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https://www.readbyqxmd.com/read/28430573/roles-of-physicians-and-health-care-systems-in-difficult-clinical-encounters
#1
Elizabeth S Goldsmith, Erin E Krebs
Physicians are, by definition, contributing partners in "difficult" patient-physician encounters. Although research on relevant physician qualities is limited, common themes mirror the more extensive literature on physician burnout. Focusing on primary care, we discuss physician-level factors in difficult encounters related to psychosocial attitudes and self-awareness, communication skills, and practice environments. Potential approaches to mitigating these factors include changes to medical training, such as structured peer case discussion groups and communication skills development, and changes to workplace environments, such as integrated mental health...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28427338/-working-is-out-of-the-question-a-qualitative-text-analysis-of-medical-certificates-of-disability
#2
Guri Aarseth, Bård Natvig, Eivind Engebretsen, Anne Kveim Lie
BACKGROUND: Medical certificates influence the distribution of economic benefits in welfare states; however, the qualitative aspects of these texts remain largely unexplored. The present study is the first systematic investigation done of these texts. Our aim was to investigate how GPs select and mediate information about their patients' health and how they support their conclusions about illness, functioning and fitness for work in medical certificates. METHODS: We performed a textual analysis of thirty-three medical certificates produced by general practitioners (GP) in Norway at the request of the Norwegian Labour and Welfare Administration (NAV)...
April 20, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28427073/surgical-management-and-techniques
#3
Marco Codenotti, Lorenzo Iuliano, Gisella Maestranzi
Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil...
2017: Developments in Ophthalmology
https://www.readbyqxmd.com/read/28425886/an-overview-of-teaching-communication-of-bad-news-in-medical-school-should-a-lecture-be-adequate-to-address-the-topic
#4
Filipe Coutinho, Anisha Ramessur
INTRODUCTION: Delivering bad news is very common in medical daily practice. Several studies have shown a lack of effective communication skills amongst medical students, particularly concerning how to deliver bad news. The SPIKES protocol allows communicating bad news in a 6-step method. The aim of this study is to investigate the perspective of students related to this subject. MATERIAL AND METHODS: A 45 minute lecture "Breaking Bad News" was given to 160 students in the fifth and sixth years of the Medicine course, using the SPIKES' protocol training...
December 30, 2016: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28424800/progressing-care-in-the-medical-high-dependency-unit-unit-configurations-staffing-standards-and-daily-routine
#5
Christopher John Wright, Russell Allan
There are currently various models of care for provision of high dependency care for acutely ill medical patients across the UK. Acute Physicians are integral to the development and progression of this both challenging and rewarding area of medicine. This article outlines current standards, best evidence, and our own experience of both setting up and developing a medical high dependency unit (MHDU).
2017: Acute Medicine
https://www.readbyqxmd.com/read/28423763/learning-healthcare-system-for-the-prescription-of-genetic-testing-in-the-gynecological-cancer-risk
#6
Cristina Suárez-Mejías, Alicia Martínez-García, María Ángeles Martínez-Maestre, José Manuel Silvan-Alfaro, Jesús Moreno Conde, Carlos Luis Parra-Calderón
Clinical evidence demonstrates that BRCA 1 and BRCA2 mutations can develop a gynecological cancer but genetic testing has a high cost to the healthcare system. Besides, several studies in the literature indicate that performing these genetic tests to the population is not cost-efficient. Currently, our physicians do not have a system to provide them the support for prescribing genetic tests. A Decision Support System for prescribing these genetic tests in BRCA1 and BRCA2 and preventing gynecological cancer risks has been designed, developed and deployed in the Virgen del Rocío University Hospital (VRUH)...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28419657/a-new-approach-to-clinical-research-integrating-clinical-care-quality-reporting-and-research-using-a-wound-care-network-based-learning-healthcare-system
#7
Thomas E Serena, Caroline E Fife, Kristen A Eckert, Raphael A Yaakov, Marissa J Carter
The disparity between ideal evidence from randomized controlled trials and real-world evidence in medical research has prompted the United States Food and Drug Administration to consider the use of real-world data to better understand safety and effectiveness of new devices for a broader patient population and to prioritize real-world data in regulatory decision making. As the healthcare system transitions from volume- to value-based care, there is a growing need to harness the power of real-world data to change the paradigm for wound care clinical research and enable more generalizable clinical trials...
