5555555 (X) Jun 24, 2017:

A refractory group is a group of patients that does not respond to treatment for various reasons. Age may be one of them. A refractory group is also a group of patients who have a refractory disease. This is a disease that is impossible or difficult to cure.

Management of a difficult patient has nothing to do with it.

Tetyana Rak Jun 24, 2017:

In medicine, refractory describes a disease or condition which does not respond to attempted forms of treatment. A cancer is said to be refractory when it does not respond to (or is resistant to) cancer treatment.
Здесь не описывают, что пациенты не отвечают на один вид лечения, поэтому им нужно выполнять МС. Они сложные в курации, с учетом их возраста и, может, наличия других факторов.
курация
(лат. curatio попечение, уход, лечение; син. ведение больного) в медицине совокупность действий врача по диагностике заболевания и лечению больного, а также по оформлению медицинской документации.
Поэтому, лучше manage.

Frank Szmulowicz, Ph. D. Jun 24, 2017:

Thank you, Kimberly. Yes, it does.

5555555 (X) Jun 24, 2017:

Hi Frank. "Difficult to follow up" means that the patient is unavailable when you are trying to contact him/her or make a follow up appointment. For example, they are not answering their phone or they are reluctant to set up a time for a meeting. The statement is about a disease that is difficult to cure, not a patient that is reluctant to communicate. Does it make sense?