Alexandra Junewicz

Patient-satisfaction surveys on a scale of 0 to 10: Improving health care, or leading it astray?

Patient-satisfaction surveys can call attention to the importance of treating patients with dignity and respect, but good ratings depend more on manipulable patient perceptions than on good medicine. In fact, the pressure to get good ratings can lead to bad medicine.

Intraoperative anatomical variations during greater occipital nerve decompression.

OBJECT A study was conducted to elucidate anatomical variations of the GON and surrounding occipital tissues. METHODS Anatomical and surgical variations were prospectively recorded for 272 patients who underwent greater occipital nerve (GON) decompression by a single surgeon between 2003 and 2012. Data collection was performed intraoperatively and specifically for the purposes of this study. Documented anatomical variations of the GON and surrounding occipital region included the extension of trapezius musculature to the midline, abnormal lymph nodes, and GON branching. Necessary variations in the surgical procedure were also noted, including resection of a lateral portion of semispinalis capitis muscle and occipital arterectomy. RESULTS The GON pierced the semispinalis muscle in all patients bilaterally. The extension of trapezius musculature to the midline was discovered in 67.3 percent of patients and lymph node enlargement was discovered in 1.5 percent of patients. Branching of the GON was noted in 7.4 percent of patients and muscles or vessels between GON branches were noted in 3.7 percent of patients. Occipital arterectomy was required in 64.0 percent of patients and resection of a lateral segment of semispinalis muscle was required in 10.7 percent of patients. CONCLUSIONS The new anatomical variations described in this study improve understanding of the intraoperative anatomy of the occipital region and prevent difficulty in finding the GON due to dissection in the wrong plane, ensuring that MH patients receive maximal benefit from surgical treatment.

Of Playoff Tickets and Preschools: Health Care Advertising and Inequality

“The Ethics of Advertising for Health Care Services” (Schenker, Arnold, and London 2014) discusses many of the ethical risks presented by health care advertisements, including risks that the pursuit of unnecessary care poses to patients and to society. The authors note that patients often know neither which health services they need nor the quality of the care they receive, rendering them particularly vulnerable to a major goal of health care advertisers: “to create demand.” I expand on the article by arguing that health care advertisements by academic and nonprofit health care institutions pose even greater risks to patients and society by exacerbating existing inequalities within the health care system. Specifically, many health care advertisements are designed and intended to attract wealthier patients with private insurance. Given the reality that health care services are limited in society, encouraging wealthier patients to pursue unnecessary care risks leaving disadvantaged patients with less opportunity to obtain the care that they need. In order to more fully understand the social risks of health care advertising, it is critical to consider the patient population that health care advertisements are often trying to lure. Regardless of the methods and strategies involved, such advertisements are intended to attract patients. Of course, health care advertisements are directed toward patients who enjoy an array of options for their health care due to fewer insurance and financial constraints. Overwhelmingly, this population consists of patients with private insurance or with the financial resources to pay out-of-pocket for their care. The targets are not patients on Medicaid or with no health insurance at all, whose choices are typically limited to institutions willing to accept Medicaid or provide care free of charge. Hospitals that do perform a modest amount of “charity care” are unlikely to market with the intent of increasing that amount. Health care advertisements target wealthier patients in the types of services they promote, in the venues in which they appear, and in the images and types of concerns they feature. In one study of advertisements by academic medical centers, 28.6% of advertisements for single therapeutic interventions were for cosmetic procedures and 38.1% were for unproven procedures (Larson et al. 2005). Cosmetic and unproven procedures are often not an option for patients covered by private insurance plans, let alone patients with Medicaid or no insurance at all. Therefore, when health care

Shackled: Providing Health Care to Prisoners Outside of Prison

“The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine” (Jotterand and Wangmo 2014) challenges equivalence as the goal of prison medi...

Nature, Nurture, and Attachment: Implications in Light of Expanding Definitions of Parenthood

Recent expansion of the legal definition of parenthood in New York State raises the question of whether the presence of a genetic relationship between a parent and child trumps environmental and interpersonal factors in the formation of a strong, secure attachment bond. The purpose of this paper is to emphasize that attachment between a child and secure attachment figure is inherently biological, and that such biological attachment supersedes the existence of a genetic parent-child relationship. First, the paper provides an overview of attachment and its biological basis. It then discusses the impact on attachment of environmental and interpersonal influences, which current research suggests have the power to alter brain biology. There is no clear evidence that a genetic relationship confers a significant advantage in terms of attachment. This paper proposes that the term “biological parent” be redefined to include anyone with whom a child shares a strong attachment bond.