April 17, 2017: Wound Repair and Regeneration
https://www.readbyqxmd.com/read/28419017/the-evaluation-of-trauma-care-the-comparison-of-2-high-level-pediatric-emergency-departments-in-the-united-states-and-turkey
#8
Alkan Bal, Michael Cooper, Amanda Lee, Murat Anil, Halim Hennes
OBJECTIVE: The purpose of the study is to compare the outcomes of pediatric trauma patients with motor vehicle crashes (MVCs) and motor vehicle versus pedestrian crashes (MPCs) at a level 1 pediatric trauma center in the United States and a pediatric trauma center in Turkey. METHODS: The medical records of all pediatric MVC and MPC subjects presenting to the emergency departments (EDs) of a level 3 hospital in Turkey (Izmir Tepecik Training and Research Hospital [ITTRH]) and a level 1 pediatric trauma center in the United States (Children's Medical Center Dallas [CMCD]) over a 1-year period were reviewed...
April 18, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28418719/the-incremental-validity-of-self-report-and-performance-based-methods-for-assessing-hostility-to-predict-cardiovascular-disease-in-physicians
#9
Gregory J Meyer, Nicholas J Katko, Joni L Mihura, Michael J Klag, Lucy A Meoni
We evaluated the utility of an integrative, multimethod approach for assessing hostility-related constructs to predict premature cardiovascular disease (CVD) and premature coronary heart disease (CHD) using participants from the Johns Hopkins Precursors Study, which was designed to identify risk factors for heart disease. Participants were assessed at baseline while in medical school from 1946 to 1962 (M age = 24.6) and have been followed annually since then. Baseline assessment included individually administered Rorschach protocols (N = 416) scored for aggressive imagery (i...
April 18, 2017: Journal of Personality Assessment
https://www.readbyqxmd.com/read/28418558/lectures-on-inhumanity-teaching-medical-ethics-in-german-medical-schools-under-nazism
#10
Florian Bruns, Tessa Chelouche
Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28418455/the-development-and-performance-of-after-hours-primary-care-in-the-netherlands-a-narrative-review
#11
Marleen Smits, Martijn Rutten, Ellen Keizer, Michel Wensing, Gert Westert, Paul Giesen
In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care physician (PCP) cooperatives. This article provides an overview of the organization, performance, and development of PCP cooperatives in the Netherlands. The Dutch after-hours primary care system might offer opportunities for other countries facing problems with after-hours care and inappropriate emergency department visits...
April 18, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28417310/telemedicine-and-palliative-care-an-increasing-role-in-supportive-oncology
#12
REVIEW
Brooke Worster, Kristine Swartz
With the emergence of telemedicine as a routine form of care in various venues, the opportunities to use technology to care for the most vulnerable, most ill cancer patients are extremely appealing. Increasingly, evidence supports early integration of palliative care with standard oncologic care, supported by recent NCCN guidelines to increase and improve access to palliative care. This review looks at the use of telemedicine to expand access to palliative care as well as provide better care for patients and families where travel is difficult, if not impossible...
June 2017: Current Oncology Reports
https://www.readbyqxmd.com/read/28417080/applying-a-systems-approach-to-thyroid-physiology-looking-at-the-whole-with-a-mitochondrial-perspective-instead-of-judging-single-tsh-values-or-why-we-should-know-more-about-mitochondria-to-understand-metabolism
#13
REVIEW
Roy Moncayo, Helga Moncayo
Classical thinking in endocrine physiology squeezes our diagnostic handling into a simple negative feedback mechanism with a controller and a controlled variable. In the case of the thyroid this is reduced to TSH and fT3 and fT4, respectively. The setting of this tight notion has no free space for any additions. In this paper we want to challenge this model of limited application by proposing a construct based on a systems approach departing from two basic considerations. In first place since the majority of cases of thyroid disease develop and appear during life it has to be considered as an acquired condition...
June 2017: BBA Clinical
https://www.readbyqxmd.com/read/28414406/residency-training-in-family-medicine-a-history-of-innovation-and-program-support
#14
Peter J Carek, Tanya Anim, Colleen Conry, Sam Cullison, Stan Kozakowski, Dan Ostergaard, Stacy Potts, Perry A Pugno
Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine...
