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The Schwartz Center Rounds

WELCOME TO SUMMA'S RESOURCE PAGE FOR THE SCHWARTZ CENTER ROUNDS.

Look below for further reading on topics

discussed at the Rounds

brought to you by the Summa Medical Library

 

Further Reading - Feb 15, 2017 - Perseverance

If technical issues prevent you from downloading an article, simply click here to notify us which article(s) you want and we will send the article to you.

Article Title: Nature and Impact of Grief Over Patient Loss on Oncologist on Oncologists' Personal and Professional Lives - For full text, click the article title and then click the PDF link on the right side of the subsequent screen.

Granek, L., Tozer, R., Mazzotta, P., Ramjaun, A., & Krzyzanowska, M. (2012). Nature and impact of grief over patient loss on oncologists' personal and professional lives. Archives Of Internal Medicine172(12), 964-966. doi:10.1001/archinternmed.2012.1426

This is a qualitative exploration of the nature and impact of grief in oncologists. "We found that for oncologists, patient loss was a unique affective experience that had a smokelike quality. Like smoke, this grief was intangible and invisible. Nonetheless, it was pervasive, sticking to the physicians' clothes when they went home after work and slipping under the doors between patient rooms..."


Article Title: Breast Cancer Education HHS Has implemented Initiatives Aimed at Young Women - For full text, click the article title and then click the PDF link on the left side of subsequent screen.

CROSSE, M. Breast cancer education:HHS Has Implemented Initiatives Aimed at Young Women. GAO Reports. i, Oct. 20, 2016.

A report on the emplementation of the EARLY Act, which directs HHS, including through CDC, HRSA, and NIH, to increase education and support for young women diagnosed with breast cancer by undertaking efforts in four specified areas: (1) prevention research, (2) a public education campaign, (3) support for young women diagnosed with breast cancer, and (4) a health professional education campaign.  Discusses grants made by the CDC to increase education, awareness, and provide support programs for young women with breast cancer.


Article Title: When a parent is dying: Helping parents explain death to their children For full text, click the article title and then click the PDF link in the upper right corner of subsequent screen.

Seccareccia, D., & Warnick, A. (2008). When a parent is dying: Helping parents explain death to their children. Canadian Family Physician54(12), 1693–1694.

Dying patients and their spouses often ask their family physicians for guidance, and many times we also feel unprepared. This is not something that is taught in medical school or often discussed in the general medical literature.


Article Title: Doing More: Trends in Breast Cancer Surgery, 2005-2011 - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Lucas, D. J., Sabino, J., Shriver, C. D., Pawlik, T. M., Singh, D. P., & Vertrees, A. E. (2015). Doing more: trends
in breast cancer surgery, 2005 to 2011. The American Surgeon, 81(1), 7480.

An increasing number of women may be choosing mastectomy over breast-conserving surgery for breast cancer as well as undergoing more bilateral resection, immediate reconstruction, and prophylactic operations... Independent predictors of mastectomy included young age, Asian race, invasive cancer (vs carcinoma in situ), bilateral resection, axillary dissection, higher American Society of Anesthesiologists class, and lower body mass index (all P < 0.001). 


Web Resources

CDC's Bring Your Brave Website

Website containing educational materials for laypersons on breast cancer in young women, including information about hereditary breast cancer genes.  Includes patient stories and social media tools.

CME Activity—Clinical Anthology: Educating Medical Providers About Breast Cancer in Young Women

This activity has been planned and implemented in accordance with the Accreditation Council for Continuing Medical Education and the American Nurses Credentialing Center (ANCC) through the joint providership of Medscape, LLC and CDC’s Division of Cancer Prevention and Control. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians and by the ANCC to provide continuing medical education for nurses.

Medscape, LLC designates this interview-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ and 1.0 ANCC Contact Hour Instructional Design and Rational Credit. Physicians and nurses should claim only the credit commensurate with the extent of their participation in the activity. 

Release Date: Jan 18, 2017; Expiration Date: Jan 18, 2018

 

Further Reading - Nov 30, 2016 - Veterans Still Serving

If technical issues prevent you from downloading an article, simply click here to notify us which article(s) you want and we will send the article to you.

Article Title: The Unasked Question - For full text, click the article title and then click the PDF link on the right side of the subsequent screen.

Brown, J. L. (2012, November 14). The Unasked Question. Jama,308(18), 1869-1870. doi:10.1001/jama.2012.14254.  

A pediatrician who served as an Army doctor during the Vietnam conflict argues that history taking should always include asking patients about their military background.  This question is as important as any other question designed to learn about occupational exposures.


