Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions ...Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions communication is better than patient perception. Objective: In a preliminary study, to compare patient and physician perception of communication at discharge. Design: Observational, survey-based. Setting: 330-bed adult teaching hospital. Participants: Surveys were mailed to 100 patients discharged home and 49 internal medicine physicians responsible for those patients’ care. Each physician had between 1 and 4 patients surveyed. Measurements: Patients and physicians received anonymous 5-item questionnaires concerning physician communication at discharge. Patient surveys inquired about their physicians’ communication at the specific physician encounter, while physician surveys asked about the physicians’ overall self-perception of discharge communication skills. Results: Completed questionnaires were returned by 59 patients and 40 physicians. Physicians reported a noticeably better perception of communication than their patients regarding spending adequate time reviewing the discharge plan (83% vs. 61%, P = 0.027), speaking slowly enough to understand (98% vs. 80%, P = 0.013), using wording that could be easily understood (100% vs. 68%, P P = 0.008). Perception of discharge communication improved with physician experience for several survey items. Conclusions: This study provides evidence suggesting that physician perception of communication at discharge is better than patient perception. Future studies of larger sample size and direct patient-physician pairing focusing on patient satisfaction and outcomes are needed.展开更多
The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human p...The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human physiology.Deleterious changes to the composition of gut microbiota,referred to as gut dysbiosis,has been linked to the development and progression of numerous diseases,including cardiovascular disease(CVD).Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression.Most CVD risk factors,including aging,obesity,dietary patterns,and a sedentary lifestyle,have been shown to induce gut dysbiosis.Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier,which in turn increases circulating levels of bacterial structural components and microbial metabolites,including trimethylamine-N-oxide and short-chain fatty acids,that may facilitate the development of CVD.This article reviews the normal function and composition of the gut microbiome,mechanisms leading to the leaky gut syndrome,its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention.As CVD is the leading cause of deaths globally,investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.展开更多
Clostridium difficile infection(CDI) is the most common nosocomial infection in the United States and is associated with a high mortality. One quarter of patients treated for CDI have at least one recurrence. Spore pe...Clostridium difficile infection(CDI) is the most common nosocomial infection in the United States and is associated with a high mortality. One quarter of patients treated for CDI have at least one recurrence. Spore persistence, impaired host immune response and alteration in the gastrointestinal microbiome due to antibiotic use are factors in recurrent disease. We review the etiology of recurrent CDI and best approaches to management including fecal microbiota transplantation.展开更多
Syncope forms a major part of medical in-flight emergencies contributing one-infour in-flight medical events accounting to 70%of flight diversions.In such patients,it is important to elucidate the pathophysiology of s...Syncope forms a major part of medical in-flight emergencies contributing one-infour in-flight medical events accounting to 70%of flight diversions.In such patients,it is important to elucidate the pathophysiology of syncope prior to diversion.Postural hypotension is the most common etiology of in-flight syncopal events.However,individuals without any underlying autonomic dysfunction can still experience syncope from hypoxia also known as airline syncope.Initial steps in managing such patients include positioning followed by the airway,breathing and circulation of resuscitation.These interventions need to be in close coordination with ground control to determine decision for flight diversion.Interventions which have been tried for prevention include mental challenge and increased salt and fluid intake.The current paper enhances the understanding of airline syncope by summarizing the associated pathophysiologic mechanisms and the management medical personnel can initiate with limited resources.展开更多
文摘Background: Physician discharge instructions are critical to patient care because they are the link transitioning the hospital care plan to the home. We hypothesize that physician perception of discharge instructions communication is better than patient perception. Objective: In a preliminary study, to compare patient and physician perception of communication at discharge. Design: Observational, survey-based. Setting: 330-bed adult teaching hospital. Participants: Surveys were mailed to 100 patients discharged home and 49 internal medicine physicians responsible for those patients’ care. Each physician had between 1 and 4 patients surveyed. Measurements: Patients and physicians received anonymous 5-item questionnaires concerning physician communication at discharge. Patient surveys inquired about their physicians’ communication at the specific physician encounter, while physician surveys asked about the physicians’ overall self-perception of discharge communication skills. Results: Completed questionnaires were returned by 59 patients and 40 physicians. Physicians reported a noticeably better perception of communication than their patients regarding spending adequate time reviewing the discharge plan (83% vs. 61%, P = 0.027), speaking slowly enough to understand (98% vs. 80%, P = 0.013), using wording that could be easily understood (100% vs. 68%, P P = 0.008). Perception of discharge communication improved with physician experience for several survey items. Conclusions: This study provides evidence suggesting that physician perception of communication at discharge is better than patient perception. Future studies of larger sample size and direct patient-physician pairing focusing on patient satisfaction and outcomes are needed.
文摘The human gut is colonized by a community of microbiota,primarily bacteria,that exist in a symbiotic relationship with the host.Intestinal microbiota-host interactions play a critical role in the regulation of human physiology.Deleterious changes to the composition of gut microbiota,referred to as gut dysbiosis,has been linked to the development and progression of numerous diseases,including cardiovascular disease(CVD).Imbalances in host-microbial interaction impair homeostatic mechanisms that regulate health and can activate multiple pathways leading to CVD risk factor progression.Most CVD risk factors,including aging,obesity,dietary patterns,and a sedentary lifestyle,have been shown to induce gut dysbiosis.Dysbiosis is associated with intestinal inflammation and reduced integrity of the gut barrier,which in turn increases circulating levels of bacterial structural components and microbial metabolites,including trimethylamine-N-oxide and short-chain fatty acids,that may facilitate the development of CVD.This article reviews the normal function and composition of the gut microbiome,mechanisms leading to the leaky gut syndrome,its mechanistic link to CVD and potential novel therapeutic approaches aimed towards restoring gut microbiome and CVD prevention.As CVD is the leading cause of deaths globally,investigating the gut microbiota as a locus of intervention presents a novel and clinically relevant avenue for future research.
文摘Clostridium difficile infection(CDI) is the most common nosocomial infection in the United States and is associated with a high mortality. One quarter of patients treated for CDI have at least one recurrence. Spore persistence, impaired host immune response and alteration in the gastrointestinal microbiome due to antibiotic use are factors in recurrent disease. We review the etiology of recurrent CDI and best approaches to management including fecal microbiota transplantation.
文摘Syncope forms a major part of medical in-flight emergencies contributing one-infour in-flight medical events accounting to 70%of flight diversions.In such patients,it is important to elucidate the pathophysiology of syncope prior to diversion.Postural hypotension is the most common etiology of in-flight syncopal events.However,individuals without any underlying autonomic dysfunction can still experience syncope from hypoxia also known as airline syncope.Initial steps in managing such patients include positioning followed by the airway,breathing and circulation of resuscitation.These interventions need to be in close coordination with ground control to determine decision for flight diversion.Interventions which have been tried for prevention include mental challenge and increased salt and fluid intake.The current paper enhances the understanding of airline syncope by summarizing the associated pathophysiologic mechanisms and the management medical personnel can initiate with limited resources.