Finding meaning in medical education - how the hermeneutic window can help primary care educators.

We have published a model in which biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching conversations both between clinicians and patients and also between teachers and learners. We have also proposed that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum. In this article, we consider how hermeneutics can be applied in primary care training and supervision, in order to enhance the experience for both teacher and learner.

Moral flux in primary care : the effect of complexity.

In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case study developed from our day-to-day experience working as clinical practitioners in primary care.

Non-nutritive sucking habits in a child: A clinical protocol to their prevention and management.

Patients presenting with anterior open bites can be challenging to manage. This paper discusses the clinical features and aetiology of anterior open bites caused by non-nutritive sucking habits in a young child. It explores how these should be recognised and how certain interventions can be effective in their management. Whilst further high quality research is needed into the different methods and their effectiveness, the aim of the article is to provide a practical guide for general dental practitioners, orthodontists and paediatric dentists, who are involved in monitoring the developing dentitions of these patients.

Evaluation of the reflecting team as an educational intervention.

Background: The reflecting team is a way of exploring clinical or educational dilemmas. A key difference from traditional case discussion is that the case presenter is not actively involved in the group discussion but instead listens to the ideas and thoughts generated, without contributing to the narrative. The origins of the reflecting team are in family therapy and there is little evidence on how successfully the technique can be transposed to clinical or educational practice.Aim: To evaluate the effectiveness of the reflecting team as an educational intervention.Design and setting: Interpretive action research involving 10 GPs who were either enrolled on the Induction and Refresher Scheme or who were members of a learning set of GP educators.Method: Interview data were audio-recorded, transcribed verbatim and thematic analysis was used to identify themes.Results: The reflecting team appeared to be an effective and acceptable intervention. Key features of the reflecting team included the opening up of new perspectives, feeling validated by peers, the need for ground rules and the perception of the reflecting team as a practical tool.Conclusions: The reflecting team is a new way of undertaking case discussion in GP education and seems to offer some advantages over traditional case discussion. It lends itself well to learning groups and it is possible that the idea might be transposed to clinical settings too.

Development of the continuous curvilinear lenticulerrhexis technique for small incision lenticule extraction.

PURPOSE: To develop and evaluate the new continuous curvilinear lenticulerrhexis (CCL) technique for small incision lenticule extraction. METHODS: Thirty-one eyes of 20 patients with myopia were included in the study. The CCL technique for lenticule extraction was developed and used in 16 eyes of 10 patients (CCL group). The traditional technique of lenticule extraction was used in 15 eyes of 10 patients (traditional group). Uncorrected and corrected distance visual acuity, manifest refraction, lenticule quality, the duration of the extraction procedure, microdistorsions in Bowman's layer under optical coherence tomography (Optovue OCT; Optovue, Inc., Fremont, CA), and adverse events were evaluated at 1 day and 1 month postoperatively. RESULTS: At the first postoperative month, all eyes in both groups had an uncorrected distance visual acuity of 1.0 or better. The safety indices were 1.12 and 1.09 for the CCL and traditional groups, respectively. The efficacy indices were 1.06 and 1.09 for the CCL and traditional groups, respectively. All lenticules in the CCL group had intact, round margins, whereas one lenticule in the traditional group had a microdefect margin. There was no statistically significant difference in duration of lenticule extraction or microdistorsions in Bowman's layer. No eyes in the CCL group developed diffuse lamellar keratitis, as compared to one eye in the traditional group. CONCLUSIONS: The CCL technique exhibited excellent safety and efficacy for myopia correction, suggesting CCL is a promising technique that merits further development and study.

Relational care and epistemic injustice.

The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.

Critical Care of the Lung Transplant Patient.

Lung transplantation is a therapeutic option for end-stage lung disease that improves survival and quality of life. Prelung transplant admission to the intensive care unit (ICU) for bridge to transplant with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) is common. Primary graft dysfunction is an important immediate complication of lung transplantation with short- and long-term morbidity and mortality. Later transplant-related causes of respiratory failure necessitating ICU admission include acute cellular rejection, atypical infections, and chronic lung allograft dysfunction. Lung transplantation for COVID-19-related ARDS is increasingly common..

Rapid Design and Implementation of Post-COVID-19 Clinics.

Survivors of COVID-19 are a vulnerable population, with complex needs because of lingering symptoms and complications across multiple organ systems. Those who required hospitalization or intensive care are also at risk for post-hospital syndrome and post-ICU syndromes, with attendant cognitive, psychological, and physical impairments, and high levels of health care utilization. Effective ambulatory care for COVID-19 survivors requires coordination across multiple subspecialties, which can be burdensome if not well coordinated. With growing recognition of these needs, post-COVID-19 clinics are being created across the country. We describe the design and implementation of multidisciplinary post-COVID-19 clinics at two academic health systems, Johns Hopkins and the University of California-San Francisco. We highlight components of the model which should be replicated across sites, while acknowledging opportunities to tailor offerings to the local institutional context. Our goal is to provide a replicable framework for others to create these much-needed care delivery models for survivors of COVID-19.

Prosthetic Rehabilitation of a Partially Edentulous Patient with Maxillary Acquired Defect by a Two-Piece Hollow Bulb Obturator (Using a Dentogenic Concept).

Patients may face functional, aesthetic, and social distress because of the palatal defects. Prosthetic rehabilitation of maxillectomy or developmental defect can be challenging for prosthodontists. Prognosis of the prosthetic appliances can be affected not only by patients' own ability to adapt to the prosthesis but also by the factors like the remaining teeth, bony structure, and existing mucosa. Maxillary defects are usually developed by surgical intercession of the benign or malignant conditions and trauma cases. Speech, mastication and aesthetics can be hampered by any extent of palatal defect. During obturation of palatal/maxillectomy defects, the primary intent of the prosthodontist should be the shutting of the maxillectomy defect and parting of the oral cavity from the sinonasal openings by use of different bulb designs. In the present case, dentogenic concept has been applied while fabricating the two-piece hollow bulb obturator for restoration of the defect. Well known fact about the gravitational force is that it acts on maxillary obturator and reduces its retentive qualities, this can be counteracted to some extent by making the obturator hollow. Dentogenic concept is the skill, training, and procedure of generating the chimera of natural teeth in artificial teeth during prosthodontic restorations.