Articles: cations.
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The Joseph M Donald Endowment for the Archival Collection of the Southern Surgical Association is named for the 73rd President Elect of the Southern Surgical Association (Figure 1), who died in 1961 at age 57 before he had the opportunity to deliver his Presidential Address. Dr Donald's career as a surgeon in Birmingham began in 1931 after the completion of his residency at the Mayo Clinic. He was one of four generations of Donalds to serve Alabama as physicians. ⋯ Two of his sons, Joseph, Jr and Thomas trained as surgeons. From 1854 until the present, twenty-four Donald or Donald-related physicians have practiced in Alabama (personal communication, Dr Thomas T Donald). The present talk is dedicated to the memory of Dr Joseph Marion Donald and his contributions to the field of surgery.
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Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis. ⋯ The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.
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The magnitude of advances in surgical care inspires awe consistent with the impact of these developments on patients' lives. With this comes greater knowledge, new practices, and novel technologies for integration into residency training, making the skillset required of today's residents quite different from those in the past. Competency-based medical education and learner-centered approaches offer innovative and studied methodologies for teaching, learning, and assessment to meet the demands of today's educational environment. ⋯ The research agenda includes five domains of inquiry: entrustment and practice readiness; bias and environment; distinguishing features and certification; qualitative feedback; and patient outcomes, and builds upon prior work by ten Cate et al. by expanding upon their organizing framework to also include the element of time. Additionally, the authors provide questions and suggest data integration strategies that might foster a breadth of studies investigating the utility of Entrustable Professional Activities in surgical training. Collectively engaging in such a process of evaluation early in the process of competency-based reform will serve to optimize education, assessment, and ultimately patient care.
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Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible. ⋯ The discussion explores how on these three levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e. not a neutral or desirable state of being), while, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also shows how patients and healthcare providers often orient to the stigma around chronic pain.