Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007
Physician Self-disclosure in Primary Care Visits: Enough About You, What About Me?
Background: The value of physician self-disclosure (MD-SD) in creating successful patient-physician partnerships has not been demonstrated.
Methods: To describe antecedents, delivery, and effects of MD-SD in primary care visits, we conducted a descriptive study using sequence analysis of transcripts of 113 unannounced, undetected, standardized patient visits to primary care physicians. Our main outcome measures were the number of MD-SDs per visit; number of visits with MD-SDs; word count; antecedents, timing, and effect of MD-SD on subsequent physician and patient communication; content and focus of MD-SD.
Results: The MD-SDs included discussion of personal emotions and experiences, families and/or relationships, professional descriptions, and personal experiences with the patient's diagnosis. Seventy-three MD-SDs were identified in 38 (34%) of 113 visits. Ten MD-SDs (14%) were a response to a patient question. Forty-four (60%) followed patient symptoms, family, or feelings; 29 (40%) were unrelated. Only 29 encounters (21%) returned to the patient topic preceding the disclosure. Most MD-SDs (n = 62; 85%) were not considered useful to the patient by the research team. Eight MD-SDs (11%) were coded as disruptive.
Conclusions: Practicing primary care physicians disclosed information about themselves or their families in 34% of new visits with unannounced, undetected, standardized patients. There was no evidence of positive effect of MD-SDs; some appeared disruptive. Primary care physicians should consider when self-disclosing whether other behaviors such as empathy might accomplish their goals more effectively.
McDaniel SH, Beckman HB, Morse DS, Silberman J, Seaburn DB, Epstein RM
Breaking Strength of Barbed Polypropylene Sutures: Rater-Blinded, Controlled Comparison With Nonbarbed Sutures of Various Calibers
Objectives: To assess the strength of 2.0 barbed polypropylene suture, and, specifically, to determine the load required to break this suture, and to compare this with the strength of nonbarbed polypropylene suture.
Design: Rater-blinded, controlled trial. The individual responsible for setting up the experimental conditions was not blinded.
Setting: Biomechanics laboratory in an academic medical center.
Materials: This study did not include human subjects. Materials used included six 2.0 barbed polypropylene sutures and 3 each of 2.0, 3.0, 4.0, and 5.0 nonbarbed polypropylene sutures. Each suture was randomly selected from a different batch or box of similar sutures.
Intervention: Each suture was strung between 2 (top and bottom) cylinders and tied with a surgeon's knot. A tensile testing device was used to apply increasing force until the suture broke. Data were acquired through an analog-to-digital board on an IBM-compatible computer using commercially available software.
Main Outcome Measures: Ultimate strength, stiffness, and elongation before suture rupture.
Results: Strength of the barbed sutures (mean [SD] ultimate strength, 39.5 [9.0] N) was intermediate between that of 2.0 (55.0 N) and 3.0 (36.4 N) nonbarbed sutures and was not significantly different from that of 3.0 nonbarbed sutures (P = .5). Barbed 2.0 polypropylene sutures differed significantly (P < .001) from each of the other types of nonbarbed sutures on measures of stiffness and elongation. Elongation of barbed sutures was closest to that of 3.0 nonbarbed sutures (P = .002). Stiffness of the barbed sutures (mean [SD], 4.7 [0.7] N/mm) was markedly in excess of that of any of the other suture types (P < .001).
Conclusions: Barbed 2.0 polypropylene sutures seem to be at least as strong as 3.0 nonbarbed polypropylene sutures. As such, barbed sutures are significantly stronger than their rated strength, which has been stated as comparable to 4.0 nonbarbed sutures. This has implications for the long-term in vivo safety of barbed sutures.
Rashid R, Sartori M, White LE, Villa MT, Yoo SS, Alam M
Abnormal Brain Structure in Children With Isolated Clefts of the Lip or Palate
Objective: To evaluate brain structure in a sample of children with isolated clefts of the lip and/or palate (ICLP).
Design: Case-control study.
Setting: Tertiary care center.
Participants: A large sample of 74 children aged 7 to 17 years with ICLP was compared with a healthy control group, matched by age and sex.
Main Exposure: Isolated cleft lip and/or palate.
Outcome Measures: General measures of height and head circumference were obtained. Brain structure was evaluated using magnetic resonance imaging, generating both general and regional brain measures (volumes).
Results: Height was significantly lower in the ICLP group (F = 4.83, P = .03). After controlling for this smaller body size, children with ICLP had abnormally small brains with both cerebrum (F = 4.47, P = .04) and cerebellum (F = 14.56, P < .001) volumes substantially decreased. Within the cerebrum, the frontal lobe was preferentially decreased (F = 7.22, P = .008) and subcortical nuclei were also substantially smaller (F = 4.18, P = .003). Tissue distribution of cortical gray matter and white matter within the cerebrum were abnormal in boys with ICLP (larger cortical volume, smaller volume of white matter) but proportional to controls in girls with ICLP.
Conclusions: Children with ICLP have abnormal brain structure, potentially due to abnormal brain development. The fact that the pattern of brain abnormalities in children with ICLP is dramatically different from the pattern of brain abnormalities seen in adults with ICLP suggests that brain growth and development trajectory is also abnormal in subjects with ICLP.
Nopoulos P, Langbehn DR, Canady J, Magnotta V, Richman L
Impact of the 80-Hour Workweek on Patient Care at a Level I Trauma Center
Hypothesis: The 80-hour workweek limitation for surgical residents is associated with an increase in mortality and complication rates among adult trauma surgical patients.
Design: Retrospective cohort study.
Setting: Academic level I trauma center.
Patients: Trauma patients admitted before and after the 80-hour workweek limitation.
Methods: We compared death and complication rates for adult trauma patients admitted during a 24-month period before (2001-2003) and a 24-month period after (2004-2006) implementation of the 80-hour workweek at our institution. Relative risk and its 95% confidence intervals were examined.
Main Outcome Measures: Patient care outcomes included preventable and nonpreventable complications and deaths.
Results: The patient populations from the 2 time periods were clinically similar. No significant differences were found in the total and the preventable death rates. The time period after the 80-hour workweek mandate had a significantly higher total complication rate (5.64% vs 7.28%; relative risk, 1.29; 95% confidence interval, 1.15-1.45; P < .001), preventable complication rate (0.89% vs 1.28%; relative risk, 1.43; 95% confidence interval, 1.06-1.91; P = .02), and nonpreventable complication rate (4.75% vs 5.81%; relative risk, 1.22; 95% confidence interval, 1.08-1.39; P = .002).
Conclusion: Although there was no difference in deaths between the 2 time periods, there was a significant increase in total, preventable, and nonpreventable complications. This increase in complication rate may be due, in part, to the new 80-hour workweek policy.
Salim A, Teixeira PG, Chan L, Oncel D, Inaba K, Brown C, Rhee P, Berne TV
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2007;9(6):449-450. doi: