We report the rare case of a 71-year-old man with a medical history including dysphagia, gastroesophageal reflux disease, and achalasia with remote open transthoracic Heller myotomy who presented ...acutely with symptoms of esophageal obstruction. Sustained gastroesophageal intussusception was diagnosed with esophagogastroduodenoscopy and computed tomography. The patient underwent urgent robot-assisted laparoscopic reduction with gastropexy. Intraoperatively, the gastric and esophageal tissue appeared inflamed without evidence of necrosis or perforation. The patient recovered well without complications. This report describes a case of successful surgical treatment of gastroesophageal intussusception by a robotic approach.
The National Association of Social Workers developed practice standards for social workers using technology in their practice. These standards were derived from the foundation of the social work code ...of ethics and are helpful as social workers explore the use of new tools for the benefit of their clients. Hospice caregivers, both active and bereaved, are in great need of support but are often unable to attend traditional support groups. Facebook secret groups offer social workers a potential tool, given the geographic barriers that exist for traditional face-to-face support groups. The authors' experience with a secret Facebook group indicates that the technology can be useful when managed by a social worker facilitator. As social workers continue to explore helpful ways to use technology with clients, it is critical that they evaluate that practice and assess the clinical outcomes to establish an evidence base behind this practice.
Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and ...include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the team's reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.
The Glasgow Coma Score (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance ...metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) to that recorded in the neurosurgery consultation (GCS-2).
This retrospective review compared GCS-1 to GCS-2. The Trauma Injury Severity Score (TRISS) method was used to calculate probability of survival (POS) for patients using both GCS-1 and GCS-2.
GCS-1 significantly differed from GCS-2 (6.69 vs 7.84, ± 2.553, p<.001). There were 172 (37.55%) patients with a GCS-1 of 3 and 87 (19.00%) with a GCS-2 of 3 (Chi-square p<0.001). The probability of survival (POS) calculated using TRISS methodology with GCS-1 (POS-1) was 74.7% ± 26.6% compared to GCS-2 (POS-2), which was 79.3% ± 24.4%. There was a statistically significant difference in the means of POS-2 and POS-2 (p<0.001). The actual observed survival rate for the cohort was 71.0% (325/458).
The immediate GCS recorded on patient arrival after trauma differs significantly from the GCS recorded at later times. This significantly altered the probability of survival as calculated by the TRISS methodology. This could have profound effects on risk-adjusted benchmarking, assessments of quality of care and injury-severity stratification for research. More studies into the optimal timing of GCS recording or changes in GCS ant their impact on survival is warranted.
Abstract Context For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and ...restrictions on social activities. Objectives Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. Methods Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. Results Results indicated that, of the 125 pain talk utterances, most referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%) concerns. Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient’s needs juxtaposed to the caregiver’s recognized limitations. Conclusion By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management.
The uveitides are a collection of over 30 diseases characterised by intraocular inflammation. Previous work demonstrated that the agreement among uveitis experts on diagnosis was modest at best with ...some pairs of experts having chance alone agreement on selected diseases. The Standardisation of Uveitis Nomenclature (SUN) is a17‐year collaboration among experts in uveitis, ocular image grading, informatics, and machine learning to improve clinical and translational uveitis research. The SUN “Developing Classification Criteria for the Uveitides” project used a rigorous, multi‐phase approach to develop classification criteria for 25 of the most common uveitic diseases. The project's phases were: (1) informatics; (2) case collection; (3) case selection; (4) machine learning; and (5) consensus review and publication. The results were classification criteria with a high degree of accuracy (93.3%–99.3% depending on anatomic class of the uveitis), the goal of which is to form the basis for future uveitis research.
Abstract As patients are cared for in their homes by family caregivers, several challenges arise in effective pain and symptom management. Despite hospice's reputation as the gold standard for ...terminal care, there is still a need to improve pain management practices, including challenges that caregivers face, related to pain assessment, reluctance and fear of administering medication, noncompliance with pain medicine regimens, and hesitance to report pain. The hospice philosophy of care promotes service for both patients and their family by an interdisciplinary team, and total pain management is a goal of this care. The aim of this control phase of a larger National Cancer Institute-funded mixed methods study was to understand the current practice of hospice assessment and collaboration on informal caregiver issues related to pain management. This study of 30 hospice caregiver–patient dyads from one rural hospice found that 87% of caregivers indicated concern with at least one question on the Caregiver Pain Medicine Questionnaire. Interdisciplinary team discussions for 23 of the dyads were recorded over nine months for a total of 86 sessions. Although caregiver concerns were identified with the Caregiver Pain Medicine Questionnaire by the research team, there was only one discussion of caregiver pain-related concerns during the hospice team meeting. This despite the finding that 38% of the time involved in a patient discussion is spent on pain-related talk. These findings indicate an opportunity for improvement by hospice teams through focusing on caregiver assessment and intervention.
This investigation probed whether embedded journalist coverage of the first days of the 2003 U.S. invasion of Iraq produced print news coverage that was either more decontextualized inform or more ...favorable in tone. Embedded news coverage of the first days of Operation “Iraqi Freedom” was compared to nonembedded, so-called “unilateral” coverage; and print coverage of “Iraqi Freedom” was compared with the first days of U.S. ground operations in Operations “Enduring Freedom” and “Desert Storm.” The results indicated that embedded journalists in Operation “Iraqi Freedom” produced news stories that featured more episodic frames, compared to both nonembedded reporters in “Iraqi Freedom” and overall coverage of Operation “Enduring Freedom.” The results also revealed that, compared to nonembedded reporting, embedded print coverage of “Iraqi Freedom” was more favorable in overall tone toward the military and in depiction of individual troops, but this bias did not produce more positive overall coverage compared to recent conflicts.
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