Diagnosis of Vascular Anomalies in Patients with Skin of Color.

Vascular anomalies can be broadly classified as vascular tumors or vascular malformations, depending on the degree of endothelial involvement. These lesions can be subtle and challenging to diagnose in individuals with darker skin tones, which can lead to a delay in treatment. Improving diagnostic accuracy of these lesions may prevent progression and potential adverse outcomes when left untreated.

When and How Should Clinicians View Discharge Planning as Part of a Patient's Care Continuum?

Inpatient admission of unhoused patients from an emergency department is becoming more frequent. Clinicians have ethical obligations to engage early in thorough discharge planning for these vulnerable patients, as discharge to the street or even to a shelter can produce poor health outcomes. This commentary on a case considers factors that influence safe discharge planning and execution, including linkage to follow-up, patient engagement, and multidisciplinary teamwork.

Review of Cutaneous Repairs on the Hand and Fingers Following Dermatologic Surgery.

Removal of cutaneous malignancies on the hand and fingers can result in challenging surgical defects to close. The dermatologic surgeon must not only be highly skilled, but also be knowledgeable regarding the complex anatomy of this area to perform reconstruction that provides optimal functional and cosmetic results. This review highlights key anatomic factors that must be considered when operating in this region.

Should Robot-Assisted Surgery Tolerate or Even Accommodate Less Surgical Dexterity?

Since their adoption during the 1990s, minimally invasive surgical techniques have demonstrated postoperative surgical recovery benefits for patients. As robotic surgery platforms continue to be developed and utilized in surgical specialty areas, dexterity and visual field limitations of laparoscopy are coming under close clinical and ethical scrutiny. This article compares robotic and laparoscopic modalities, with special attention to dexterity, surgeon performance, ergonomics, and patient outcomes.

Preoperative Care Assessment of Need Scores Are Associated With Postoperative Mortality and Length of Stay in Veterans Undergoing Knee Replacement.

Background: Care Assessment of Need (CAN) scores predicting 90-day mortality and hospitalization are automatically computed each week for patients receiving care at Veterans Health Administration facilities. While currently used only by primary care teams for care coordination, we explored their value as a perioperative risk stratification tool before major elective surgery.

Methods: We collected relevant demographic and perioperative data along with perioperative CAN scores for veterans who underwent total knee replacement between July 2014 and December 2015.

Keloids: A Review of Etiology, Prevention, and Treatment.

Keloids are abnormal scars that cause significant emotional and physical distress in patients when inadequately treated. Keloid formation is theorized to occur as a result of an imbalance between an increased synthesis of collagen and extracellular matrix and decreased degradation of these products. Inflammatory mediators- namely, transforming growth factor beta-have been proposed to influence the dysregulation of collagen remodeling in the scar healing process.

"Disbelief and Sadness": First-Year Health Profession Students' Perspectives on Medical Errors.

Objectives: The aims of the study were to examine the reactions of first-year health profession students to medical errors and determine whether differences exist between disciplines.

Methods: After viewing the Team STEPPS Program's Susan Sheridan video that describes two separate medical errors, students from anesthesia assistant, medical imaging, medicine, nursing, physical therapy, and physician assistant programs provided unstructured open responses reflecting on initial impressions of medical errors depicted in the film. Student responses were assessed via inductive coding techniques and thematic analysis and stratified by discipline.

Using Stroke Order Sets to Improve Compliance With Quality Measures for Ischemic Stroke Admissions.

Creation of electronic health record order sets may improve adherence to The Joint Commission National Quality Measures for care of veterans with ischemic stroke.

Strategies for Responding to Undocumented Immigrants With Kidney Disease.

It is a tough road for undocumented immigrants with kidney disease. There are many barriers that these patients must overcome, which prevents them from receiving proper treatments to prevent or slow the progression of their kidney disease. Those who are dialysis dependent also face an uphill battle, as some states limit access to regular dialysis.

Are You SURE You Want to Send That? A Model for Email Professionalism in Medical Education.

Email is an essential method of communication within academic medical environments and elsewhere. There is a growing body of literature that focuses on provider-to-patient communication in addition to studies examining the intersection of social networking and professionalism. Relatively little research exists, however, regarding the components of professional email interactions or "best practices" for electronic correspondence among colleagues, faculty, and trainees.

Efficiently finding and using evidence to guide clinical practice and improve care.

Using evidence to guide patient care improves patient outcomes. However, the volume of clinical and scientific literature and demands on provider time make staying current challenging. Primary literature searching or using public search engines to answer clinical questions often results in low-quality or incorrect answers, potentially yielding suboptimal clinical care.

Reflection-Based Learning for Professional Ethical Formation.

One way practitioners learn ethics is by reflecting on experience. They may reflect in the moment (reflection-in-action) or afterwards (reflection-on-action). We illustrate how a teaching clinician may transform relationships with patients and teach person-centered care through reflective learning.

Error Disclosure in Pathology and Laboratory Medicine: A Review of the Literature.

Since the 1990s, the fields of anatomic and clinical pathology have made strong commitments to improving patient safety, including the creation of formal and informal guidelines for assessing and reporting quality lapses. Unfortunately, some medical errors are inevitable. Patient safety experts advocate full and complete disclosure of all serious medical errors in an effort to preserve the patient-physician relationship and minimize the risk of harm to patients.

Clinician-Educators as Dual Professionals: A Contemporary Reappraisal.

Physicians who teach face unique responsibilities and expectations because they must educate learners while simultaneously caring for patients. Recently this has become even more difficult as the environment for clinician-educators has been undermined by public antipathy toward both the education profession and the medicine profession.Erosion of public confidence in both professions is evidenced by three trends.

The Use of Narrative as a Treatment Approach for Obesity: A Storied Educational Program Description.

Introduction: Childhood obesity is a health care crisis according to the leading pediatric advocacy groups (National Medical Association, American Academy of Pediatrics, and American Diabetes Association) and the White House. The problem has reached epidemic proportions for all children, but it has an even greater impact on racial minorities. The subject of childhood obesity can lead to a host of medical, psychological, and social problems, including low self-esteem and discrimination.

Process-oriented inpatient groups: alive and well?

This paper explores the trend away from offering process-oriented groups on inpatient units, given decreasing lengths of stay, increasing acuity levels, and current biases toward psychoeducational groups and cognitive-behavioral treatments. A model for doing process-oriented groups that provides a structure while allowing a theme to emerge and maximal interaction to take place is presented. A case is made for the benefits of process-oriented inpatient groups as compared to, and complementary with, psychoeducational, cognitive, and behavioral approaches.

Evaluation and management of patients with nocturia.

Nocturia, or awakening one or more times to void at night, becomes clinically significant with two or more voids a night. In the past, nocturia has typically been viewed as a symptom of benign prostatic hyperplasia and/or overactive bladder syndrome. However, newer evidence supports that this is no longer just a symptom but a medical condition that warrants further workup and treatment given its effect on quality of life.