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Health practice relationships
\"The quality, resourcing and accessibility of healthcare is a key issue facing societies in the 21st century. Despite the system delivery focus of these factors it is critical to remember that healthcare is a human service and as such, people need to be placed at the centre of healthcare systems and processes. To do this we need to improve the way that people are valued and involved in healthcare practices. Professional relationships lie at the heart of such practices. This book illuminates and challenges professional healthcare relationships. The authors examine the nature, context and purpose of healthcare relationships, explore models through which these relationships are enacted, developed and critiqued, and provide narratives of health practice relationships in action. These narratives reveal how health practice relationships are experienced and created in real-world situations. The various chapters generate a range of implications and recommendations for healthcare practice and systems and for the education of health professionals. This is a book for practitioners, educators, clients, members of the community, advocacy and agency groups, regulatory bodies and those with power to shape the future direction of healthcare\"--Back cover.
Book
Peripheral Neuropathy: Evaluation and Differential Diagnosis
Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing. Early peripheral neuropathy may present as sensory alterations that are often progressive, including sensory loss, numbness, pain, or burning sensations in a “stocking and glove” distribution of the extremities. Later stages may involve proximal numbness, distal weakness, or atrophy. Physical examination should include a comprehensive neurologic and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation for potential underlying etiologies should initially focus on treatable causes. Initial laboratory evaluation includes a complete blood count; a comprehensive metabolic profile; fasting blood glucose, vitamin B 12, and thyroid-stimulating hormone levels; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., electrodiagnostic studies, specific antibody assays, nerve biopsy) should be considered. Treatment of peripheral neuropathy focuses on managing the underlying etiology. Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain.
Journal Article
Firehorse
Spirited fifteen-year-old horse lover Rachel Selby determines to become a veterinarian, despite the opposition of her rigid father, her proper mother, and the norms of Boston in 1872, while that city faces a serial arsonist and an epidemic spreading through its firehorse population.
Book
Dysphagia: Evaluation and Collaborative Management
Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.
Journal Article
Human factors in healthcare : a field guide to continuous improvement
Have you ever experienced the burden of an adverse event or a near-miss in healthcare and wished there was a way to mitigate it? This book walks you through a classic adverse event as a case study and shows you how. It is a practical guide to continuously improving your healthcare environment, processes, tools, and ultimate outcomes, through the discipline of human factors. Using this book, you as a healthcare professional can improve patient safety and quality of care. Adverse events are a major concern in healthcare today. As the complexity of healthcare increases-with technological advances and information overload-the field of human factors offers practical approaches to understand the situation, mitigate risk, and improve outcomes. The first part of this book presents a human factors conceptual framework, and the second part offers a systematic, pragmatic approach. Both the framework and the approach are employed to analyze and understand healthcare situations, both proactively-for constant improvement-and reactively-learning from adverse events. This book guides healthcare professionals through the process of mapping the environmental and human factors; assessing them in relation to the tasks each person performs; recognizing how gaps in the fit between human capabilities and the demands of the task in the environment have a ripple effect that increases risk; and drawing conclusions about what types of changes facilitate improvement and mitigate risk, thereby contributing to improved healthcare outcomes.
Book
Frailty: Evaluation and Management
Frailty, which is a geriatric syndrome that affects 5% to 17% of older adults, is a state of increased vulnerability across multiple health domains that leads to adverse health outcomes. Frail older adults are at increased risk of falls, disability, hospitalizations, and death. Frailty may initially be overlooked or incorrectly identified as part of the normal aging process because of the variable nature of the presentation and diagnosis. Symptoms include generalized weakness, exhaustion, slow gait, poor balance, decreased physical activity, cognitive impairment, and weight loss. There is no current recommendation for routine screening. A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty. Several validated frailty assessment tools can evaluate a patient for frailty. Patients are diagnosed as not-frail, prefrail, or frail. Patients with a larger number of frail attributes are at higher risk of poor outcomes. The management of frail patients must be individualized and tailored to each patient's goals of care and life expectancy. Physical activity and balance exercises may be suitable for patients who are less frail. Palliative care and symptom control may be appropriate for those who are more frail.
Journal Article
Reframing reproduction : conceiving gendered experiences
\"How do rapid social and technological changes shape reproductive realms today? What is at stake? What problems are raised? What solutions are offered? In this collection, leading international scholars consider the complex 'choices', anxieties, and challenges of reproduction in postmodernity for both women and men in a range of cultural positions and geographical locations in the West. Focusing on topical issues such as surrogacy, online sperm banking, gamete donation, contraception, and breastfeeding, Reframing Reproduction proposes a new framework for conceptualising the relationship between gender and reproduction in the twenty-first century. Each of the 14 chapters uniquely explores the social aspects of how women and men feel, think, and act in relation to their reproductive 'choices'. Providing accessible and thought-provoking discussions, this book will appeal to those interested in contemporary reproductive practices, technologies, and experiences\"-- Provided by publisher.
Book
Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach
Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.
Journal Article
The tincture of time : a memoir of (medical) uncertainty
\"Growing up as the daughter of a dedicated surgeon, Elizabeth L. Silver felt an unquestioned faith in medicine. When her six-week-old daughter, Abby, was rushed to the Neonatal Intensive Care Unit with sudden seizures, and scans revealed a serious brain bleed, her relationship to medicine began to change. The Tincture of Time is Silver's gorgeous and haunting chronicle of Abby's first year. It's a year of unending tests, doctors' opinions, sleepless nights, promising signs and steps backward, and above all, uncertainty : The mysterious circumstances of Abby's hospitalization attract dozens of specialists, none of whom can offer a conclusive answer about what went wrong or what the future holds. As Silver explores what it means to cope with uncertainty as a patient and parent and seeks peace in the reality that Abby's injury may never be fully understood, she looks beyond her own story for comfort, probing literature and religion, examining the practice of medicine throughout history, and reporting the experiences of doctors, patients, and fellow caretakers. The result is a brilliant blend of personal narrative and cultural analysis, at once a poignant snapshot of a parent's struggle and a wise meditation on the reality of uncertainty, in and out of medicine, and the hard-won truth that time is often its only cure. Heart-wrenching, unflinchingly honest, and beautifully written, The Tincture of Time is a powerful story of parenthood, an astute investigation of the boundaries of medicine, and an inspiring reminder of life's precariousness\"-- Provided by publisher.
Book
Inguinal Hernias: Diagnosis and Management
Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.
Journal Article