The Mount Sinai journal of medicine, New York
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Laboratory tests comprise a significant portion of hospital expenditure. Attempts to reduce their use have had mixed results. ⋯ The intervention developed here produced significant and sustained reduction of financial savings in the number of laboratory tests ordered, without negatively impacting diagnostic capability or patient care.
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Case Reports
Pulsed radiofrequency for the treatment of ilioinguinal neuralgia after inguinal herniorrhaphy.
Ilioinguinal neuralgia secondary to inguinal hernia repair is frequently a chronic, debilitating pain. It is most often due to destruction or entrapment of nerve tissue from staples, sutures, or direct surgical trauma. Treatment modalities, including oral analgesics, nerve blocks, mesh excision, and surgical neurectomy, have varied success rates. Pulsed radiofrequency (PRF) has recently been described as a successful method of treating chronic groin pain. Unlike conventional radiofrequency, PRF is non-neurodestructive and therefore less painful and without the potential complications of neuritis-like reactions and neuroma formation. Although the mechanism is unknown, it appears that the interaction of an electromagnetic field and c-fos proteins may alter normal transmission of painful impulses. Our study examines five patients treated with PRF for ilioinguinal neuralgia secondary to inguinal herniorrhaphy. ⋯ Ilioinguinal neuralgia is challenging to treat. We have demonstrated the successful use of PRF for four out of five patients seen in our office.
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This paper reviews the development of the concept of medical futility, particularly as it applies to pediatrics. It discusses the difference between technical considerations and value considerations in futility determinations, and then breaks down the concept of futility into four components - power, money, trust and hope.
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Case Reports
An exploration of the ethical, legal and developmental issues in the care of an adolescent patient.
Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. ⋯ Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.
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Parents often make medical decisions for their children. As pediatricians, we must be sure that the decisions are medically informed. At times, we may disagree with the decisions that parents make and must decide if they are acting in the best interest of their child. This article presents a case in which these issues arose regarding a child with trisomy 13.