Experiences and expectations of physician communication: A focus group discussion with Indian patients with type 2 diabetes mellitus.

OBJECTIVES: This pilot study aimed to: (a) understand the experiences of Indian patients with type 2 diabetes mellitus and their expectations of their physicians during a medical consultation, (b) serve as a preliminary study to inform the development of a larger project exploring and improving patients' communication experiences, and (c) assess whether the pilot study findings indicate the viability of using the Relationship: Establishment, Development, and Engagement model of communication as the conceptual framework for the larger project. METHODS: Using convenience sampling, 11 patients participated in a focus group discussion. Conventional content analysis was used. RESULTS: Two themes were generated: (a) A plethora of negative feelings: experiences of the physician's verbal and nonverbal communication styles, and (b) 'I know what I want': Expectations of communication by patients from their physician. CONCLUSIONS: The medical encounter with the physician elicited a range of negative experiences and clear expectations from the patients with type 2 diabetes mellitus. This pilot points to the need for (a) a mixed methods approach to comprehensively examine the communication needs of patients with type 2 diabetes mellitus from their physician, (b) understand physicians' communication practices, and (c) using these findings, culturally adapt and test the Relationship: Establishment, Development, and Engagement to improve physicians' communication skills in India.

Nodulisporium Fungal Brain Abscess In Early Post-Renal Transplant: A Rare, Unexpected, Mysterious Pathogen.

BACKGROUND Central nervous system fungal infections are rarely encountered in current medicine, with fungal abscesses even less commonly seen. Clinical entities and their development largely depend on the interplay between the host's immune system and fungal virulence factors. Due to the large size of fungal organisms, they are prevented from entering the meningeal circulation. Hence, they cause focal diseases like cerebritis, abscesses, vasculitis of larger vessels, vascular occlusion, cerebral infarcts, and aneurysms. CASE REPORT A 34-year-old male patient of Indian descent diagnosed with stage 5 chronic kidney disease, bilaterally small kidneys, and hypertension underwent cadaveric renal transplantation and subsequent immunosuppression. Three months later, he returned with complaints of high-grade fever with chills and rigor, along with massive headaches. Plain brain computed tomography showed an intra-axial heterogeneously hypodense area with a hyperdense rim in the right temporal lobe. MRI revealed a well-defined enhancing lesion with irregular crenated margins and satellite lesions. Abscess wall biopsy showed fragments of hyaline septate filamentous fungal hyphae. Craniotomy with excision and drainage of the abscess was done and sent for histopathological examination along with culture. The results showed the growth of Nodulisporium fungus. The patient was then managed on amphotericin B and voriconazole for completion of treatment. CONCLUSIONS This is the first case reported of a Nodulisporium species fungal abscess developing in the brain after cadaveric kidney transplantation. Urgent evaluation via imaging and biopsy is crucial in determining the exact causal organism of brain abscesses, which can lead to better patient outcomes.