Discrepant Views of Oncologists and Cancer Patients on Complementary and Alternative Medicine in a Chinese General Hospital.

PURPOSE: Complementary and alternative medicine (CAM) has been widely used by cancer patients but rarely discussed by oncologists. This study was designed to evaluate the communication gap between China's oncologists and cancer patients on CAM. METHODS: Two parallel cross-sectional studies assessed 83 oncologists and 402 cancer patients on CAM communication between patients and oncologists, and attitudes toward CAM use and clinical decisions about CAM. RESULTS: A majority (75.1%) of the cancer patients (302/402) were identified as CAM users within the most recent three months while 77.6% of the cancer patients (312/402) were identified as CAM users since diagnosis of cancer. Oncologists and patients responded differently ( P < .001) on CAM communications. Both oncologists and patients expected that CAM could improve the immune system. They both agreed that oncologists usually discouraged their patients from using CAM. Regarding the effectiveness of CAM, cancer patients were more likely to believe that CAM was effective while oncologists had more concerns about adverse effects of CAM use. CAM use by patients was predicted by disease duration (≥9 months) in the multivariable logistic regression model. CONCLUSION: China's oncologists and cancer patients may hold discrepant views on CAM. China's oncologists are encouraged to improve their knowledge on CAM and to initiate more discussions with their patients regarding effective and the safe use of CAM.

Implementation and assessment of a required transitions-of-care residency rotation.

PURPOSE: The implementation of a required residency rotation in transitions of care (TOCs) and the resulting resident-led clinical interventions and learning experiences are described. SUMMARY: A newly required four-week TOC rotation was implemented for postgraduate year 1 (PGY1) pharmacy residents at Massachusetts General Hospital (MGH). Unlike acute care rotations, this learning experience encouraged residents to focus on providing direct patient care in a holistic manner and use pharmacologic and nonpharmacologic strategies to improve patient outcomes. The residents encountered patients with multiple comorbidities and were expected to manage common chronic diseases in a predominantly geriatric population. This rotation focuses on medically complex patients at high risk for readmission. TOC pharmacists and residents collaborate with multidisciplinary teams in both the outpatient and inpatient settings around the time of discharge from the hospital. All residents found the experience valuable and believed that the lessons learned would be incorporated into their future clinical practice. Residents gained a thorough understanding of conducting comprehensive medication reviews, assessing barriers to patients' understanding of and adherence to their medications, and working as part of a multidisciplinary team to address and overcome medication-related barriers during TOCs. CONCLUSION: The TOC rotation at MGH provided PGY1 residents with a better understanding of the challenges of continuity of care, the impact of medication access on patient outcomes, and the promotion of medication adherence through patient engagement. The activities reported most valuable by residents included providing direct patient education, performing case reviews with the preceptor, collaborating with the preceptor on patient visits, and completing comprehensive medication reviews.

Teaching a neuromedical-contextual approach to psychosomatic medicine.

The practice of psychosomatic medicine in the general hospital setting can be challenging, particularly for the inexperienced trainee. Guidance for how to approach a psychiatric consultation can be nonspecific or lacking altogether. In response, we offer a pedagogical model that emphasizes patient-specific neurological, medical, and contextual variables. A stepwise, "ABC" approach to psychiatric consultation is elaborated, beginning with collection of critical history ("Admission, Background, Consultation Question"), followed by both patient encounter ("Appearance, Behavior, Context") and actual patient examination ("Arousal, Brain/Body, Cognitive Assessment"), ultimately informing any given case formulation. Multiple clinical vignettes illustrate this approach and are offered for educational purposes in dissemination to trainees.

Risk mitigation of shared electronic records system in campus institutions: medical social work practice in singapore.

In 2013, the Singapore General Hospital (SGH) Campus initiated a shared electronic system where patient records and documentations were standardized and shared across institutions within the Campus. The project was initiated to enhance quality of health care, improve accessibility, and ensure integrated (as opposed to fragmented) care for best outcomes in our patients. In mitigating the risks of ICT, it was found that familiarity with guiding ethical principles, and ensuring adherence to regulatory and technical competencies in medical social work were important. The need to negotiate and maneuver in a large environment within the Campus to ensure proactive integrative process helped.