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We describe the implementation of brief action planning in conjunction with evidence-based clinical practice guideline recommendations to improve self-efficacy in a patient with psychosocial barriers and persistent nonspecific low back pain.Ileocecal knitting should be considered as a differential diagnosis of small intestinal obstruction. Aggressive resuscitation and early surgery will be life-saving. One should anticipate finding extensive bowel gangrene which requires aggressive resection.Acrocyanosis and digital necrosis, which caused by microangiopathi