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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/28430572/lessons-about-so-called-difficult-patients-from-the-uk-controversy-over-patient-access-to-electronic-health-records
#2
Federica Lucivero
Increasing numbers of patients have direct access to their electronic health records (EHRs). Proponents of direct access argue that it empowers patients by making them more informed and offering them more control over their health and care. According to some proponents of patients' access to EHRs, clinicians' concerns about potential negative implications are grounded in a form of paternalism that protects clinicians' authority. This paper draws upon narratives from patients in the United Kingdom (UK) who have access to their EHRs and suggests strategies for moving beyond these controversies between proponents and critics of the system...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28430570/repairing-difficult-patient-clinician-relationships
#3
Denise M Dudzinski, Carrol Alvarez
Using a case example, we offer guidance for improving "difficult" clinician-patient relationships. These relationships may be repaired by acknowledging a clinician's part in conflict, empathizing with patients, identifying a patient's skill deficits, and employing communication and engagement techniques used by mental health professionals. Clinicians will inevitably take on more of the work of repairing damaged relationships, but doing so improves the odds of these patients receiving the help they need.
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28430569/courage-and-compassion-virtues-in-caring-for-so-called-difficult-patients
#4
Michael Hawking, Farr A Curlin, John D Yoon
What, if anything, can medical ethics offer to assist in the care of the "difficult" patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the "difficult" patient as an example of a "moral stress test" that especially challenges the physician's character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of "difficult" patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28430565/do-physicians-have-an-ethical-duty-to-repair-relationships-with-so-called-difficult-patients
#5
Micah Johnson
This essay argues that physicians hold primary ethical responsibility for repairing damaged patient-physician relationships. The first section establishes that the patient-physician relationship has an important influence on patient health and argues that physicians' duty to treat should be understood as including a responsibility to repair broken relationships, regardless of which party was "responsible" for the initial tension. The second section argues that the person with more power to repair the relationship also has more responsibility to do so and considers the moral psychology of pain as foundational to conceiving the patient in this case as especially vulnerable and disempowered...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28421865/it-s-not-all-about-moral-reasoning-understanding-the-content-of-moral-case-deliberation
#6
Mia Svantesson, Marit Silén, Inger James
BACKGROUND: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28409101/microdrilling-surgery-augmented-with-intra-articular-bone-marrow-aspirate-concentrate-platelet-rich-plasma-and-hyaluronic-acid-a-technique-for-cartilage-repair-in-the-knee
#7
Joseph E Broyles, M Adaire O'Brien, M Patrick Stagg
The ideal treatment of large full-thickness chondral lesions in the knee, especially "kissing lesions" and osteoarthritis, has not been determined. Microdrilling surgery augmented with injections of peripheral blood stem cells and hyaluronic acid has been used to treat patients with a wide range of articular cartilage disease including patients with bipolar lesions and joint space narrowing. Excellent results in this difficult patient population have been reported, and second-look biopsy has shown repair tissue very similar to native hyaline cartilage...
February 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28374626/cochlear-implantation-in-inner-ear-malformations-systematic-review-of-speech-perception-outcomes-and-intraoperative-findings
#8
Zachary Farhood, Shaun A Nguyen, Stephen C Miller, Meredith A Holcomb, Ted A Meyer, And Habib G Rizk
Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used...
March 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28369771/intervention-radiology-for-venous-thrombosis-early-thrombus-removal-using-invasive-methods
#9
REVIEW
Ana I Casanegra, Robert D McBane, Haraldur Bjarnason
The post thrombotic syndrome is one of the most dreaded complications of proximal deep vein thrombosis. This syndrome leads to pain and suffering with leg swelling, recalcitrant ulceration and venous claudication which greatly impairs mobility and quality of life. The prevalence can be high in patients with iliofemoral venous involvement particularly in the setting of a proximal venous stenosis, such as occurs in May Thurner syndrome. Anticoagulation alone does not reduce the likelihood of this outcome. Compression therapy may be effective but garment discomfort limits its implementation...
April 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/28303525/failed-epilepsy-surgery-is-this-the-end
#10
REVIEW
Riëm El Tahry, Irene Zhong Wang
Resective epilepsy surgery can lead to sustained seizure control in 70-80% of patients evaluated for epilepsy surgery, indicating that up to 30% of patients still have recurrent seizures after surgery. Definitions of failed epilepsy surgery vary amongst studies. This review focuses on seizure outcome predictors after reoperation, possible mechanisms of failure and best management for this difficult patient population.
March 16, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/28302612/difficult-lumbar-puncture-pitfalls-and-tips-from-the-trenches
#11
REVIEW
P A Hudgins, A J Fountain, P R Chapman, L M Shah
Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat...
March 16, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28283833/managing-difficult-patients-roles-of-psychologists-in-the-age-of-interdisciplinary-care
#12
William N Robiner, Megan L Petrik
Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system...
March 10, 2017: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/28279404/strategies-for-hemodialysis-access-a-vascular-surgeon-s-perspective
#13
Larry A Scher, Saadat Shariff
Problems related to hemodialysis access are a significant cause of morbidity and mortality in patients with end-stage renal disease. Physicians of all specialties who are involved in the placement and maintenance of vascular access for hemodialysis must have a long-term strategy for sequential placement of autogenous fistulas, transpositions, and prosthetic grafts to preserve access sites and to avoid long-term use of tunneled dialysis catheters. The Fistula First and KDOQI initiatives have provided strategies and algorithms for access placement in patients with chronic kidney disease...