April 2017: Family Medicine
https://www.readbyqxmd.com/read/28413928/the-oncology-specialist-s-role-in-polst-form-completion
#15
Austin J Lammers, Dana M Zive, Susan W Tolle, Erik K Fromme
INTRODUCTION: Patients with cancer and oncology professional societies believe that advance care planning is important, but we know little of who actually has this conversation. Physician Orders for Life-Sustaining Treatment (POLST) forms can help to document these important conversations to ensure patients receive the level of treatment they want. We therefore sought to determine the specialty of those signing POLST forms for patients who died of cancer to better understand who is having this discussion with patients...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28412708/validity-and-reliability-of-patient-reported-outcomes-measurement-information-system-computerized-adaptive-tests-in-systemic-lupus-erythematosus
#16
Shanthini Kasturi, Jackie Szymonifka, Jayme C Burket, Jessica R Berman, Kyriakos A Kirou, Alana B Levine, Lisa R Sammaritano, Lisa A Mandl
OBJECTIVE: The aims of this study were to assess the construct validity and the test-retest reliability of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CAT) in patients with systemic lupus erythematosus (SLE). METHODS: Adults with SLE completed the Medical Outcomes Study Short Form-36, LupusQoL-US version ("legacy instruments"), and 14 selected PROMIS CAT. Using Spearman correlations, PROMIS CAT were compared with similar domains measured with legacy instruments...
April 15, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28411933/wilderness-emergency-medical-services-systems
#17
REVIEW
Michael G Millin, Seth C Hawkins
Wilderness emergency medical services (WEMS) are designed to provide high quality health care in wilderness environments. A WEMS program should have oversight by a qualified physician responsible for protocol development, education, and quality improvement. The director is also ideally fully trained as a member of that wilderness rescue program, supporting the team with real-time patient care. WEMS providers function with scopes of practice approved by the local medical director and regulatory authority. With a focus on providing quality patient care, it is time for the evolution of WEMS as an integrated element of a local emergency response system...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28411013/physician-reported-factors-that-encourage-collaboration-with-community-pharmacists
#18
Nicole C Pezzino, Macary Weck Marciniak, Megan G Smith, Stefanie P Ferreri
OBJECTIVE: To determine factors that encourage physicians to establish collaborative practice agreements with community pharmacists. METHODS: A 20-item cross-sectional survey was mailed to a random sample of 1000 family medicine physicians practicing in North Carolina. Two weeks after the initial mailing, a reminder was sent to physicians. Physicians were entered into a drawing to receive a gift card as an incentive for survey completion. The questionnaire collected demographic information, factors important to physicians for collaboration with a community pharmacist, and physician perceptions of pharmacist qualifications...
April 12, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28410848/improving-access-to-image-guided-procedures-at-an-integrated-rural-critical-access-hospital-ultrasound-guided-thyroid-biopsy-program
#19
Thang Q Le, Yadiel Sánchez, Alexander S Misono, Sanjay Saini, Anand M Prabhakar
PURPOSE: Critical access hospitals face difficulty providing all services locally and may need to refer patients off-site for additional care. Providing on-site minimally invasive biopsies, may obviate visits to tertiary or quaternary care centers. This study aims to assess feasibility and outcomes of an ultrasound-guided thyroid biopsy program in a critical access hospital. METHODS: In this HIPAA compliant, IRB approved study, the Interventional Radiology (IR) database of a 19-bed, island, rural, critical access hospital without onsite pathology services affiliated with our quaternary care institution was retrospectively reviewed to identify all thyroid biopsies that were performed on site since inception of the service in April 2014 through August 2016...
February 16, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/28409480/genetic-testing-for-opioid-pain-management-a-primer
#20
Deepti Agarwal, Mercy A Udoji, Andrea Trescot
Patients see their primary care physicians (PCPs) for a variety of medical conditions, chronic pain being one of the most common. An increased use of prescription medications (especially opioids) has led to an increase in adverse drug reactions and has heightened our awareness of the variability in response to medications. Opioids and other pain adjuvants are widely used, and drug-drug interactions involving these analgesics can be problematic and potentially lethal. Pharmacogenetics has improved our understanding of drug efficacy and response, opened doors to individual tailoring of medical management, and created a series of ethical and economic considerations...
April 13, 2017: Pain and Therapy
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