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Expertise in physician‐patient communication is a primary outcome measure for physicians. We evaluated residents' communication behaviors with clinic patients following an educational intervention as measured by the Communication Assessment Tool (CAT). Thirty‐five internal medicine residents were assessed by patients using the CAT for 3 months before and after the educational intervention. The intervention included a simulated, videotaped patient encounter, mock CAT, and preceptor coaching during video review. The primary outcome was the percentage of CAT items receiving an "excellent" rating from patients before and after the intervention. Research results were compared to previously published CAT studies. Within‐resident improvement in the percentage of excellent ratings was small with median changes between 0 and 3 percentage points. Compared to previously published studies, similar results were found for the highest and lowest‐scored communication items. Many clinical encounters are time‐limited, and physicians do not pursue time‐consuming conversations that could reduce health care risk. This data and other published studies suggest seven communication items taking the most time to complete (i.e., shared decision‐making) were items demonstrating little or no improvement. This study identified clinical performance risk factors applicable to the Enterprise Risk Management Framework that could impact complication and readmission rates if addressed by changes in physician‐patient communication. [ABSTRACT FROM AUTHOR]

There is a paucity of literature describing the preparation of hospital institutions prior to a nursing strike and the quality outcomes during and after a prolonged nursing strike. No published study was found describing the effects of a prolonged strike on quality outcomes specific to trauma patients. The American College of Surgeons (ACS) suggests specific critiques and complications data that each trauma program may choose to track as quality indicators, and those metrics are submitted to regional, state and national databanks and closely examined during site accreditations. This research study analyzed data from three equal time periods following a multiservices strike involving both nurses and service/technical staff lasting 63 days. The purposes of this study were to (1) evaluate the effects of prestrike organizational leadership and crisis management planning on organizational staffing and emergency management to reduce health care risk during the strike, (2) describe outcomes data from three equal time periods: prestrike, strike, and poststrike, and (3) specifically compare the trauma program's selected ACS trauma metrics for critiques and complication rates for our high‐risk/high‐volume population as a level 1 trauma center. [ABSTRACT FROM AUTHOR]

Presents information on the case of a teenage black man with asymptomatic penile rash. Medical history of the patient; Diagnosis; Description of penile papules.

Surgical repair of difficult or nonunion fractures is frequently performed with autogenous bone grafts, most commonly from the iliac crest. Complications from this procedure may include vessel injury, nerve injury, pelvic instability, bowel herniation, and ileus. The authors report a case of iliac crest herniation in a patient presenting with a small-bowel obstruction 2 years after anterior iliac crest graft harvest for an open reduction and internal fixation repair of a right humeral shaft fracture. An emergency operation revealed that the right colon had herniated through an opening in the right iliac crest. The appendix had adhered to new osseous bone formed postoperatively, requiring an appendectomy. The hernia defect was successfully repaired with polypropylene mesh. A high index of suspicion for graft site herniation is needed for patients with a history of iliac crest bone grafting who present with symptoms of abdominal pain, flank or hip pain, ileus, or small-bowel obstruction.

Severe anemia is associated with high mortality, and patients with this condition are typically treated with packed blood red cells. Patients of Jehovah's Witness faith, however, do not accept blood transfusion therapy. The authors report the case of a Jehovah's Witness patient who presented with lower gastrointestinal bleeding secondary to Clostridium difficile colitis. Because the patient refused blood transfusion therapy, he underwent a right hemicolectomy with a preoperative hemoglobin level of 2.7 g/dL and a postoperative hemoglobin level of 1.8 g/dL. He was neurologically intact and discharged to a skilled care facility on postoperative day 10. The surgical team worked with the patient, his family, the anesthesiologists, and the Jehovah's Witness Hospital Liaison Committee physician members to devise a care plan that fully supported and respected the patient's religious beliefs and allowed him to maintain complete autonomy in his treatment decisions. Health care providers should be aware of how a patient's ethical, cultural, and religious background may impact treatment options., (© 2014 The American Osteopathic Association.)