March 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28276847/individual-interpersonal-and-organisational-factors-of-healthcare-conflict-a-scoping-review
#14
Sara Kim, Naike Bochatay, Annemarie Relyea-Chew, Elizabeth Buttrick, Chris Amdahl, Laura Kim, Elise Frans, Matthew Mossanen, Azhar Khandekar, Ryan Fehr, Young-Mee Lee
Unresolved conflicts among healthcare professionals can lead to difficult patient care consequences. This scoping review examines the current healthcare literature that reported sources and consequences of conflict associated with individual, interpersonal, and organisational factors. We identified 99 articles published between 2001 and 2015 from PubMed, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medical Database. Most reviewed studies relied on healthcare professionals' perceptions and beliefs associated with conflict sources and consequences, with few studies reporting behavioural or organisational change outcomes...
May 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28272004/surgical-outcomes-post-neoadjuvant-chemotherapy-in-stage-iv-cancers-of-oral-cavity
#15
(no author information available yet)
AIM: To know the effect of neoadjuvant chemotherapy on surgical outcomes (R1 resections, post-operative complications, recurrence and follow up) in Stage IV borderline operable cancers of oral cavity. MATERIALS AND METHODS: Patients in group A (n=45) were those who were referred for neoadjuvant chemotherapy (NACT) with an intention to operate at a later date. These were compared with 45 patients of group B who were operated upfront. All 90 patients have stage IV squamous cell carcinoma of oral cavity...
January 2017: Gulf Journal of Oncology
https://www.readbyqxmd.com/read/28185307/professional-interpersonal-dynamics-and-burnout-in-european-transplant-surgeons
#16
Michelle T Jesse, Marwan Abouljoud, Anne Eshelman, Chantal De Reyck, Jan Lerut
BACKGROUND: Burnout within the health professions has become an increasingly important topic. Evidence suggests there are differences in burnout across different countries. Research has yet to examine burnout in transplant surgeons throughout Europe. METHODS: A cross-sectional survey of transplant surgeons across Europe. Survey included sociodemographics, professional characteristics, frequency and discomfort with difficult patient interactions (PI), decisional autonomy, psychological job demands (PJD), support (coworker, supervisor, and hospital administration), and burnout including emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)...
April 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28164254/utility-of-18f-sodium-fluoride-pet-ct-imaging-in-the-evaluation-of-postoperative-pain-following-surgical-spine-fusion
#17
D Pouldar, S Bakshian, R Matthews, V Rao, M Manzano, S Dardashti
STUDY DESIGN: A retrospective case review of patients who underwent 18F sodium fluoride PET/CT imaging of the spine with postoperative pain following vertebral fusion. OBJECTIVE: To determine the benefit of 18F sodium fluoride PET/CT imaging in the diagnosis of persistent pain in the postoperative spine. The diagnosis of pain generators in the postoperative spine has proven to be a diagnostic challenge. The conventional radiologic evaluation of persistent pain after spine surgery with the use of plain radiographs, MRI, and CT can often fall short of diagnosis in the complex patient...
February 6, 2017: Musculoskeletal Surgery
https://www.readbyqxmd.com/read/28150406/preoperative-assessment-of-factors-associated-with-difficulty-in-performing-total-laparoscopic-hysterectomy
#18
Ako Saito, Tetsuya Hirata, Kaori Koga, Masashi Takamura, Shinya Fukuda, Kazuaki Neriishi, Gia Pastorfide, Miyuki Harada, Yasushi Hirota, Osamu Wada-Hiraike, Tomoyuki Fujii, Yutaka Osuga
AIM: Our objective was to determine the preoperative factors associated with difficulty in total laparoscopic hysterectomy (TLH). METHODS: This retrospective clinical study included 157 patients who underwent TLH for leiomyoma or adenomyosis between 2009 and 2013. All patients underwent magnetic resonance imaging (MRI) before surgery. We categorized patients as 'difficult' if the operation time was > 243 min, if total blood loss was > 500 mL, or if conversion to laparotomy was necessary...
February 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/27994840/intraspinal-lumbar-juxtaarticular-cyst-treatment-through-ct-guided-percutaneus-induced-rupture-results-in-a-favorable-patient-outcome
#19
Adisa Kursumovic, Richard Bostelmann, Maria Gollwitzer, Stefan Rath, Hans Jakob Steiger, Athanasios K Petridis
Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016...
October 24, 2016: Clinics and Practice
https://www.readbyqxmd.com/read/27956233/graft-augmentation-versus-bridging-for-large-to-massive-rotator-cuff-tears-a-systematic-review
#20
REVIEW
Yohei Ono, Diego Alejandro Dávalos Herrera, Jarret M Woodmass, Richard S Boorman, Gail M Thornton, Ian K Y Lo
PURPOSE: To systematically review the literature on the healing rates and clinical outcomes of the 2 different graft indications (i.e., augmentation vs bridging) during rotator cuff repair. METHODS: A systematic literature review was performed for clinical studies of rotator cuff repair using grafts for large to massive tears. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcomes included visual analog scale for pain, American Shoulder and Elbow Surgeons score, and University of California at Los Angeles score, and forward elevation...
March 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
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