Q: Do patients who received only two doses of hepatitis B vaccine need a booster?

They should get one. However, two doses may be enough in healthy younger adults.

Victimization and Vulnerability: A Study of Incarceration, Interpersonal Trauma, and Patient-Physician Trust.

Despite the critical importance of patient–physician trust, it may be compromised among vulnerable patients, such as (1) incarcerated patients and (2) those patients who have been victims of trauma. The purpose of this study was to examine patient–physician trust among forensic and civilian psychiatric inpatient populations and to explore whether it varied based on a patient’s history of incarceration and/or victimization. A trust survey (WFPTS) and a trauma instrument (LEC-5) were administered to 93 patients hospitalized on forensic and civilian psychiatric hospital units in a large, urban public hospital. Results showed no difference in patient–physician trust between incarcerated and civilian patients. Similarly, there was no effect of a history of physical assault or sexual assault on ratings of patient–physician trust. However, the hospitalized civilian and forensic patients who reported being the victim of weapons assault had significantly lower patient–physician trust scores than their counterparts.

Rating Scales for Psychiatric Disorders

A large body of literature describes clinical and research instruments to evaluate patients with psychiatric illness along specific dimensions of symptom expression, comorbidity, and multiple other health outcomes. The use of rating scales in clinical practice and in research standardizes approaches for diagnosis and assessment. This chapter will review some of these rating scales within common diagnostic categories such as mood and psychotic disorders, post-traumatic stress disorder (PTSD) and anxiety disorders. Additional discussion will cover use of rating scales in clinical and research settings and future directions in the application of standardized rating scales. While there is a considerable body of literature on the many ways to use rating scales to measure a variety of important health domains, much work still needs to be done to optimize use of rating scales in advancing clinical practice and research. Standardized instruments can help in identifying individual or groups of individuals in order to quickly and efficiently deliver treatment that is appropriate for a given individual. The more standardization can be achieved, the easier it will be to compare individuals or groups of individuals and assess the relative quality of care and outcomes across care settings.

Management of soft tissue injuries

Soft tissue injuries represent the most common manifestation of craniomaxillofacial trauma seen and evaluated by emergency medical as well as surgical personnel. These soft tissue injuries of the head and neck frequently pose challenging reconstructive problems for the craniomaxillofacial surgeon, and their management entails careful evaluation and planning for optimal treatment. This chapter provides an overview of craniomaxillofacial soft tissue injuries and highlights the major considerations in their management. The reader is provided with a basic framework for analysis of the respective injuries by anatomic region as well as a guiding set of principles for repair. The chapter concludes with special considerations for bite wounds, pediatric soft tissue injuries, and soft tissue injuries associated with craniomaxillofacial fractures to give the reader additional information on these commonly encountered entities.

Primary cutaneous vs. parotid mucoepidermoid carcinoma of the scalp: A case report

Primary cutaneous mucoepidermoid carcinoma remains a rare occurrence. This is the first report of a case of primary cutaneous mucoepidermoid carcinoma originating on the scalp and subsequently metastasizing to the parotid gland. The patient was a 53-year-old female who presented with a purple mass on her scalp since 5 months prior to examination. Histopathology revealed nests and islands of atypical epithelioid cells with pleomorphism, medium to prominent nucleoli, and scattered mucin deposition highlighting with a mucicarmine stain. The atypical cells demonstrated intravascular involvement. These findings were compatible with metastatic adenocarcinoma. Later, fine needle aspiration of the patients parotid lesion revealed malignant cells from a poorly differentiated carcinoma that appeared similar to the patients previously excised scalp lesion. In addition to summarizing this patients presentation, clinical course, and management, we discuss the diagnostic challenges posed by this atypical presentation. Primary cutaneous mucoepidermoid carcinoma should be considered in the differential diagnosis of patients presenting with a scalp mass. Moreover, patients with primary cutaneous mucoepidermoid carcinoma originating on the scalp should be evaluated for possible metastases.