The roles of doxazosin, terazosin, and prazosin in the management of patients with hypertension are limited due to the paucity of outcome data and the absence of a unique role for special populations or compelling indications from JNC 7. 

Sleep disorders are common. Approximately 50% of adults will report a sleep complaint over the course of their lives.2 In general, sleep disturbances increase with age, and each disorder may have gender differences. The full extent and impact of disordered sleep on our society are not known because many patients sleep disorders remain undiagnosed. Normal sleep, by definition, is a reversible behavioral state of perceptual disengagement from... 

Note The AUA Symptom Score focuses on seven items (incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia) and asks that the patient quantify the severity of his complaints on a scale of 0 to 5. Thus, the score can range from 0 to 35. 

A 56-year-old man presents to the emergency room with complaints of right lower leg pain and redness. Examining his leg, you notice that he has erythema and edema extending from his ankle to proximal tibia. The area feels warm. On questioning, the patient states that the redness started approximately 2 days ago. He has felt feverish over the previous 48 hours but did not check his temperature. He has had no other symptoms. He states that he bumped his shin on the bed frame last week and sustained a bruise but no apparent breaks in the skin. His vital signs at the clinic reveal a temperature of 38.3°C, pulse 102 beats per minute, blood pressure 11 0/72 mm Hg, and respiratory rate 20 breaths per minute. The physician diagnoses this patient with cellulitis. 

If extravasation occurs, the infusion should be stopped immediately, with aspiration of fluid from the site, needle, and tubing as much as possible. The affected limb or area should be elevated (if possible). The site should be documented photographically as well as the time, date, site, patient complaints, and estimated volume of extravasated drug.36 Both hot and cold packs have been used to manage extravasations, but use of the proper therapy for certain agents is critical. For example, warm compresses have been shown to worsen doxorubicin extravasations, whereas cold packs may exacerbate vinca alkaloid... 

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