Neuroscience at the Core of a Sound Sleep Health Curriculum.

Neuroscience should be at the core of a sound sleep health curriculum, especially in early classroom-based medical education. This article canvasses ways in which sleep medicine has been rapidly transformed by tele-sleep tools and by research on neurobiological mechanisms underlying sleep disorders and on comorbidities associated with sleep disorders, including stroke, traumatic brain injury, and movement or neurocognitive disorders.

What Do Clinicians and Organizations Owe Patients With Recalled Implanted Devices or Materials?

Placement of prosthetic breast implants for augmentation or reconstruction is common. Two specific safety concerns are considered in this article: breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and complexes of symptoms known as breast implant illness. In response to a case involving a patient with concerns about BIA-ALCL, this commentary notes that triage, counseling, and treatment are guided in practice by available data in the literature.

How Should Compassion Be Expressed as a Primary Clinical and Ethical Value in Anorexia Nervosa Intervention?

Use of force in the care of patients with severe anorexia nervosa is controversial but can be justified when the disorder becomes life-threatening. This commentary examines the role of force in compassionate care of an adolescent patient hospitalized with extreme anorexia nervosa and suggests strategies for reaching consensus, minimizing harm, and maximizing the chance of a therapeutic outcome when forced intervention is a compassionate thing to do.

Delinquent Medical Records: Who Are the Stakeholders for Timely Medical Documentation?

The explosion of electronic documentation associated with Meaningful Use-certified electronic health record systems has led to a massive increase in provider workload for completion and finalization of patient encounters. Delinquency of required documentation affects multiple areas of hospital operations. We present the major stakeholders affected by delinquency of the electronic medical record and examine the differing perspectives to gain insight for successful engagement to reduce the burden of medical record delinquency.

Neurogenic Bladder Management.

Neurogenic bladder dysfunction (NBD) is a condition caused by damage to or diseases of the brain, spinal cord, or nerves that results in atypical bladder function. If not managed appropriately, NBD can lead to upper urinary tract damage. This article explains typical bladder anatomy and the voiding process, causes of NBD, techniques for diagnosis and assessment, and treatment options.

What Should an Anesthesiologist and Surgeon Do When They Disagree About Terms of Perioperative DNR Suspension?

This case examines perioperative suspension of a do-not-resuscitate (DNR) order during surgery. The commentary considers the appropriateness of DNR orders; types of DNR order suspension in the context of alternative anesthesia techniques; and what is required from a surgeon, anesthesiologist, and patient or surrogate to reach a decision expressing the patient's best interest. It concludes by offering communication recommendations based on joint discussion and decision sharing.

The Implementation Chasm Hindering Genome-informed Health Care.

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the "last mile' infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain - both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease management, we will need to integrate both new knowledge and new care processes into existing workflows.

Psychopharmacology in Pediatric Mixed Anxiety Disorder: An Evidence-based Review.

Anxiety disorders are the most prevalent psychiatric disorders among youth, with prevalence rates ranging from 25 to 32 percent. These disorders are under-recognized and often undertreated in this population. Anxiety disorders in youth exhibit a chronic and persistent course of symptoms with a higher risk of comorbidities, functional impairment, and worsening of severity.

A Review of the Pharmacological Management of Chronic Pain in Patients with Heart Failure.

The incidence rates of heart failure (HF) and chronic pain increase with age. In the geriatric population, both disorders often coexist and pose a challenge to clinicians in treating them simultaneously. We conducted an online literature search for reports of the heart failure effects of pharmacological treatments for chronic pain.

Asymptomatic Hypertensive Urgency at a VA Emergency Department.

Management of asymptomatic hypertension in a primary care setting rather than in the emergency department showed similar outcomes and was more cost-effective.

Training Physicians as Healers.

Spirituality is increasingly recognized as an essential element of patient care and health. It is often during illness that patients experience deep spiritual and existential suffering. With clinicians' care and compassion, patients are able to find solace and healing through their spiritual beliefs and values.

A CRNA Preceptor Workshop to Increase Preceptor Satisfaction, Confidence, and Comfort: A Quality Improvement Project.

The purpose of this quality improvement project was to determine whether a 4-hour Certified Registered Nurse Anesthetist (CRNA) preceptor workshop would significantly increase staff CRNA preceptors' satisfaction, confidence, and/or comfort, to better prepare CRNAs to precept. A review of the literature, interviews with experienced CRNA preceptors, and a needs assessment survey were completed and used to develop the workshop's curriculum. For evaluation of the impact of this quality improvement project, attendees were asked to complete preworkshop and postworkshop surveys.

Therapeutic Interchange From Rosuvastatin to Atorvastatin in a Veteran Population.

A change in formulary statins was not associated with any differences in liver enzymes or lipid control for patients but did result in significant cost savings at the North Florida/South Georgia Veterans Health System.

Treatment of a complex thoracoabdominal aneurysm and dissection with a branched graft.

This article describes the management of a patient with a complex symptomatic thoracoabdominal aneurysm and discusses the branched graft approach to surgical repair of complex aortic aneurysms. The case highlights the importance of a team approach during a complex, high-risk surgery and the perioperative period.

Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2: What to Look for and How to Recommend an Effective Fiber Therapy.

Dietary fiber that is intrinsic and intact in fiber-rich foods (eg, fruits, vegetables, legumes, whole grains) is widely recognized to have beneficial effects on health when consumed at recommended levels (25 g/d for adult women, 38 g/d for adult men). Most (90%) of the US population does not consume this level of dietary fiber, averaging only 15 g/d. In an attempt to bridge this "fiber gap," many consumers are turning to fiber supplements, which are typically isolated from a single source.

Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 1: What to Look for and How to Recommend an Effective Fiber Therapy.

Dietary fiber that is intrinsic and intact in fiber-rich foods (eg, fruits, vegetables, legumes, whole grains) is widely recognized to have beneficial effects on health when consumed at recommended levels (25 g/d for adult women, 38 g/d for adult men). Most (90%) of the US population does not consume this level of dietary fiber, averaging only 15 g/d. In an attempt to bridge this "fiber gap," many consumers are turning to fiber supplements, which are typically isolated from a single source.

Diagnostic Considerations in Pediatric Inflammatory Bowel Disease Management.

Approximately 20% of all inflammatory bowel disease (IBD) first presents in childhood or adolescence, and approximately 10% of the estimated 1.4 million Americans with IBD are under age 17. Diagnosis in pediatric patients may be complicated at presentation due to atypical symptoms and/or extraintestinal manifestations (eg, short stature, chronic anemia, unexplained fever, arthritis, mouth ulcers).