Addressing mental health issues in primary care: An initial curriculum for medical residents

Objective

Many express concern that modern medicine fails to provide adequate psychosocial and mental health care. Our educational system has not trained the primary care providers who care for most of these patients. Our objective here is to propose a quantum change: prepare residents and students during all years of training so that they are as effective in treating psychosocial and mental health issues as they are medical problems.

Method

We operationalize this objective, following Kern, by developing an intensive 3-year curriculum in psychosocial and mental health care for medical residents based on models with a strong evidence-base.

Results

We report an intensive curriculum that can guide others with similar training interests and also initiate the conversation about how best to prepare residency graduates to provide effective mental health and psychosocial care.

Conclusion

Identifying specific curricula informs education policy-makers of the specific requirements they will need to meet if psychosocial and mental health training are to improve.

Practice Implications

Training residents in mental health will lead to improved care for this very prevalent primary care population.     

新型超声导管体外消融血栓

目的探讨新型超声导管体外消融血栓的可行性和疗效。方法体外制备人全血细胞血栓54份并分成三组,应用传统球型（Ⅰ型）和新的球部顶端平截面型（Ⅱ型）及前方带缺口球型（Ⅲ型）三种不同头端的低频高能超声导管,体外对全血细胞血栓块行超声消融60s,比较消融前后固体血栓称重及融栓后上清液血栓碎片和红细胞直径。结果不同头端超声导管均可明显消融血栓,消融前后固体血栓称重差异比有显著意义（P〈0．01）,Ⅲ型和Ⅰ型组明显优于Ⅱ型组（P〈0．05）;显微镜下90％血栓碎片直径小于红细胞。结论体外低频高能超声可消融血栓,头端形状对血栓超声消融能力有明显的影响。     

ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion

Background

A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a “Salvage Procedure” for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure.

Is there any difference between right hepatectomy and left lateral sectionectomy for living donors? As much you cut,as much you hurt?

Background:

The worldwide rising demand for cadaveric donors in liver transplantation is an important incentive for the development of alternative transplantation options, such as living donors. A precise evaluation of surgical complications is, therefore, considered to be an important issue in this setting.

Aim:

Present a retrospective analysis of 126 living donors hepatectomies undertaken at our centre.

Methods:

From December 2002 to August 2009, 126 living donors were submitted to hepatectomy. Donors'' complications were stratified according to Clavien''s scoring system to compare the morbidity of right hepatectomy (RH) (Group 1) and left lateral sectionectomy (LLS) (Group 2).

Results:

Thirty-nine complications were observed in 35 patients. Sixty LLS, 3 left (LH) and 63 RH were performed. The complications were classified as: Clavien grade 1–11 (28.2%), grade 2–12 (30.7%), grade 3A–13 (33.3%), grade 3B–2 (5.1%) and grade 4A–1 (2.5%). When Group 1 (63 patients) and Group 2 (60 patients) were compared, there was no significant difference between the number of complications: 20 (31%) and 14 (23%), respectively (P > 0.3).

Conclusions:

Hepatectomy for living donor liver transplantation (LDLT) was a safe procedure, regardless of the type of liver resection undertaken. We found no difference in morbidity between RH and LLS, which suggests that complications may occur despite the amount of liver retrieved.