Charting, Rhetoric, and Technical Communication: Improving Primary-Care Progress Notes and Patient Care through Attention to Audience and Purpose

Medical documentation--i.e., charting--is widely known to be crucial for patient care, billing, and legal protection, but it is simultaneously largely viewed as tedious, time-consuming busywork that takes clinicians away from patients, especially in the era of electronic health records (EHRs). There has been excellent but limited research on how writing skills (and thus, explicit writing instruction) influence both the charting experience and charting outcomes (Schryer, 1993; Opel & Hart-Davidson, 2019). In this project, I investigate how progress notes within EHRs could be improved if medical providers had more training in rhetoric and technical writing. Specifically, I focus on primary care, as primary-care providers have been shown to spend the most time on EHRs (Rotenstein et al, 2023). I draw upon a corpus of de-identified primary-care progress notes and the insights of primary-care providers, both sourced from clinics in rural Oregon. My major conclusions are that primary-care providers would benefit from being taught how to write with attention to audience and purpose and that rhetoricians of health and medicine have an opportunity to help improve patient charting

Breast Cancer Patients’ Experiences with Information and Communication in Cancer Disease Trajectories

Patients’ experiences have been used as an indicator for hospital quality for a long time. The concept of patient experiences has many facets. One aspect of particular importance for optimal treatment and patients’ quality of life is efficient and understandable information and communication between patients and health professionals. In this paper, we look closer into patients’ experiences in breast cancer care by following patients through their narratives related to their treatment trajectory 7–8 years after diagnosis. The specific aim has been to explore their perceptions and experiences regarding received information from and communication with health professionals during their breast cancer disease trajectory in a long-term perspective. Findings show that even though the participants expressed high levels of satisfaction with care, they also highlighted elements that they experienced as problematic during their treatment trajectory. Three major themes emerged: 1) the need to be taken seriously and for immediate action; 2) evolving information needs across stages of treatment; and 3) finding the right network.publishedVersionCopyright © 2017 by the paper's authors. Copying permitted for private and academic purposes

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Effects of the Antifungals Voriconazole and Fluconazole on the Pharmacokinetics of S-(+)- and R-(−)-Ibuprofen

Our objective was to study the effects of the antifungals voriconazole and fluconazole on the pharmacokinetics of S-(+)- and R-(−)-ibuprofen. Twelve healthy male volunteers took a single oral dose of 400 mg racemic ibuprofen in a randomized order either alone, after ingestion of voriconazole at 400 mg twice daily on the first day and 200 mg twice daily on the second day, or after ingestion of fluconazole at 400 mg on the first day and 200 mg on the second day. Ibuprofen was ingested 1 h after administration of the last dose of voriconazole or fluconazole. Plasma concentrations of S-(+)- and R-(−)-ibuprofen were measured for up to 24 h. In the voriconazole phase, the mean area under the plasma concentration-time curve (AUC) of S-(+)-ibuprofen was 205% (P < 0.001) of the respective control value and the mean peak plasma concentration (C(max)) was 122% (P < 0.01) of the respective control value. The mean elimination half-life (t(1/2)) was prolonged from 2.4 to 3.2 h (P < 0.01) by voriconazole. In the fluconazole phase, the mean AUC of S-(+)-ibuprofen was 183% of the control value (P < 0.001) and its mean C(max) was 116% of the control value (P < 0.05). The mean t(1/2) of S-(+)-ibuprofen was prolonged from 2.4 to 3.1 h (P < 0.05) by fluconazole. The geometric mean S-(+)-ibuprofen AUC ratios in the voriconazole and fluconazole phases were 2.01 (90% confidence interval [CI], 1.80 to 2.22) and 1.82 (90% CI, 1.72 to 1.91), respectively, i.e., above the bioequivalence acceptance upper limit of 1.25. Voriconazole and fluconazole had only weak effects on the pharmacokinetics of R-(−)-ibuprofen. In conclusion, voriconazole and fluconazole increased the levels of exposure to S-(+)-ibuprofen 2- and 1.8-fold, respectively. This was likely caused by inhibition of the cytochrome P450 2C9-mediated metabolism of S-(+)-ibuprofen. A reduction of the ibuprofen dosage should be considered when ibuprofen is coadministered with voriconazole or fluconazole, especially when the initial ibuprofen dose is high

A platform for efficient establishment and drug-response profiling of high-grade serous ovarian cancer organoids

The broad research use of organoids from high-grade serous ovarian cancer (HGSC) has been hampered by low culture success rates and limited availability of fresh tumor material. Here, we describe a method for generation and long-term expansion of HGSC organoids with efficacy markedly improved over previous reports (53% vs. 23%-38%). We established organoids from cryopreserved material, demonstrating the feasibility of using viably biobanked tissue for HGSC organoid derivation. Genomic, histologic, and single-cell transcriptomic analyses revealed that organoids recapitulated genetic and phenotypic features of original tumors. Organoid drug responses correlated with clinical treatment outcomes, although in a culture conditions dependent manner and only in organoids maintained in human plasma-like medium (HPLM). Organoids from consenting patients are available to the research community through a public biobank and organoid genomic data are explorable through an interactive online tool. Taken together, this resource facilitates the application of HGSC organoids in basic and translational ovarian cancer research.Peer reviewe