It's hard to talk about breathlessness: a unique insight from respiratory trainees .

This paper describes how difficult it can be to discuss the experience of breathlessness with patients, as identified by respiratory trainees in a psychology-led workshop. The reasons why it is considered an essential role for clinicians to facilitate conversations about patients' breathlessness are outlined within the context of the challenges of respiratory care. The benefits for both patient and clinician are described including rapport building, more focused and targeted consultations, and increasing a patient's receptivity to interventions.

Hormonal Replacement Therapy in Heart Failure: Focus on Growth Hormone and Testosterone.

A growing body of evidence led to the hypothesis that heart failure (HF) could be considered a multiple hormone deficiency syndrome. Deficiencies in the main anabolic axes cannot be considered as mere epiphenomena, are very common in HF, and are clearly associated with poor cardiovascular performance and outcomes. Growth hormone deficiency and testosterone deficiency play a pivotal role and the replacement treatment is an innovative therapy that should be considered.

Letter to Editor - Shaping the future of Acute Medical training.

I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs( and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training.

Notes from the field: Outbreak of pertussis in a school and religious community averse to health care and vaccinations--columbia County, Florida, 2013.

On August 30, 2013, the Florida Department of Health in Columbia County was notified of a Bordetella pertussis laboratory-positive unimmunized child attending a local charter school (316 students from pre-K through 8th grade) in a large religious community averse to health care and vaccinations. Kindergarten immunization records showed that only five (15%) of 34 students were fully immunized with pertussis-antigen-containing vaccines. In seventh grade, only one (5%) of 22 students was fully immunized with pertussis-antigen-containing vaccines.

Do antipsychotics ameliorate or exacerbate Obsessive Compulsive Disorder symptoms? A systematic review.

Background: Paradoxically, some reports in the literature support the use of antipsychotics in the treatment of Obsessive Compulsive Disorder (OCD), while other reports suggest that antipsychotics can exacerbate OCD symptoms. To date, there is no published systematic review of the relationship between OCD symptoms and antipsychotic drugs.

Methods: A Medline and PsychInfo search (1980-2003) was conducted to collect published reports of the interactions between antipsychotics and OCD symptoms.

Current management of depression in cancer patients.

Depression is a common but treatable condition among cancer patients. Screening for depression can be done simply and effectively, and a variety of practical treatment strategies are available. Numerous factors should be considered when prescribing medications from an ever-growing antidepressant armamentarium, including selective serotonin-reuptake inhibitors, serotonin norepinephrine-reuptake inhibitors, serotonin antagonist-reuptake inhibitors, norepinephrine dopamine modulators, monoamine oxidase inhibitors, reversible inhibitors of monoamine oxidase type A, tricyclic antidepressants, and psychostimulants.

An open-label clinical trial of nefazodone in hypochondriasis.

Hypochondriasis is a common and challenging problem in general medical practice, but little research is available on pharmacotherapeutic treatment approaches. The purpose of the present study was to evaluate the use of nefazodone in the treatment of hypochondriasis in an open-label trial. Eleven patients with a primary diagnosis of DSM-IV hypochondriasis received an 8-week trial of nefazodone with a maximum dose of 600 mg/day and a mean dose of 432 mg.