Introduction: Although existing evidence is insufficient to recommend routine neonatal male circumcision, it is a procedure commonly performed in the United States. There are no commercially available infant penile models available for circumcision training. We improved the design of a low-fidelity penile model constructed of cocktail wieners following the one by Brill and Wallace (Fam Med 2007;39:241-243) and attached it to a high-fidelity infant simulator. Providing simulated movement and crying similar to what is encountered in routine newborn circumcisions create a more realistic training scenario.The study objectives were to (1) evaluate the educational experience of a simulated skill training program as perceived by participants based on a comparison scale and (2) evaluate the fidelity of the simulated model., Methods: Standardized workshops were held for family medicine (n = 23) and obstetrics/gynecology (n = 6) residents (n = 29). Residents evaluated the realism of the simulation, the realistic adequacy of the model, and the overall educational effectiveness of the workshop., Results: Using a Likert scale where 1 was the lowest and 4 was the highest, the average participant ratings were 3.96 for educational experience and improved medical knowledge and 3.89 for improved technical ability for both Mogen and Gomco clamps. The model was evaluated for anatomic landmarks (3.7), anesthesia administration (3.9), dorsal crush and slit (3.9), and breaking adhesions (3.5). Qualitative comments for perceived fidelity of the model were summarized., Conclusions: This project demonstrated successful development of a low-cost, easy-to-construct penile model combined with a high-fidelity infant simulator that, according to the responses of the participants in this study, enhances the simulated neonatal circumcision training. A tutorial for model construction and investigator-developed skill assessment checklists for Gomco and Mogen techniques are included in this technical report.

Background and Objectives: There are multiple procedural skills common to all residency programs. This study had two main objectives: (1) Use an interdisciplinary team to develop a procedural competency checklist for adult endotracheal intubation that could be shared across specialty programs and levels of training and (2) Evaluate the validity and reliability of the checklist., Methods: Clinical faculty from the institutional residency programs for family medicine, emergency medicine, obstetrics, and the simulation laboratory developed the initial checklist. Face validity and content validity of the checklist was established using literature review, expert opinion, and Lawshe's Content Validity Ratio. A training DVD was produced to standardize teaching and evaluation use of the checklist. Four teams of two physician raters representing a mix of specialty (family medicine, emergency medicine, obstetrics) and skill levels (clinical faculty and residents) were used to test inter-rater reliability of the checklist., Results: A convenience sample of 35 residents from family medicine, emergency medicine, and obstetrics participated. Bland and Altman's method for measuring differences between raters was used to test inter-rater reliability. No differences were found between raters based on specialty area or level of training., Conclusions: Procedural skills common to multiple specialty residency programs can be taught and evaluated across residency programs when a standardized training program and checklist is used. Resources could be maximized by offering training and evaluation sessions across resident specialty programs that are cooperatively staffed by evaluators of different levels of training and specialty backgrounds.

Traction folliculitis is a component of traction alopecia syndrome and has received minimal attention in primary source medical literature. The popularity of hairstyles that produce hair traction and the knowledge that early intervention improves prognosis amplify the importance of recognizing this entity. Traction folliculitis presents as perifollicular erythema and pustules on the scalp in areas where hairstyles produce traction on the hair shaft. In addition to the traction, concurrent hair care practices may play a facilitatory role in the development of traction folliculitis. Treatment involves immediate removal of traction on hair and temporary alteration of the facilitatory hair care practices. In more severe cases, topical or systemic antibacterial therapy and, occasionally, topical corticosteroid therapy may be necessary. Failure to discontinue traction-producing hairstyles can lead to traction alopecia and irreversible hair loss. Cultural considerations often are paramount in hairstyle choices and hair care practices that cause predisposition to traction disorders. Thus, culturally competent counseling requires understanding the significance of the hairstyle and hair care practices to the patient (or caregivers), discussing the recommendations in a culturally sensitive manner, and negotiating mutually acceptable alternative practices.