Caring for the hypochondriac

The patient's manner and the content of his complaints offer early diagnostic leads. The hypochondriac clings to his symptoms. Rather than relief, his goal is forming a relationship with the doctor that provides care and understanding. The physician's goal must be the provision of this care in such manner as to reassure, treat sparingly and convert this potentially fatal illness to a chronic disorder with which the patient can function to the limits of his capabilities.     

Double-blind evaluation of 5-mum final filtration to reduce postinfusion phlebitis

A double-blind study was conducted to determine the effectiveness of 5-mum final filtration in preventing phlebitis secondary to intravenous fluid administration. An experimental administration set which contained distal portion of the tubing was used for patients randomly assigned to receive filtered intravenous solutions. An identical administration set minus the filter was used in the control group to allow double-blind evaluation of the injection site. Data were collected on 49 patients whose average age was eight years and one month. Most patients had a primary diagnosis of acute lymphocytic or myelocytic leukemia or solid tumor. The patients' injection sites were evaluated daily for clinical findings of phlebitis (erythema, induration, heat, erythematous-streak and discomfort). The incidence of phlebitis was significantly lower (p less than 0.01) in patients receiving filtered intravenous solutions. For the patients in this study, filtration of intravenous fluids with a 5-mum mesh filter appeared to be a feasible and effective means of reducing postinfusion complications.