Article Title: Haunted by Their Decisions in War - For full text, click the article title.

Gibbons-Neff, T. (2015, March 6). Haunted by Their Decisions in War. The Washington Post. Retrieved December 5, 2016, from https://www.washingtonpost.com/opinions/haunted-by-their-decisions-in-war/2015/03/06/db1cc404-c129-11e4-9271-610273846239_story.html?utm_term=.df8f48c56f49

A discussion of the concept of moral injury and the author's witness of it in his friend's life after a devastating incident in Afghanistan.


Article Title: Healing a Wounded Sense of Morality - For full text, click the article title.

Puniewska, M. (2015, July 3). Healing a Wounded Sense of Morality. The Atlantic. Retrieved December 5, 2016, from http://www.theatlantic.com/health/archive/2015/07/healing-a-wounded-sense-of-morality/396770/

Many veterans are suffering from a condition similar to, but distinct from, PTSD: moral injury, in which the ethical transgressions of war can leave service members traumatized


Local Website

Warriers Journey Home - http://warriorsjourneyhome.org/

A local organization dedicated to helping returning veterans adjust to civilian life.

 

Further Reading - Sep 28, 2016 - Overdose Overdose

If technical issues prevent you from downloading an article, simply click here to notify us which article(s) you want and we will send the article to you.

Article Title: Heroin: Life, Death, and Politics - For full text, click the article title and the PDF version of the article will open in a new window --- Only one concurrent Summa user at a time allowed. If blocked, try the link later.

Jacobson, J. (2014). Heroin: Life, Death, and Politics. American Journal Of Nursing114(5), 22-23.  

Discusses Good Samaritan laws in the context of drug overdoses, as well as naloxone distribution laws.  Tells how one North Carolina nurse became an advocate for such laws after experiencing a personal tragedy.


Article Title: Memorial Day - For full text, click the article title and the PDF version of the article will appear in a new window.

Ross, A. (2016). Memorial Day. Annals Of Emergency Medicine67(1), 135-136.

 An emergency physician shares his experience of notifying a family that a loved one has died of an overdose.


Article Title: Expanded access to naloxone: options for critical response to the epidemic of opioid overdose mortality - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Kim, D., Irwin, K., & Khoshnood, K. (2009). Expanded access to naloxone: options for critical response to the epidemic of opiod overdose mortality. American Journal Of Public Health, 99(3), 402-407.

Presents advantages and limitations associated with a range of possible naloxone policies and programs.  Although this article is over 7 years old, it provides some historical statistics on the escalation of the overdose epidemic and basic background information about naloxone such as safety, effectiveness, and risk-benefit ratio. 

 

Further Reading - Aug 31, 2016 - Unlovable

Article Title: Safe from harm - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Marriott, S. (2011). Safe from harm. Mental Health Today, 18-20.  

Self-harm and borderline personality disorder are often closely linked, and clinicians often make assumptions about these, but what helps and what hinders?  This article offers insights for constructive ways for healthcare workers to interact with patients who self-harm.


Article Title: The hateful patient revisited: relevance for 21st century medicine - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Strous, R., Ulman, A., & Kotler, M. (2006). The hateful patient revisited: Relevance for 21st century medicine. European Journal of Internal Medicine, 17(6), 387-393. doi:10.1016

Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the “hateful patient” can therefore be very informative to the physician. NOTE: This article was also cited as related reading for a previous Summa Schwartz Rounds in September, 2015.  In case you missed it then, we are posting it again as a related reading for this month as it is very relevant once again.


Article Title: Raising awarenss of borderline personality disorder and self-injury - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Lamph, G. (2011). Raising awareness of borderline personality disorder and self-injury. Nursing Standard26(5), 35-40.

Patients diagnosed with borderline personality disorder are often excluded from services and are highly stigmatised both in mental health services and the wider society. This article aims to increase the awareness of borderline personality disorder and self-injury among non-mental health nurses to assist them to work more effectively with patients who present with these difficulties. 


Article Title: Management of borderline personality disorder - For full text, click the article title and then click the green "Download PDF" button on the right side of subsequent screen

Pack, S., Wakeham, S., Beeby, R., Fawkes, E., Yeandle, J., & Gordon, C. (2013, April 16-23). Management of borderline personality disorder. Nursing Times, 109(15), 21-23.

This article gives an overview of personality disorders, with a focus on borderline personality disorder.  It also describes some past and current treatment approaches.  The authors then describe the treatment approach at their own institution, called "guided formulation."

