Case-Based Specialty Training for Medical Students to Elicit Social Determinants of Health.

Introduction: Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively equip future physicians to serve their patients. We created this workshop on health equity with a focus on SDoH to help students more effectively communicate with diverse populations.

Methods: Third-year medical students and faculty were provided with class guides, learning objectives, role-play vignettes containing clerkship-specific history and physical exams, schedules, and discussion questions during a 2-hour session centered on SDoH.

Supine Pharyngeal Width Is Associated With Complete Concentric Palatal Collapse During Drug-Induced Sleep Endoscopy and Hypoglossal Nerve Stimulator Outcomes.

Objective: Hypoglossal nerve stimulation (HNS) implantation in the US requires preoperative drug-induced sleep endoscopy (DISE) screening for complete concentric palatal collapse (CCC) to establish treatment candidacy. We hypothesized that supine pharyngeal width (SPW) in awake patients is associated with CCC and HNS therapy outcomes.

Methods: Adults with moderate to severe obstructive sleep apnea underwent awake measurement of SPW followed by DISE screening for CCC.

Teaching Second-Year Medical Students How to Counsel Pediatric Patients With Unhealthy Body Mass Index.

Obesity affects the health and well-being of children globally. Despite recommendations to routinely screen children for obesity starting at age 6 years, physicians do not consistently address weight or provide effective weight-management counseling. We developed an interactive session for second-year medical students with foundational knowledge and practical communication skills around partnership and discussion of pediatric healthy weight management.

A Noninferiority Analysis of 3- vs 2-Incision Techniques for Hypoglossal Nerve Stimulator Implantation.

Objective: The only hypoglossal nerve stimulation (HNS) device available for US clinical use is implanted through 3 incisions. A recently proposed 2-incision modification moved the respiratory sensing lead from the fifth to the second intercostal space to eliminate the third lower chest incision. This study compared perioperative data and therapeutic outcomes between the techniques.

Hope is a creative process.

Clinicians often limit hope to life extension. Hope, rather, is a much broader, creative process. This reflective piece underscores this through personal experience I had with my wife and her mom and dad, all of who have passed away.

Case Report: Lateral Chest Placement of IPG for Hypoglossal Nerve Stimulator Implantation.

Hypoglossal nerve stimulation for the treatment of obstructive sleep apnea is an increasingly common procedure. The hypoglossal nerve is stimulated by an implanted pulse generator that is placed in a subcutaneous pocket in the upper chest over the pectoralis muscle. A pressure sensor is placed through a separate incision between two ribs to detect respiratory effort.

Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface.

Background: In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use.

Method: The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties.

How do-not-resuscitate orders are utilized in cancer patients: timing relative to death and communication-training implications.

Objectives: End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs).

Determinants of trust in the patient-oncologist relationship.

Objective: The relationship between the patient and physician is at the heart of good medical care, and trust is an essential component of this relationship. To enable the oncologist to better form a trusting relationship with the patient, this article describes four factors that influence patient trust.

Methods: Thematic literature review and a clinical vignette.

Physician cultural sensitivity in African American advance care planning: a pilot study.

Background: Physician cultural sensitivity is particularly important for end-of-life care. This study correlates physicians' own racial background, clinical experience, and cultural sensitivity training with their attitudes, perceptions, and knowledge of advance care planning issues for African American patients.

Methods: A cross-sectional self-report questionnaire was distributed to 236 physicians at three major teaching hospitals.

Double-disease management or one care manager for two chronic conditions: pilot feasibility study of nurse telephonic disease management for depression and congestive heart failure.

This study assessed the feasibility of a telephonic nurse double-disease management program (DDMP) for patients with depression and congestive heart failure. Thirty-five patients with depression and congestive heart failure were entered into a novel DDMP modeled after Wagner's chronic illness care model and implemented as part of a 13-month Breakthrough Series Collaborative administered by the Institute of Healthcare Improvement. Twenty-four patients remained in the program long enough to complete at least one follow-up assessment (ie, 6 weeks or longer).

Avoiding iatrogenic harm to patient and family while discussing goals of care near the end of life.

Background: Treatment of suffering is a core mission of medicine. Communication about treatment planning with the patient and family, called the goals of care discussion, offers the opportunity to provide effective relief. Such communication is particularly important near the end of life, because many medical decisions are determined then by emotional considerations and personal values.

Manualized communication interventions to enhance palliative care research and training: rigorous, testable approaches.

Palliative care practice requires excellent communication between the patient, family, and clinical team. Experts in the field have proposed a variety of communication interventions that can be used in the palliative care setting. However, these interventions are at a high level of generality: the specifics of each intervention are not well codified; the individual steps in each intervention are not easily reproducible and thus not comparable between practitioners; the methods to measure adherence to these communication protocols have not been established; and there is little detail on how to adapt these general interventions to the individual patient and family.

ACare: a communication training program for shared decision making along a life-limiting illness.

Objective: This article describes an innovative 8-h training program that provides clinicians with the competencies necessary to conduct efficient, effective, and compassionate advance care planning discussions throughout the trajectory of life-limiting illnesses.

Method: The Advance Care Training Program (ACare) includes 6 h of group workshops and 2 h of one-on-one faculty-learner interaction. In this article, we describe the (1) objectives of ACare; (2) structure, training procedures, and educational rationale of ACare training; and (3) educational outcome studies in progress.

Three principles to improve clinician communication for advance care planning: overcoming emotional, cognitive, and skill barriers.

Background: Medical care of patients with life limiting illness remains fraught with serious deficiencies, including inadequate advance care planning, delayed hospice referral, and continued delivery of aggressive treatment that is overtly counter to patients' preferences.

Objective: This paper describes clinicians' emotional, cognitive, and skill barriers to shared decision-making with seriously ill patients and their loved ones.

Design: Thematic literature review.

Two-year evaluation of the logic model for developing a psycho-oncology service.

Objective: The objective of this study was to test whether reorganizing a psycho-oncology service in a planned and focused manner would maximize the achievement of coherent developmental goals.

Methods: The logic model, a strategic program development tool, was used in the context of a public psychiatry fellowship to analyze and plan the organizational objectives of a psycho-oncology service. To assess the efficacy of the logic model, a two-year prospective evaluation of the model's outcome measures was performed.

Intranasal verrucous carcinoma: relationship to inverting papilloma and human papillomavirus.

Objectives: To establish the incidence, appearance, behavior, and appropriate treatment of intranasal verrucous carcinoma and determine its relationship to inverting papilloma and human papillomavirus (HPV).

Study Design: Retrospective review of all cases of intranasal verrucous carcinoma seen at the Mayo Clinic from 1960 through May 1996.

Methods: Retrospective chart review and data collection for age, sex, smoking history, location, association with inverting papilloma, treatment, recurrence, and follow-up.

Relationship of human papillomavirus to Schneiderian papillomas.

Objectives/hypothesis: To classify a large group of Schneiderian papillomas (SPs) into their histologic subtypes and to determine the incidence of human papillomavirus (HPV) in each subtype.

Study Design: Pathologic review and polymerase chain reaction-based (PCR-based) examination of archived tissue.

Methods: Slides of 114 tumors diagnosed as Schneiderian, inverting, fungiform, or cylindric cell papillomas, or any associated carcinomas, were examined by a head and neck pathologist.