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Never Waste a Pandemic: Strategies to Increase Advance Care Planning Now
Coronavirus disease 2019 (COVID-19)–related deaths and hospitalizations have created a global health crisis with unprecedented scarcity of health care resources and staffing in parts of the United States and around the world. The pandemic has led to important discussions about just allocation of health care resources. News headlines about COVID-19 feature family members who announce hospitalized loved ones died after treatment options were denied. Other articles demonstrate that patients may not fully understand the ramifications of elected care in an intensive care setting, unpredictability of outcomes, and how this may impact future abilities.Harry Lee Parker: Games Lost and Won on the Playing Fields of Neurology
Harry Lee Parker (1894–1959) was an American and Irish neurologist who reported unique paroxysmal symptoms in patients with multiple sclerosis,1 and wrote a book on clinical neurology popular enough to be reprinted 13 years after initial publication.2 Parker penned profiles of other physicians,3-5 but his biography has only been touched on briefly in obituaries,6,7 articles,1,8,9 and books.10-13 Following his advice that “a honeyed obituary is an insult to the dead (p. 596),”5 we will describe in detail the life of Dr.The Team Approach to Spinal Cord and Dorsal Root Ganglion Stimulation: A Guide for the Advanced Practice Provider
Because of shortages in the US primary care workforce in the 1960s, the role of the nurse practitioner and physician assistant emerged.1 The tasks of these individuals are often considered similar, and together they are known as advanced practice providers (APPs). The nurse practitioner is an advanced practice registered nurse who has completed additional training and education, earning a master’s or doctoral degree. Physician assistants train for an additional 2 years beyond a Bachelor of Arts or Science degree to earn a physician assistant degree.2020—The Year the World Was Awakened to the Importance of Supply Chain Management
Some consumers have an understanding of and appreciation for the importance of supply chains. However, most also take for granted that a supply chain performs flawlessly. Over many years, we have been lulled into a false sense of supply chain stability and security. From the consumer perspective, this belief is primarily the result of a product being immediately available when we shop or having it delivered the next day to our doorstep from a fulfillment center. When this happens, the obvious conclusion is, “it must be working.” The coronavirus disease 2019 (COVID-19) pandemic challenges conventional wisdom related to the resiliency and agility of the supply chains in health care and many other industries.Learning Health System in Crisis: Lessons From the COVID-19 Pandemic
The coronavirus disease 2019 (COVID-19) pandemic is the gravest public health crisis that the United States has seen in more than a century. Health care delivery systems are the focal point for interfacing with COVID-19; however, many were and remain unprepared for this or similar outbreaks. In this article, we describe the learning health system (LHS) as an ideal organizing principle to inform an evidence-based response to public health emergencies like COVID-19. We further describe barriers and challenges to the realization of the LHS and propose a call to action for a substantial investment in the LHS, with a focus on public health.Reciprocal Development and Progressive Responsibility: The History of the Mayo Clinic Neurology Residency
The first Mayo Clinic neurology resident began training approximately 1 century ago. Over the subsequent 100 years, 639 budding specialists in diseases of the nervous system graduated from the Mayo Clinic Neurology Residency in Rochester, Minnesota. The history of the American residency has been thoroughly covered by Ludmerer in his 2014 book Let Me Heal,1 and a history of the Mayo Clinic Otolaryngology Residency Program was published in 2020.2 Mulder discussed education in the Mayo Clinic Department of Neurology as part of an overview of the history of the department in 1971.Balancing Unbalanced Lives: A Practical Framework for Personal and Organizational Change
Rising rates of physician burnout have led to efforts to decrease stress in clinical environments. Although mild to moderate stress can improve productivity, prolonged or sustained stress becomes “distress,” as revealed by national statistics on physician burnout.1 Burnout can affect personal relationships and disrupt family life. Professionally, burnout can harm patient care, relationships with patients and colleagues, a person's integrity, and, eventually, the viability of our health care system, as providers exit prematurely and patients lose confidence in their care.Survival With Auricular Fibrillation: The View From a Century Ago at the Mayo Clinic
Atrial fibrillation is a common disease affecting millions of Americans. A century ago, it was a less regularly recognized phenomenon. With the advent of the electrocardiogram (ECG), this arrhythmia could be more readily identified. Frederick Willius, the first specialist in cardiology at the Mayo Clinic Rochester, became interested in the survival of patients with this condition. Using the tools at hand, he studied the outcome of 500 patients found to have ECG changes consistent with auricular fibrillation, as the condition was known at that time.Offshore Pharmaceutical Trials: Evidence, Economics, and Ethics
Backed by a group of wealthy investors and an American university, a US pharmaceutical company recently flouted United States Food and Drug Administration (FDA) safety protections by testing an experimental herpes vaccine offshore.1 More than 20 American patients with herpes were flown to St Kitts several times to be vaccinated.1 By participating in a study that was not monitored by the FDA or a safety panel, patients forewent mandated layers of protection against dangerous adverse effects or even death.Integrated Care: A Disruptive Innovation for Extending Psychiatric Expertise to Primary Care Practices
Behavioral health disorders (mental health problems and substance use disorders) are highly prevalent, negatively impact chronic medical illness, and raise the overall cost of health care from increased emergency department utilization, hospital readmission rates, and occupational disability.1-3 Psychiatrists make up a scarce and expensive resource needed to address the demand for treatment of patients with behavioral health disorders. Patients in rural areas are even more in need as problems with access and capacity persist, particularly as psychiatrists are located primarily in major cities and urban areas.The Challenging Conundrum of Diagnosing and Managing Clostridium difficile Infection
Management of patients with Clostridium difficile infection (CDI) can be very difficult, especially for the approximately 25% of patients who have had recurrences, and particularly for those who have had multiple recurrences. Following recurrence, patients typically respond to a new course of antimicrobial treatment, usually with vancomycin or fidaxomicin, but often have another recurrence within a few days to months after stopping treatment. Although treatment failure to resolve symptoms is not uncommon when metronidazole is used,1 failure to resolve symptoms when treated with a new course of antimicrobial treatment with either vancomycin or fidaxomicin is an indication that a condition other than CDI may be the cause of the patient's symptoms.
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