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https://www.readbyqxmd.com/read/28817301/patients-views-of-a-behavioral-intervention-including-financial-incentives
#1
Judy A Shea, Aderinola Adejare, Kevin G Volpp, Andrea B Troxel, Darra Finnerty, Karen Hoffer, Thomas Isaac, Meredith Rosenthal, Thomas D Sequist, David A Asch
OBJECTIVES: Clinical trials are increasingly testing the effectiveness of paying patients' financial incentives for achieving desired clinical outcomes. Some researchers and providers are concerned that patient financial incentives will harm the doctor-patient relationship. How patients feel about these approaches, and these trials, is largely unknown. This study examined patients' perceptions of a compound behavioral and financial incentive intervention used in a large multicenter trial to lower low-density lipoprotein cholesterol (LDL-C), including their perceptions of benefits and challenges and the study's effect on patients' relationship with their primary care physicians (PCPs)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28800796/difficult-patients-in-the-emergency-department-personality-disorders-and-beyond
#2
REVIEW
Nidal Moukaddam, Araceli Flores, Anu Matorin, Nicholas Hayden, Veronica Theresa Tucci
Physician-patient encounters in clinical settings, especially in the emergency department, can be of varying degrees of difficulty. Medically complicated, challenging cases can be paradoxically rewarding, whereas psychologically driven difficulty is frustrating and counterproductive for patient care. This article presents 3 different complementary perspectives on difficult patients: clinical presentations, manifestations of personality traits and disorders in clinical settings, and how physician feelings may affect care...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28779809/is-this-my-ankle-or-my-foot
#3
REVIEW
William Hodges Davis
Understanding of the complexities of the adult acquired pathologic flatfoot has undergone serious evolution in the past 30 years to an understanding of the subtleties of what causes the different presentations and drives successful treatment. As the treatment of ankle arthritis evolves from fusion to ankle replacement, the need for answers for the difficult patient with valgus degenerative ankle disease begs a look at what causes this form of flatfoot. This article poses the question, is there a subset of patients with "flatfoot" that has little to do with the foot and is all about the ankle?...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28775221/in-situ-medical-simulation-for-pre-implementation-testing-of-clinical-service-in-a-regional-hospital-in-hong-kong
#4
P P Chen, N Tk Tsui, A Sw Fung, A Hf Chiu, W Cw Wong, H T Leong, P Sf Lee, J Yw Lau
The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service...
August 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28745190/giving-equal-care-to-the-difficult-patient
#5
Mandy Day-Calder
One of our dogs, Ben, is a timid little thing. On a lead he can bark and growl, and to the untrained eye he must appear aggressive at times.
July 26, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28736122/treatment-of-tibial-nonunion-with-posterolateral-bone-grafting
#6
Michael J Foster, Robert V O'Toole, Theodore T Manson
OBJECTIVES: Posterolateral bone grafting to treat nonunions of the distal two-thirds of the tibia avoids the often traumatized and more tenuous anterior soft-tissue envelope. Few modern reports of its effectiveness are available. We assessed whether posterolateral bone grafting leads to high union and low complication rates. METHODS: We conducted a retrospective review at a Level I trauma center. Our study group was 59 patients with distal two-thirds tibial fractures treated with posterolateral bone grafting...
May 3, 2017: Injury
https://www.readbyqxmd.com/read/28734722/guidelines-for-the-understanding-and-management-of-pain-in-chronic-pancreatitis
#7
REVIEW
Asbjørn M Drewes, Stefan A W Bouwense, Claudia M Campbell, Güralp O Ceyhan, Myriam Delhaye, Ihsan Ekin Demir, Pramod K Garg, Harry van Goor, Christopher Halloran, Shuiji Isaji, John P Neoptolemos, Søren S Olesen, Tonya Palermo, Pankaj Jay Pasricha, Andrea Sheel, Tooru Shimosegawa, Eva Szigethy, David C Whitcomb, Dhiraj Yadav
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories...
July 13, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28699946/using-standardized-patients-to-assess-hospitalist-communication-skills
#8
Dennis Chang, Micah Mann, Terry Sommer, Robert Fallar, Alan Weinberg, Erica Friedman
Standardized patients (SPs) have been used to assess communication skills in undergraduate medical education, but no published studies describe the use of SPs in assessing practicing physicians on their communication skills. In this study, done with 23 hospitalists at a large urban academic hospital, 3 SP scenarios, daily rounding, discharge, and interacting with a difficult patient, were created. After each encounter, each hospitalist reviewed their videotape and received feedback from their SP based on a checklist that had 3 core domains: Listen, Courtesy and Respect, and Explain...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28689863/long-term-results-of-open-complex-abdominal-wall-hernia-repair-with-self-gripping-mesh-a-retrospective-cohort-study
#9
Leonard F Kroese, Lien H A van Eeghem, Joost Verhelst, Johannes Jeekel, Gert-Jan Kleinrensink, Johan F Lange
BACKGROUND: In case of complex ventral hernias, Rives-Stoppa and component separation technique are considered as favourable treatment techniques. However, mesh-related complications like recurrence, infection and chronic pain are still a common problem after mesh repair. Previous studies have reported promising results of the use of a self-gripping mesh (ProGrip™) in incisional hernia repair. This study aimed to evaluate the long term results of this mesh for complex ventral hernia treatment...
