In the STAR*D study, the efficacy of treatments for major depression was examined. It was found that, while many responded to the initial antidepressant treatment, only 30% of participants achieved complete remission. Concerning treatment resistance in depression, there is a recent distinction emerging between treatment-resistant depression (TRD) and difficult-to-treat depression (DTD). Historically, TRD and DTD have been conflated, but it is essential to recognize them as separate entities. While TRD is characterized by a patient’s inadequate response to two or more consecutive antidepressant treatments given for an adequate duration and dosage without achieving acceptable therapeutic effects, DTD describes a clinical category where patients do not achieve full symptom control despite various therapeutic approaches. The recent shift in perspective proposes a more integrated approach for DTD, encompassing psychosocial, biological, and interactive factors. This multifactorial model calls for a multidisciplinary therapeutic intervention, not restricted to pharmacological treatments but also including psychotherapy, neurostimulation, and social interventions. Informing professionals and the general public about the significance of this new approach could mitigate the stigma associated with depression and enhance the quality of care. The future challenge will involve a deeper clinical understanding of DTD and its optimal management by refining available treatments.

Coronaviruses of the human variety have been the culprit of global epidemics of varying levels of lethality, including COVID-19, which has impacted more than 200 countries and resulted in 5.7 million fatalities as of May 2022. Effective clinical management necessitates the allocation of sufficient resources and the employment of appropriately skilled personnel. The elderly population and individuals with diabetes are at increased risk of more severe manifestations of COVID-19. Countries with a higher gross domestic product (GDP) typically exhibit superior health outcomes and reduced mortality rates. Here, we suggest a predictive model for the density of medical doctors and nursing personnel for 134 countries using a support vector machine (SVM). The model was trained in 107 countries and tested in 27, with promising results shown by the kappa statistics and ROC analysis. The SVM model used for predictions showed promising results with a high level of agreement between actual and predicted cluster values.

Patients view their negative emotions as troublesome and they expect psychiatrists to deal with them, often wanting them taken away. We present a neuropsychoanalytical understanding of the essential biological function of emotion and how it influences behaviour. Through a vignette, we demonstrate how this understanding can contribute to the psychiatrist's management of the clinical encounter, in particular regarding the patient's expectations about their emotions and the pressures placed on the clinician.

This article describes how the core principles and techniques of transference-focused psychotherapy (TFP) can be used in general psychiatry to help in the management of patients with borderline personality disorder (or other moderate to severe personality disorders). It focuses on: knowledge – appreciating how an understanding of object relations assists the clinician in assessment and treatment; attitude – developing a stance to manage the confusing and negative feelings that may arise in both clinician and patient; and skills – describing how use of TFP techniques (technical neutrality, analysing the transference and countertransference, and judicious use of interpretation) helps the clinician to continue thinking in the fraught clinical encounter. The structural (including contemporary object relations) and structured approach in TFP are exemplified in clinical vignettes.

Resistance is a qualitative interpretation of antimicrobial activity in vitro. Critical to management of bovine respiratory disease (BRD) is the clinical response in vivo. Attempts to connect activity in vitro to response in vivo have been complicated by the complexity of BRD, interpretation of antimicrobial activity in vitro, and inconsistent measures of clinical success or failure. During recent history, the discovery, development, and commercialization of antimicrobials have decreased. In response to resistance, voluntary and imposed restrictions on use of antimicrobials have been implemented. Resistance can be reversed using technology and knowledge of mechanisms of resistance. Perhaps approaches that reverse resistance will be used in clinical management of BRD in the future. The short answer to the question posed in the title is, ‘yes.’ Since antimicrobial drugs were discovered, resistance has been a consideration for selection of treatment of any infectious disease and BRD is not unique. In the opinion of the author, the more important question is, ‘How will antimicrobial resistance of BRD pathogens impact BRD management in the future?’

Despite numerous advances in bovine infectious disease research, bovine respiratory disease (BRD) remains a significant disease threat and a cause of tremendous loss. Renewed efforts and innovative strategies are required to build on the successes of the past to achieve the successes of tomorrow. Continued and improved support of BRD research will prove to be a worthwhile investment. To achieve better coordination and more efficient use of resources, the following supportive actions should be considered. There should be coordination of integrative teams through an over-arching agency (United States Department of Agriculture (USDA)) to provide peer review and priority review for available public research funds. This would include use of development grants (as seed and matching funding) available to public/private partnerships. Testing and validation of new procedures in production settings (providing more than cost analyses) should be strengthened. Publication of studies should be promoted and old links between clinicians, diagnosticians and basic researchers should be re-established. Sets of ‘best practices’ should be published. Programs to support both basic and applied research through graduate fellowships, residencies, workshops and start-up funding for young research scientists should be strengthened. Sustained funding to train the next generation of research investigators should be addressed as a critical need.

Two retrospective cohorts of patients who had undergone a primary total hip replacement (THR) were studied in Japan and England. We analyzed information from hospital case notes and self-administered questionnaires. THR was highly effective in both countries, with significant improvements in morbidity and health status. There were, however, important differences in clinical management and outcome. Japanese patients were more likely to be treated under regional anesthesia by means of an anterior/anterolateral incision, to be transfused, to have a prosthesis implanted without cement, and to stay longer in the hospital. A higher rate of serious in-hospital complications occurred in England, mostly due to the high frequency of hypotension. The incidences of minor complications were consistent with known differences in risks between the two countries. The persistent postoperative perception of limping reported by the English patients was unexpected.

A new definition of intestinal failure is of reduced intestinal absorption so that macronutrient and/or water and electrolyte supplements are needed to maintain health or growth. Severe intestinal failure is when parenteral nutrition and/or fluid are needed and mild intestinal failure is when oral supplements or dietary modification suffice. Treatment aims to reduce the severity of intestinal failure. In the peri-operative period avoiding the administration of excessive amounts of intravenous saline (9 g NaCl/l) may prevent a prolonged ileus. Patients with intermittent bowel obstruction may be managed with a liquid or low-residue diet. Patients with a distal bowel entero-cutaneous fistula may be managed with an enteral feed absorbed by the proximal small bowel while no oral intake may be needed for a proximal bowel enterocutaneous fistula. Patients undergoing high-dose chemotherapy can usually tolerate jejunal feeding. Rotating antibiotic courses may reduce small bowel bacterial overgrowth in patients with chronic intestinal pseudo-obstruction. Restricting oral hypotonic fluids, sipping a glucose-saline solution (Na concentration of 90–120 mmol/l) and taking anti-diarrhoeal or anti-secretory drugs, reduces the high output from a jejunostomy. This treatment allows most patients with a jejunostomy and >1 m functioning jejunum remaining to manage without parenteral support. Patients with a short bowel and a colon should consume a diet high in polysaccharides, as these compounds are fermented in the colon, and low in oxalate, as 25% of the oxalate will develop as calcium oxalate renal stones. Growth factors normally produced by the colon (e.g. glucagon-like peptide-2) to induce structural jejunal adaptation have been given in high doses to patients with a jejunostomy and do marginally increase the daily energy absorption.