Research Cum Training: Assumptions, Balint's Method, and Future Directions.

Michael Balint conducted several multi-year training programs for general practitioners designed to teach lessons from a psychoanalytic perspective on the relationships doctors have with their patients and contribute to their healing skills. This group process evolved, and it was described along with an elaboration of significant researched observations of interferences in those relationships. There were several other similar multi-year experiential group endeavors conducted and/or inspired by Michael and Enid Balint which were designed to further investigate the subtleties in relationships between doctors and patients.

Process improvement for follow-up radiology report recommendations of lung nodules.

Unlabelled: In the modern healthcare system, there are still wide gaps of communication of imaging results to physician and patient stakeholders and tracking of whether follow-up has occurred. Patients are also unaware of the significance of findings in radiology reports. With the increase in use of cross-sectional imaging such as CT, patients are not only being diagnosed with primary urgent findings but also with incidental findings such as lung nodules; however, they are not being told of their imaging findings nor what actions to take to mitigate their risks.

Demystifying Balint culture and its impact: An autoethnographic analysis.

Balint groups are a structured group process designed for physicians and other helping professionals to provide feedback to each other concerning troublesome patient encounters. The process of Balint groups has survived and even thrived for more than a half century since their inception, suggesting their inherent value. However, measuring the impact in order to communicate the nature of that value has been elusive.

Rapid Response: To Scan or Not to Scan? The Utility of Noncontrast CT Head for Altered Mental Status.

Objectives: The aims of the study were the following: (1) to determine how often computed tomography (CT) scans of the head are obtained on rapid responses called for altered mental status (AMS), (2) to determine whether CT imaging of the head is required during all rapid responses called for AMS, (3) to determine which patients would benefit from CT scans of the head in this setting, (4) to note whether an adequate neurologic exam was documented, (5) to determine the cost of CT scans that did not change management, and (6) to examine the role of medications leading to AMS.

Methods: The study was a retrospective chart review at Abington Jefferson Hospital. Data collected included the age, sex, time of rapid response, clinical condition of the patient, whether an arterial blood gas and blood glucose were done, and whether a neurological exam was documented in the resident's rapid response team note.

Mapping the Balint groups to the Accreditation Council for Graduate Medical Education family medicine competencies.

Unlabelled: Introduction Balint group discussions provide learning opportunities for many of the competencies and milestones put forward by the Accreditation Council for Graduate Medical Education. The current literature is mixed concerning the effect of Balint groups on communication skills and professionalism. Aim To map the content of the Balint discussion to the competencies and milestones put forward by the Accreditation Council for Graduate Medical Education.

Filling the void: a low-cost, high-yield approach to addressing incidental findings in trauma patients.

Background: Incidental findings are prevalent in imaging but often go unreported to patients. Such unreported findings may present the potential for harm as well as medico-legal ramifications.

Methods: A chart review of trauma patients was undertaken over a year.

Developing Emotional Intelligence in the Clinical Learning Environment: A Case Study in Cultural Transformation.

Background: Burnout continues to erode the physician workforce, and there are few effective intervention studies to guide educators.

Objective: We explored residents' experience in a model environment emphasizing resident wellness, safety, and interpersonal skills.

Methods: As 1 of 14 participants in the national Preparing the Personal Physician for Practice (P) project, the family medicine residency at Lehigh Valley Health Network implemented a series of curricular changes designed to transform the culture of education.

The unique contribution of behavioral scientists to medical education: the top ten competencies.

Understandably, the focus of most physicians is primarily on the biomedical-What is this disease or injury? Behavioral scientists from various disciplines in medical education generally have a broader approach-Who is this person with these symptoms and what is their story? Since behavioral scientists are often alone among U. S. residency faculty, physicians may fail to recognize the value of their approach to medical resident training.

Teaching the value of continuity of care: a case conference on long-term healing relationships.

The Continuity Case Conference provides a model for teaching family medicine residents the value, importance, and impact of developing long-term doctor-patient relationships. A resident's presentation of challenging patient cases and the ensuing group interaction with resident peers, faculty, and medical staff are designed to offer residents alternate perspectives on complex, multiproblem cases while validating the often emotional process of patient care. This learning model is designed to demonstrate how a physician, in the context of the cumulative progression of contacts with a patient, can better manage myriad health issues, chronic and acute, and improve patient outcomes.

Intramyocardial dissecting hematoma: an unusual form of subacute cardiac rupture.

Intramyocardial dissecting hematoma following myocardial infarction is an unusual form of subacute cardiac rupture that tends to develop along naturally occurring dissection planes between the spiral muscles of the ventricle. The diagnosis has commonly been made at surgery, postmortem examination, or by echocardiography. Most are associated with acute transmural inferior infarction.

A multicenter, randomized, controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis.

Eight-four patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were randomized to receive 100 micrograms of octreotide intravenously immediately prior to ERCP, and 100 micrograms subcutaneously 45 min after the initial dose, or placebo. Amylase, lipase, and glucose were measured and clinical assessment was performed before, and 2 and 24 h after, ERCP. We define clinical pancreatitis as the combination of elevated amylase or lipase with abdominal pain and tenderness.

Ablation of abnormal energy expenditure by curative tumor resection.

Resting energy expenditure is abnormal in most patients with cancer and may contribute to cancer cachexia. These metabolic abnormalities may be a direct measure of tumor metabolism, or represent alterations in the size or activity of the body cell mass, or both. To unravel this pathogenesis, we prospectively studied 68 preoperative patients with cancer about to undergo curative resection by measuring resting energy expenditure before and after tumor resection.

Optimal microporous surface for endothelialization of metal heart valves in the blood stream.

Optimum surface porosity of a prosthetic heart valve was obtained with use of microspheres less than 40 microns in diameter. A thin and translucent neointima then forms on the valve surface, so thin that its nutrition is supplied by diffusion and thickening will not take place, thereby avoiding interference with the functioning disc. Larger microspheres tend to promote clotting and buildup of fibromyxoid soft tissue, which may cause such interference.

Modified porous metal-surfaced Björk-Shiley monostrut heart valve. Long-term study in goats without anticoagulation.

To diminish the risk of thrombosis on a mechanical heart valve without anticoagulation, specific areas of the valve ring should be polished, as thrombosis has not been found to start there. By limiting the porous-surfaced area to the groove and the adjacent part of the flange, the thin endothelialized covering of the carbonized suture ring will continue over the groove and top of the flange to the high-flow area. As the high-flow areas that are not completely covered with the neointima, i.

The porous metal-surfaced heart valve. Long-term study without long-term anticoagulation in mitral position in goats.

On review, all thromboembolic complications in mechanical heart valves start from a thrombus lining that covers the suture ring. The thrombus organizes to a fibrous white sheet over the suture ring, which then can protrude out over the polished surface of the valve ring flange. Pieces of the thrombus can be knocked off by the disc and cause emboli.