July 6, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28622670/adaptive-clutter-demodulation-for-non-contrast-ultrasound-perfusion-imaging
#10
Jaime Tierney, Crystal Coolbaugh, Theodore Towse, Brett Byram
Conventional Doppler ultrasound is useful for visualizing fast blood flow in large resolvable vessels. However, frame rate and tissue clutter caused by movement of the patient or sonographer make visualizing slow flow with ultrasound difficult. Patient and sonographer motion causes spectral broadening of the clutter signal, which limits ultrasound's sensitivity to velocities greater than 5-10mm/s for typical clinical imaging frequencies. To address this, we propose a clutter filtering technique that may increase the sensitivity of Doppler measurements to at least as low as 0...
June 13, 2017: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28597797/percutaneous-intervention-for-central-shunts-new-routes-new-strategies
#11
Bjorn Cools, Stephen C Brown, Derize E Boshoff, Benedicte Eyskens, Ruth Heying, Filip Rega, Bart Meyns, Marc Gewillig
Introduction In traditional locations, the standard Blalock-Taussig shunt presents numerous technical difficulties for percutaneous intervention. We changed our strategy to a central type shunt (Laks-type) with end-to-side pulmonary and side-to-side aortic anastomosis. The aim of this study was to determine whether this modified strategy would allow easier percutaneous manipulation in patients with small pulmonary arteries. Methods All children with a stretchable central vascular graft who required any form of percutaneous intervention were prospectively enrolled in the study...
April 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28577776/does-prior-cartilage-restoration-impact-outcomes-following-knee-arthroplasty
#12
REVIEW
Rachel M Frank, Craig J Della Valle, Darren R Plummer, Peter N Chalmers, Brian J Cole
This study compared patients who failed a cartilage restoration procedure and underwent ipsilateral knee arthroplasty with matched control subjects undergoing knee arthroplasty without prior cartilage restoration. Although patients with a failed cartilage procedure derived benefit from knee arthroplasty, their magnitude of improvement and final outcomes scores were lower than the matched control subjects. In this cohort, the cartilage patients also experienced little to no benefit from cartilage restoration, suggesting that unmeasured shared patient characteristics may play a role...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28523743/applying-lessons-from-social-psychology-to-transform-the-culture-of-error-disclosure
#13
Jason Han, Denise LaMarra, Neha Vapiwala
CONTEXT: The ability to carry out prompt and effective error disclosure has been described in the literature as an essential skill among physicians that can lead to improved patient satisfaction, staff well-being and hospital outcomes. However, few studies have addressed the social psychology principles that may influence physician behaviour. METHODS: The authors provide an overview of recent administrative measures designed to encourage physicians to disclose error, but note that deliberate practice, buttressed with lessons from social psychology, is needed to implement further productive behavioural changes...
May 18, 2017: Medical Education
https://www.readbyqxmd.com/read/28501246/advances-in-laparoscopic-colorectal-surgery
#14
REVIEW
James Michael Parker, Timothy F Feldmann, Kyle G Cologne
Laparoscopic colorectal surgery has now become widely adopted for the treatment of colorectal neoplasia, with steady increases in utilization over the past 15 years. Common minimally invasive techniques include multiport laparoscopy, single-incision laparoscopy, and hand-assisted laparoscopy, with the choice of technique depending on several patient and surgeon factors. Laparoscopic colorectal surgery involves a robust learning curve, and fellowship training often lays the foundation for a high-volume laparoscopic practice...
June 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28497219/robot-assisted-adrenalectomy-indications-and-drawbacks
#15
C Nomine-Criqui, A Germain, A Ayav, L Bresler, L Brunaud
Adrenal tumors can vary from a benign adrenocortical adenoma with no hormonal secretion to a secretory adrenocortical malignancy (adrenocortical carcinoma) or a hormone-secreting tumor of the adrenal medulla (pheochromocytoma). Currently, laparoscopic adrenalectomy is regarded as the preferred surgical approach for the management of most adrenal surgical disorders, although there are no prospective randomized trials comparing this technique with open adrenalectomy. However, widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers...
May 12, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28473795/self-rated-health-and-sick-leave-among-nurses-and-physicians-the-role-of-regret-and-coping-strategies-in-difficult-care-related-situations
#16
Stéphane Cullati, Boris Cheval, Ralph E Schmidt, Thomas Agoritsas, Pierre Chopard, Delphine S Courvoisier
Moral distress - such as feeling strong regret over difficult patient situations - is common among nurses and physicians. Regret intensity, as well as the coping strategies used to manage regrets, may also influence the health and sickness absence of healthcare professionals. The objective of this study was to determine if the experience of regret related to difficult care-related situations is associated with poor health and sick leave and if coping strategies mediate these associations. Two cross-sectional surveys were conducted in Switzerland (Geneva, 2011 and Zurich, 2014)...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28430573/roles-of-physicians-and-health-care-systems-in-difficult-clinical-encounters
#17
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
#18
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
#19
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
#20
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
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