How to do when PFO closure failed under routine guidance:the first clinical experience for PFO closure

Patent foramen ovale(PFO)is the most common abnormality of fetal origin and is affecting approximately 25%of the worldwide adult population.[1]During the past two decades,instead of surgical closure,catheter-based procedures to close the PFO have become widely used among patients.Periprocedural guidance with fluoroscopy,transesophageal echocardiography(TEE)or intracardiac echocardiography have been the mainstream technique to ensure a safe and successful procedure.     

The caring physician: a journey in self-exploration and self-care

Caring for patients involves empathic listening and awareness of the needs and feelings of the patient as well as our own; the acceptance of the fallibilities of medicine and ourselves. Too often we lead unbalanced lives in terms of work, relationships, play and personal time. We frequently strive for perfection, deny our needs and feelings, assume total responsibility for the patient, and are altruistic to the point of self-denial. Caring for patients without adequately caring for ourselves is frequently associated with subconscious needs for external validation. The hidden agenda may be harmful to the patient and the physician. Change requires self-awareness and recognition of the overt and covert benefits and risk of our current work patterns. Often there is a need to reexamine our life priorities, set limits at work, admit vulnerability, share our emotional lives, and appreciate the small things in our daily life that give us meaning and purpose.     

A guide for considering performance-based assessments when determining a patient's capacity for safe, independent living

Clinicians treating older adults are often asked to evaluate the everyday functioning capabilities of their patients. Difficulties with daily functioning are part of the diagnostic criteria for most neuropsychiatric disorders, including dementia. Many methods of assessing daily functioning exist, including self- or collateral reports (through clinical interview or structured rating scales), direct home- or community-based observations, and performance-based measures conducted within the clinic or laboratory. Performance-based measures use simulated or role-play functioning scenarios and have the key advantage of decreasing reporter bias; these instruments may provide complementary information to subjective reports and/or field observations. Thus, treating clinicians should consider incorporating performance-based assessments as part of the diagnostic process to establish (or rule out) presence of functioning impairments and when developing recommendations about a patient's capacity for safe independent living.