 

 

Further Reading - Jul 27, 2016 - The First Year

Article Title: Hold On One Second: Interrupting the Intern Year. - For full text, click on the article title, and then click on "PDF Full Text" on left side of next screen. 

George, A. E. (2015). Hold on one second: interrupting the intern year. Medical Education49(5), 451-453. doi:10.1111/medu.12746

Aaron George describes a typical scenario from his intern experience and argues that "modern residency is as much about multitasking as it is about medical knowledge, and as much about prioritisation as it is about procedural skill."


Article Title: Fluffing the Pillows -  For full text, click on the article title, and then click on "Article as PDF" on right side of next screen. 

Beachy, L. (2012). Fluffing the pillows. Nursing42(4), 62-63. doi:10.1097/01.NURSE.0000412924.74641.03

A nurse with only 7 months experience learned that she had made an important contribution to the care of a patient that her more experienced colleagues had not been able to provide.


Article Title: Welcome New Nurses to the Wonderful World of Emergency Nursing! - For full text, click on the article title, and then click on "PDF Full Text"  on next screen. 

Papa, A., & Lefton, C. (2015). Welcome New Nurses to the Wonderful World of Emergency Nursing!. JEN: Journal Of Emergency Nursing41(3), 245-248. doi:10.1016/j.jen.2015.01.019

A number of different veteran emergency nurses share their thoughts and advice on how new graduate nurses can survive and thrive in the emergency department. 

 

 

Further Reading - May 25, 2016 - A Guardian's Dilemma

Article Title: Ethics Roundtable. Assigning an appropriate surrograte. - For full text, click on the article title, and then click on "PDF Full Text" link on next screen. 

Baumrucker, S., Stolick, M., Morris, G., VandeKieft, G., Harrington, D., & Sheldon, J. (2007). Ethics roundtable. Assigning an appropriate surrogate. American Journal Of Hospice & Palliative Medicine24(5), 422-428.

Professionals from four different disciplines; an ethicist, a lawyer, a physician, a social worker, and a nurse; each address a clinical ethical dilemma involving a decision relating to withdrawing life support from a young patient.  There is a conflict between the wishes of an absent legal surrogate, the patient's wife, and the patient's father, who wishes to keep the patient alive despite the a diagnosis of persistant vegetative state.


Article Title: Clinical Ethics Comittees: Organizational Support for Ethical Practice - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen

Lachman, V. D. (2010, November/December). Clinical Ethics Committees: Organizational Support for Ethical Practice. Medsurg Nursing, 19(6), 351-353.

Provides a brief history of clinical ethics committees in hospitals and outlines three roles of such a committee which includes policy development, ethics education, and case consultation.
 

Article Title: Epidemiologic Notes and Reports Gasoline Sniffing and Lead Toxicity among Siblings -- Virginia -  For full text, click on the article title. 

Epidemioligic Notes and Reports Gasoline Sniffing and Lead Toxicity among Siblings -- Virginia. (1985). MMWR: Morbidity and Mortality Weekly Report, 34(29), 449-450, 455.

A case report from the 1980's in which young children were habitually sniffing gasoline for the euphoric effects.  These effects were discovered in the process of siphoning gasoline.  This habit resulted in lead toxicity for some of the children. Of historical importance, the editorial note states that the US EPA, in 1986 is mandating a 10-fold reduction in lead in gasoline and was "considering a total ban on all lead additives." 

AND, RELATED TO THE ABOVE:

Article Title: Lead Poisoning  For full text, click on the article title. 

Needleman, H. (2004). LEAD POISONING. Annual Review Of Medicine, 55(1), 209-­222.

Understanding of lead toxicity has advanced substantially over the past three decades, and focus has shifted from high-dose effects in clinically symptomatic individuals to the consequences of exposure at lower doses that cause no symptoms, particularly in children and fetuses.  See pages 215-6 for a brief discussion of the effects of chronic lead exposure on behavior. 

 

Further Reading - Apr 27, 2016 - Finding the Words

Article Title: Thinking All Wrong about How You Die - For full text, click on the article title, and then click on "PDF Full Text" link on next screen.

Battin, M. P. (2015). Thinking All Wrong about How You Die. Hastings Center Report, 45(4), Insidebackcover. doi:10.1002/hast.473

How do we approach our deaths?...We write advance directives. We execute durable powers of attorney. We give instructions to loved ones: “No tubes, no machines.” That's the wrong approach, I think. All this stuff we put together doesn't guarantee that what we say we want will actually happen or that we'll have what we'd call a “good death”—what you would think of as a good death for you.

