Epidural pain management in advanced gastric cancer with inoperable malignant bowel obstruction.

Presented is a case of a man in his 20s with gastric cancer with metastasis to a perineal nodule and the splenic flexure (previously resected due to acute bowel obstruction) who presented with prolonged, intermittent, inoperable bowel obstruction likely due to adhesions, exacerbated by functional ileus due to substantial opioid requirement. In an episode of obstruction during the described admission, the patient remained obstructed after more than 10 days of medical management. The patient suffered from intense abdominal distention and pain, necessitating hundreds of oral morphine equivalents daily.

Patient-level adherence and interventions in an interdisciplinary DOAC clinic.

Background: Direct oral anticoagulants (DOACs) are high risk medications with short half-lives making adherence vitally important. Global measures for adherence have been described; however, there is a lack of patient-level data on adherence.

Methods: This prospective, single-center study in an interdisciplinary internal medicine clinic included patients referred by their primary care physician for DOAC therapy evaluation.