No abstract

SUMMARYA 45 year-old woman who presented with non-specific neck and shoulder pain, was found to have mild hypercalcaemia, markedly elevated parathyroid hormone levels, and an irregular parathyroid gland on imaging. The patient underwent a parathyroidectomy and the pathology report came back positive for parathyroid carcinoma with muscular invasion. Parathyroid carcinoma is an exceptionally rare cause of primary hyperparathyroidism and can have a poor prognosis due to metastases and a high propensity to recur after resection. Reports of non-functioning parathyroid carcinomas tend to behave even more aggressively. Repeat imaging on this patient showed residual cancer present, so the patient underwent a second surgery with radical neck dissection and has since been doing very well postoperatively. Diagnosis and treatment is challenging and it is critical to continuously follow-up for recurrent disease. BACKGROUND

Apocrine breast carcinoma is a rare subtype of the invasive ductal carcinoma and accounts for as little as 0.3–1% of all breast cancers. It is usually positive for human epidermal growth factor receptor 2 (HER-2) and negative for both estrogen receptor and progesterone receptor. Here we present an exceptionally rare case of apocrine breast carcinoma that is a triple receptor negative with metastases and to our knowledge this is the first published case. This is a significant finding because it implies that the tumor would not respond to the typical hormonal agents. This case highlights the need for studies to elucidate better treatment strategies for these types of patients.

No abstract

Background: As the US healthcare system is becoming a more outcomes based system, increasing emphasis is being paid to improving all aspects of health care delivery. Interpersonal and communication skills, an ACGME (Accreditation Council for Graduate Medical Education) core competency in resident education, play a fundamental role in this effort. This aspect of healthcare delivery is also part of Medicare hospital reviews. In our hospital, the administration has introduced AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) as a communication strategy which promises to improve exchange of information between healthcare professionals as well as with patients and their families. Objective: Determine if the AIDET strategy used in our facility has improved patient satisfaction. Methods: This study was done using pretest post test experimental design. Patient satisfaction was measured using scores from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) quarterly reports from the 3 rd quarter of 2010 to the 2 nd quarter of 2013. Pre and post AIDET implementation results were statistically analysed using a paired t-test.Results are reported as a p-value with < .05 being statistically significant. Results: There were a total of 1,811 patient responses sampled from the 3 rd quarter of 2010 to the 2 nd quarter of 2013. A significant change < .05 was seen in the way Nurses Explain, Doctors Explain and Nurses listen in the pre and post AIDET implementation comparison. The change in percentage of patients that believed doctors and nurses explained things to them in a way they could understand showed a p-value of .02. The trend in percentage of patients that perceived that nurses always listened carefully to them showed a p-value of .02 as well. On the other hand, the data evaluating how doctors listened carefully to them did not reach statistical significance with a p-value of .08. The remaining categories of "Told About Medication" and "Help after Discharge" were both found not have changed significantly either. Conclusions:The implementation of AIDET education may have had a significant impact on provider-patient communication in our facility, especially in the patient's perception of explaining things in a way they could understand. On the other hand, in the responses to the question of whether or not doctors listened carefully to them, there was some improvement over time, however this did not achieve statistical significance.