Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report.

Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP.

Factors associated with the public's trust in physicians in the context of the Lebanese healthcare system: a qualitative study.

BACKGROUND: The Lebanese public perceives the physician-patient relationship as flawed. The objectives of this study are to assess factors associated with the public's trust in physicians in the context of the Lebanese healthcare system and to explore potential ways to enhance it. METHODS: We conducted a qualitative study based on a grounded theory methodology using semi-structured interviews with members of the Lebanese public (not restricted to patients). We selected participants through convenience and maximum variation sampling approaches. The constant comparative analysis resulted in a theoretical framework that describes the factors influencing trust in physicians. RESULTS: Participants trusted an experienced, up-to-date, graduate of a North American or Western European school, working in a reputable hospital, with a high level of diagnostic skills. The personal characteristics that improved trust were physicians who are 'non-materialistic', have a good rapport, and have sufficient encounter time with patients. Social factors that enhance trust in the physician include: being a family member, recommended by a family member, featured in mainstream media, and/or having a good reputation. Trust increased compliance, loyalty despite occasional mistakes committed, high consultation fees, and negative attitudes towards the physician's institution. Conversely, no trust led to severed therapeutic relationship and seeking second opinions. CONCLUSION: The level of trust of members of the Lebanese public in physicians was affected by the personal characteristics of physicians, their practice or clinical skills, their interactions with the patient, finances, in addition to a number of social factors. Moreover, the level of trust had major implications on patients' interactions with their physicians.