Citations

The Society for Vascular Medicine was founded in 1989. During the subsequent 25 years, the Society has grown to approximately 500 members and has achieved international recognition while making important contributions to vascular disease education, clinical vascular medicine and biology research, and patient care. In celebration of the Society’s 25th anniversary, its past and current presidents reflect on the Society’s history, challenges, and achievements, and emphasize the vital role of the SVM in the discipline of vascular medicine.

E-consultations are being offered within clinic walls as an option for specialist advice without a face-to-face consultation appointment. In a six month time frame, nearly 100% of primary care internists and family medicine providers in a multispecialty practice had used an e-consultation at least once. Specialists also used e-consultations for advice from other specialists. E-consultations were often questions about interpreting images or laboratory tests, or questions about management of chronic conditions such as osteoporosis, hypertension, or headaches. Although e-consultations were offered as an alternative to face-to-face specialty consultations, 1,111 of 5,334 e-consultations eventually did receive face-to-face appointments in the same specialty. Within 30 days of the e-consultation 11.5% had a specialty face-to-face visit and 17.7% had seen a specialist face-to-face within 90 days of the e-consultation. The conversions of e-consultations to face-to-face consultations depended on the specialty providing the e-consultation (fewer for gastroenterology and infectious disease), patient distance from the clinic (fewer for international patients and those living greater than 800 kilometers from the clinic), and experience of specialist responding to the e-consultation (lower conversions for specialists providing 15 or more e-consultations).

This article experiments with the dialogic epistolary form as a non-traditional representation of ethnographic research on the topic of breastmilk donation. The epistolary genre was chosen because its structure, purpose, and history embodies the key findings of this research, for example, the gulf between milk donors and recipients and the curiosity held by each for the other. The article argues that the dialogic epistolary form provides a more engaging, expansive, and expressive account of the researcher’s role in the ethnographic research process than that offered by traditional academic genres. The article presents research findings in the epistolary form, which provides an accessible and novel presentation of research by inviting readers to occupy the position of both the milk donor and the donor milk recipient. The letters can be used as a resource by health professionals and communities involved in human milk donation or the use of donor milk. The letters are accompanied by an exegesis which offers ethnographers an account of the epistolary genre as a non-traditional form of research representation.

Background and Purpose— Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. Methods— Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. Results— The sample included 148 367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission ( r 2 =0.107). No important additional effect for any other variable was detected when added to this model. Conclusions— This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set.