Article Title: Communication about Serious Illness Care Goals: a Review and Synthesis of Best Practices - For full text, click on the article title. PDF version is available by clicking on the PDF symbol on the extreme right side of next screen. 

Bernacki, R. E., & Block, S. D. (2014). Communication about Serious Illness Care Goals: a Review and Synthesis of Best Practices. JAMA Internal Medicine JAMA Intern Med, 174(12), 1994-2003. doi:10.1001/jamainternmed.2014.5271

An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of nonbeneficial medical care near death, enhanced goal-consistent care, positive family outcomes, and reduced costs. Existing evidence does not support the commonly held belief that communication about end-of-life issues increases patient distress.


Article Title: Starting End-of-Life Conversations in Hospital - For full text, click on the article title. PDF version is available by clicking on the green "Download PDF" button on the next screen.    

Davis, R. (2015). Starting End-of-Life Conversations in Hospital. Nursing Times, 111(4), 18-21.

Describes the The Conversation Project, aimed at encouraging end-of-life discussions between healthcare providers and patients.  "The project team explored the experience of staff based on a ward caring for older people. They found staff sometimes found it difficult to initiate end-of-life conversations and, therefore, to make patient-centred care plans. A development and support programme has improved staff confidence and resulted in more documented planning and discussion about the end of life."


Websites Mentioned During the Rounds:

Death Over Dinner - deathoverdinner.org

The Conversation Project - theconversationproject.org

Five Wishes - www.agingwithdignity.org/five-wishes/

Summa Health System Advance Directives Page - Ohio forms are available here

 

 

Further Reading - Mar 23, 2016 - Fatal Secret

Article Title: The Duty to Warn and Clinical Ethics: Legal and Ethical Aspects of HIV/AIDS - For full text, click on the article title, and then click on the blue "Download PDF" button on the next screen

Säfken, C., & Frewer, A. (2007). The Duty to Warn and Clinical Ethics: Legal and Ethical Aspects of Confidentiality and HIV/AIDS. HEC Forum,19(4), 313-326.

Confidentiality is a principal corollary to medical treatment… There are, however, difficult cases in which physicians contemplate exceptions to confidentiality. They arise in situations where medical secrecy puts the physical integrity or the life of others at risk.

Article Title: The End of AIDS: HIV as a Chronic Disease - For full text, click on the article title. PDF version is available by clicking on the PDF symbol on the subsequent screen. 

Deeks, S. G., Lewin, S. R., & Havlir, D. V. (2013). The end of AIDS: HIV infection as a chronic disease. The Lancet, 382(9903), 1525-1533.

The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life.

 

 

Further Reading - Feb 24, 2016 - Subtle as a Brick

Article Title: Microaggression and Its Relevance in Health Care - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen

Bleich, M. R. (2015). Microaggression and Its Relevance in Health Care.The Journal of Continuing Education in Nursing,46(11), 487-488.

A brief introduction to the concept of microagression..."The subtle nature of a microaggression is that it slides in under the radar, probably in a manner that is not reportable to or identified through any of the traditional human resource mechanisms in place."

Article Title: Dealing with Racist Patients -  For full text, click on the article title, and then click the PDF link on the right side of subsequent screen

Kimani, P., JD, PhD, Smith, A. K., MD, MPH, Lo, B., MD, & Fernandez, A., MD. (2016). Dealing with Racist Patients. New England Journal of Medicine, 374(8), 708-711.

"A patient’s refusal of care based on the treating physician’s race or ethnic background can raise thorny ethical, legal, and clinical issues — and can be painful, confusing, and scarring for the physicians involved. And we fear that race-based reassignment demands will only increase as the U.S. physician population becomes more racially and ethnically diverse. So we’ve created a framework for considering and addressing such demands.."


Article Title: The Racist Patient - EssayAdditional Commentaries, and Author's Reply - For full text, click on the article title, and then click the PDF link of the left side of the subsequent screen. 

Jain, S. H. (2013). The racist patient. Annals Of Internal Medicine158(8), 632.

There are two links above.  The first is an essay; a compelling account of a doctor's unpleasant encounter with a patient and his own reflections on his internal responses to the event. The second link includes letters that were published in response to the essay followed by a reply to these comments from the author.


Article Title: Bias, Black Lives, and Academic Medicine - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen

Ansell, D. A., & McDonald, E. K. (2015). Bias, Black Lives, and Academic Medicine. New England Journal of Medicine N Engl J Med, 372(12), 1087-1089.

"White Coats for Black Lives" were large demonstrations staged a couple of years ago by medical students to call attention to implicit bias in academic medical centers that result in continued disparities in the recruitment of black physicians and faculty in academic medical centers.  These demonstrations also expressed concern for racial disparities in healthcare outcomes in the United States. 

