Spring 2008 - Volume 12 Number 2

Spring 2008 - Volume 12 Number 2Original Articles

Special Report:
Introducing the “Teamlet”: Initiating a Primary Care Innovation at San Francisco General Hospital
By Brian Yoshio Laing; Lisa Ward, MD, MScPH, MS; Thomas Yeh; Ellen Chen, MD; Thomas Bodenheimer, MD
The 15-minute visit cannot meet the health care needs of patients in primary care. In the Family Health Center, the “Teamlet” practice innovation--a clinician and a health coach--was implemented to expand the traditional medical visit into previsit, visit, postvisit, and between-visit care.

Special Report:
Gaining New Insights into Early Abdominal Aortic Aneurysm Disease
By Julie J White; Ronald L Dalman, MD, FACS, FAHA
A special report on a multidisciplinary research effort to efficiently identify and handicap suppressive therapeutic strategies for early abdominal aortic aneurysm disease--a prevalent and highly morbid condition among older people--for which there are no proven methods of reducing or eliminating enlargement.
 
Lawrence Patient Safety Award 2007
Implementation of a High-Alert Medication Program
By Suzanne Graham, RN, PhD; Molly P Clopp, RN, MS, MBA; Nicholas E Kostek, RPh, MS; Barbara Crawford, RN, MS
High-alert medications--500,000 doses annually through Kaiser Permanente Northern California--carry a high risk of alarm, with potential clinical outcomes from administration errors. With program introduction, a statistically significant drop in errors occurred for 23 consecutive months. As of November 30, 2007, 232 days had passed without a negative event. The multidisciplinary group standardized handling, enhanced education, and developed monitoring functions.
 
Abdominal Lipectomy: A Prospective Outcomes Study
Nadine B Semer, MD, FACS; Wan C Ho, MD, FRCS; Sharrie Mills, MD, FACS; BM Rajashekara, MD, FACS; Jason R Taylor, MD; Nguyen B Trung, MD; Henry Young, MD; Juris Kivuls, MD, FACS
Abdominal lipectomy is performed for symptomatic, functional, and cosmetic relief for patients with excess abdominal tissue. This is the first prospective outcomes study and shows that 98.3% of 72 patients were happy to have had the surgery. Major (5.6%) and minor (27.8%) complications were comparable to other studies.
 
Prescribers’ and Organizational Leaders’ Preferences for Education about Heavily Marketed Drugs
David W Price, MD, FAAFP; Marsha A Raebel, PharmD; Douglas A Conner, PhD; Leslie A Wright, MA
In a study regarding heavily marketed drugs, assessment of organizational needs and of the educational needs and interests of medication prescribers demonstrated that top interest areas in both groups were: accessing unbiased drug information, comparing evidence about drugs within class, critical appraisal of drug information, off-label drug use, and addressing patient medication inquiries.
 
Five-Year Experience: Reflective Writing in a Preclinical End-of-Life Care Curriculum
Marcy E Rosenbaum, PhD; Kristi J Ferguson, PhD; Ann Broderick MD, MS
Analysis of 829 medical students’ reflection essays (2002-2007)--522 out-of-class and 307 in-class--identified four themes related to caring for dying patients: emotional response, communication support, shift from curing to caring, and feeling ill-prepared.

Review Articles

Natural Orifice Transluminal Endoscopic Surgery: The Future of Gastrointestinal Surgery
Lee L Swanström, MD, FACS; Yashodan Khajanchee, MD; Maher A Abbas, MD, FACS, FASCRS
Flexible endoscopy, used to perform therapeutic procedures beyond the wall of the gastrointestinal tract, is gaining prominence and application. It could provide all of the advantages of laparoscopic surgery and, with the elimination of all abdominal wall incisions, could completely eliminate the risk of wound infections. This article reviews technology, technique, challenges, and impact.

