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Several factors seemed to contribute to the difficulties case managers experienced in identifying unmet needs including the limited contacts between the case managers and patients and carers.
Most cases exhibited some of the typical non-motor features often recognized in Parkinson's disease (Lees et al., 2009), such as cognitive difficulties (Case 5), hyposmia (Cases 3 6 and 10) constipation (Cases 4 and 10), urinary problems (Cases 5, 6 and 9), fatigue (Cases 2 and 5) and sleep disturbances (Cases 4 6 and 10).
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The reverse-flow anterolateral thigh island flap with reliable blood supply and long vascular pedicle can be designed to repair soft tissue defects around ipsilateral knee joint or contralateral distal rejoins of the leg, especially in the difficulty cases.
In cases of diagnostic difficulty, cases were discussed with a specialist in old age psychiatry and a consensus on the most likely clinical diagnosis reached.
In addition to the baseline survey data, 2 endoscopist-specific variables were created as surrogates of "efficiency" in standard cases: grade-1-case procedure time (median time from inserting to removing scope in grade-1-difficulty cases); grade-1-case fluoroscopy time (median fluoroscopy time in grade-1-difficulty cases).
Four endoscopist-specific factors were significant: country, annual volume, and practice "efficiency" surrogates (median procedure and fluoroscopy times in grade-1-difficulty cases).
This design was chosen because residents in difficulty (cases) are relatively rare and because the time from exposure (early medical school) to manifest (struggling in residency) is long.
Surrogates of ERCPist "efficiency" included median procedure and fluoroscopy times in grade-1-difficulty cases of 25 min and 3 min, respectively.
Difficulties in case detection, hazardous or inaccessible carcasses, and misdiagnosis hinder surveillance.
Children were historically excluded from TB drug trials due to perceived difficulties in case definitions and markers of treatment response.
However, several limitations of the parallel approach also exist beyond inherent difficulties with case coordination (Stewart and Conrod 2008).
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