As another school year starts parents renew their annual efforts to help their children do well. Dr. Levine states that authoritative parents are able to cultivate much higher levels of motivation in their children than those who use other parenting styles.
The Canadian Medical Protective Association (Canada’s provider of medical liability protection) has advised its members to consider fully the risks when caring for patients having bariatric surgery.
“Understanding the medicolegal risks of caring for patients having bariatric surgery in Canada allows surgeons, and other physicians involved in caring for these patients, to better manage those risks,” Diane Héroux, a medical analyst, and Gordon Wallace, the association’s director of education, write in an association journal.1
Between 2006 and 2011 the association dealt with 27 medicolegal cases relating to bariatric surgery, 21 of which were settled. A review of the closed cases showed that the main allegations from patients were that consent discussions were lacking and histories were inadequate. Experts did not express concerns about the appropriateness of the surgery. The only association members involved in these cases were general surgeons.
The procedure performed most often was gastric banding (vertical banding or adjustable gastric banding), followed by open or laparoscopic Roux-en-Y gastric bypass and open biliopancreatic bypass (biliopancreatic diversion or duodenal switch). The patients’ body mass indexes (BMIs) ranged from 35 to 74, and many had comorbid conditions such as type 2 diabetes, hypertension, and sleep apnoea.
Review of the cases showed that all three surgical approaches commonly used in Canada had major complications. In the gastric banding procedures, complications included surgical site infection, gastric band leakage, and slippage or erosion with secondary peritonitis.
Complications of Roux-en-Y gastric bypass included ventral incisional hernia, anastomotic leak, and death from septic shock. Complications of biliopancreatic bypass included gastrojejunal anastomotic stricture and persistent diarrhoea and nutritional deficiencies.
The authors suggest various strategies for managing the risks of bariatric surgery (strategies that are based on the opinions of the surgical experts who examined the clinical care in the cases reviewed). They recommend that before an operation there should be an appropriate informed consent discussion that informs patients about the proposed surgical procedure, the expected outcome, significant risks and complications, and available alternatives.
The authors remind members that the surgeon should comprehensively document all care and be attentive to communication with patients and families. It is also important to identify possible pregnancy in female patients and consider the provision of prophylactic antibiotics and deep vein thrombosis prophylaxis.
They suggest that during the operation surgeons should consider converting from a laparoscopic to an open approach when uncertain of the anatomy or when experiencing difficulty.
After the operation, patients should receive discharge instructions that include the signs and symptoms of potential complications and explain the importance of seeking additional care (with whom and when). Doctors should inform patients of arrangements for follow-up care, including who will be providing the care. The association advises its members to document discharge advice (general and customised) in the medical record, with either a reference to or a copy of any associated handout material given to the patient.
“All physicians should be aware that it is often challenging to assess patients with complications from bariatric surgery as the symptoms can be non-specific and develop anywhere from a few hours to years after the surgery,” recommend the authors.
The Mind-Body Medicine Research Laboratory at Baylor and its national associates are researching how to use hypnotherapy and “cool” mental imagery to treat menopausal women who are experiencing hot flashes.
UK Happiness study explores who are the happiest people in the uk. Link. This entry was posted in Lifestyle and tagged UK, happiness, personality, psychology. Bookmark the permalink. ← A Look at 2011 Mobile Users of ...
If you're happy and you know it, you may just live longer than the sad sack sitting next to you. Researchers have found that happier people are 35% less likely to die over the next five years than their less joyful counterparts.
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