Case Studies

Cauda Equina Syndrome--Think of Cancer
Mohammad Sami Walid, MD, PhD; Mohammed Ajjan, MD; Kim W Johnston, MD, FACS; Joe Sam Robinson Jr, MD, FACS
In the presence of the triad: back pain, weakness in the lower extremities, and urinary urgency/incontinence, leptomeningeal carcinomatosis is a serious complication found in approximately 1% to 8% of patients with solid cancer.

Clinical Medicine

Corridor Consult
Informed Consent and Consent Forms
Paul Deiter, MD, LLB
Informed consent is a process of communication between patient and physician. A completed consent form does not effectively obviate the need for a documented discussion in the medical record of the risks and benefits of the proposed treatment.
 
What Is Trying to Happen Here? Using Mindfulness to Enhance the Quality of Patient Encounters
Philip Knowles, PhD
Mindful self-awareness is a disciplined means of directing attention to the thoughts, affect, intentions, and physiologic shifts that occur moment to moment, and is a way of promoting optimal outcomes in patient encounters, such as the formation of an empathetic relationship.

Commentary

The Integral Model: Answering the Call for Whole Systems Health Care
Marilyn Mandala Schlitz, PhD
Integral Health Care--an emerging new model--acknowledges multiple dimensions of living, healing, and curing that go beyond reduction of symptoms. Tools include: a ten-minute mindfulness break; working together in teams to make shared decisions; expanding to meet your patient’s needs and perspectives; and finding new ways to stay open to new ideas.
 
Caring for the Whole Person with HIV: Mind, Body, and Spirit
The Very Reverend Father Drew A Kovach, MD, MDiv, ABFM
“When we care for our patients, we care for whole people to make people whole, and meet people on the road where they are, not where we think they should be.” Experienced approaches are offered for issues of finance, job, partners, depression, and relationship.
 
A Conversation with David Bates, MD, MSc, Chairman of the American Medical Informatics Association
By Brian Raymond, MPH
In an interview, Harvard Professor of Medicine, David Bates, MD, speaks on recent progress towards widespread health information technology adoption; why decision-support tools are now more important than ever; and the necessity to develop the next generation of health informatics professionals.

Editorials

From Wolfman to Medicine Man: Podcasting for Clinicians
Robert W Hogan, MD
If Gen X youth can walk about with tens of gigabytes--thousands of their favorite tunes--nestled in MP3 players the size of a short stack of credit cards--could this technology make life better in clinical medicine? Learn how to glimpse the clever, technically sophisticated world of medical podcasting: audio files.

Narrative Medicine

Healing the Self Through Self-Portraits--A Drawing Workshop
Amy Stein, MFA
During a step-by-step drawing lesson by a portrait artist, participants unconsciously draw their own faces, and explore their drawings through a meditation and visualization exercise.
 
Reflective Writing in the Competency-Based Curriculum at the Cleveland Clinic Lerner College of Medicine
By J Harry Isaacson, MD; Renee Salas; Carl Koch; Margaret McKenzie, MD
A report from a five-year medical school, with an emphasis on training physician investigators, places the reflective writing competency at the level of the medical knowledge and clinical skill competencies, because writing is one of the most powerful and concrete ways to learn the art of reflection: vital for personal and professional development.
 
Constructing Stories of Past Lives: Cadaver as First Patient: “Clinical Summary of Dissection” Writing Assignment for Medical Students
Kristi J Ferguson, PhD; William Iverson, MD; Marc Pizzimenti, PhD
Students write one-page summaries hypothesizing about the cadaver’s lifestyle, possible diagnoses of chronic and acute diseases, probable age, and probable cause of death. Students are encouraged to reflect on what the experience means to each of them.

Letters

From Readers

Book Reviews

They Can’t Find Anything Wrong! Seven Keys to Understanding, Treating, and Healing Stress Illness
By David D Clarke, MD
Review by Erik K Fromme, MD

Soul of the Healer

Cherry Blossoms

Fisherman in flooded plain near Mandalay, Myanmar

St Emilion

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Letters to the Editor

Articles, editorials, letters to the editor, and other material represent the opinion of the authors. Send your comments to permanente.journal@kp.org.


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