 

Further Reading - Jan 27, 2016 - Caring for the LGBT Patient

Article Title: Transgender Care Moves into the Main Stream - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen

Buchholz, L. (2015). Transgender Care Moves Into the Mainstream. Jama, 314(17), 1785-1787.

“Trans people have been excluded from medical care, and their issues have been deemed not medical and not important,” said Joseph Freund, MD, a primary care physician at Franklin Family Practice in Des Moines, Iowa.  This article explores the research base on transgender health, resources for physician education and more. 
 

Article Title: Civil Rights and Health - Beyond Same Sex Marriage -  For full text, click on the article title, and then click the PDF link on the right side of subsequent screen

Landers, S. (2015). Civil Rights and Health — Beyond Same-Sex Marriage. New England Journal of Medicine N Engl J Med,373(12), 1092-1093.

"The idea that the acceptance of same-sex marriage as part of the fundamental right to marriage heralds the end of bad treatment of LGBT people and denial of their rights may be a commonly held notion, but it's most likely overly optimistic, as well as contrary to the evidence on health disparities."


Article Title: The Invisible Elderly: Lesbian, Gay, Bisexual, and Transgender Older Adults - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen

Jablonski, R. A., Vance, D. E., & Beattie, E. (2013). The Invisible Elderly: Lesbian, Gay, Bisexual, and Transgender Older Adults.Journal of Gerontological Nursing J Gerontol Nurs, 39(11), 46-52..

More than 2 million older adults identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this article is to present an overview of the physical and mental health needs of LGBT older adults to sensitize nurses to the specific needs of this group. Nurses are in a prominent position to create health care environments that will meet the needs of this invisible, and often misunderstood, group of people. 


Article Title: Last Chance to Say Goodbye - For full text, click on the article title, and then click the PDF link on the left side of subsequent screen

Ufema, J. (2004). Last chance to say good-bye. Nursing, 34(2), 73-74.

A tragic anecdote about a young man dying of AIDS.

 

Further Reading - Oct 28, 2015 - A Family Caught Off Guard

Article Title: Ten strategies to extinguish potentially explosive behavior - For full text, click on the article title, which is a direct link to the full text in PDF format

Leckey, D. (2011). Ten strategies to extinguish potentially explosive behavior. Nursing, 41(8), 55-59.

According to a survey by the Emergency Nurses Association, between 8% and 13% of ED nurses reported that they were victims of violence at work every week. ...This article will review how to protect your patients and yourself from potentially violent behavior by taking a look at early signs of patient agitation and potential causes of anger. It will also discuss 10 practical strategies to help you defuse violent situations.
 

Article Title: Assaults leave nurses fearful - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen

Burns, B. (2014). Assaults leave nurses fearful. Kai Tiaki : Nursing New Zealand, 20(5), 14-7.

Reported assaults on mental health nurses are rising. Behind the statistics are the human faces of nurses coping with the fallout of violence.


Article Title: Sudden death in emergency care: responding to bereaved relatives - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Scott, T. (2013). Sudden death in emergency care: responding to bereaved relatives. Emergency Nurse, 21(8), 36-39.

Many emergency nurses find it difficult to support relatives whose loved ones are being resuscitated or to witness relatives' distress after their family members have died...This article discusses this issue and includes exercises that practitioners can undertake to identify their personal strengths and professional competences when caring for suddenly bereaved relatives. 

 

Further Reading - Sep 23, 2015 - Throwing It Around

Article Title: We couldn't come to terms with Hank... until he signed a contract - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Mengel, T. (1992). We couldn't come to terms with Hank... until he signed a contract. Nursing, 22(1), 50-52.  

Ever hear of putting an uncontrollable patient in charge of his care? That's what these nurses did when they got him to sign a patient-care agreement. Find out how it worked in this story of bitterness turned to hope.


Article Title: The hateful patient revisited: relevance for 21st century medicine - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Strous, R., Ulman, A., & Kotler, M. (2006). The hateful patient revisited: Relevance for 21st century medicine. European Journal of Internal Medicine, 17(6), 387-393. doi:10.1016

Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the “hateful patient” can therefore be very informative to the physician.


Article Title: Mean ol' cuss -- or pussycat? - For full text, click the article title and then click the PDF link on the left side of subsequent screen

Seabolt, J. (2006). Mean ol' cuss -- or pussycat?. Nursing, 36(8), 55.

This angry patient was a challenge -- until I realized how much we had in common. 

 
 

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