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Medical educators increasingly have embraced literary and narrative means of pedagogy, such as the use of learning portfolios, reading works of literature, reflective writing, and creative writing, to teach interpersonal and reflective aspects of medicine. Outcomes studies of such pedagogies support the hypotheses that narrative training can deepen the clinician's attention to a patient and can help to establish the clinician's affiliation with patients, colleagues, teachers, and the self. In this article, the authors propose that creative writing in particular is useful in the making of the physician...

To reduce inequities in child health, we need to reduce the gap between what we know and what we do. We must challenge our practices and traditions, develop new solutions and have the strength and courage to change how we practice. Based on my experience that the best way to help children is to help their parents, and the best way to reach parents is through their children, I propose a new frame of a 2-generation approach that focuses not only on the child but also on the parents and their relationship to guide our innovation and target improvements...

BACKGROUND: Immune cytopenias are a recognized life-threatening complication following pediatric solid organ transplants (SOT), but treatment responses and overall outcome are not well described. The aim of this study was to evaluate the demographic characteristics, response to treatments, and outcomes of a cohort of patients who developed immune cytopenias following SOT. PROCEDURE: In this single center retrospective review, patients with immune cytopenias after SOT were identified by electronic medical record (EMR) search and transplant databases from 1995-2012...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The American Academy of Pediatrics recommends that all newborns receive a single dose of intramuscular vitamin K to prevent vitamin K deficiency bleeding. How should the clinician respond when parents decline vitamin K? Although vitamin K deficiency bleeding can have devastating sequelae, they are uncommon; therefore, parents are generally allowed to decline vitamin K after counseling is provided. When parents ask for a vitamin K preparation of unproven effectiveness, should the clinician honor that request? To address these questions, we present a case of a healthy newborn whose parents declined intramuscular vitamin K and requested an oral preparation...

OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. METHODS: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50...

No abstract text is available yet for this article.

BACKGROUND: Framing is known to influence decision making. OBJECTIVE: The study objective was to describe language used by physicians when discussing treatment options with a critically and terminally ill elder. METHODS: High-fidelity simulation was used, involving an elder with end-stage cancer and life-threatening hypoxia, followed by a debriefing interview. Subjects were hospitalist, emergency medicine, and critical care physicians from three academic medical centers...

The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889-1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re-centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine...