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Primary care in internal medicine

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https://www.readbyqxmd.com/read/27900863/-symptomatic-and-asymptomatic-primary-hyperparathyroidism-in-outpatient-care-current-issues
#1
Helena Šiprová, Miroslav Souček, Zdeněk Fryšák, Květoslav Šipr
OBJECTIVE: To assess the diagnostic and therapeutic options in the care of patients with primary hyperparathyreosis in outpatient practice.Cohort and methods: The study included all the patients with primary hyperparathyroidism treated at the 2nd Internal Medicine Department, Masaryk University and the University Hospital of St. Anne in Brno in the period from Jan 1, 2008 to Dec 31, 2013. The sample consisted of 218 patients, including 41 men and 177 women. Patients with secondary hyperparathyroidism, especially patients with underlying hypovitaminosis D, renal insufficiency and those taking medications with possible effects on parathyroid hormone levels, have not been included in the study...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27897470/faculty-development-efforts-to-promote-screening-brief-intervention-and-referral-to-treatment-sbirt-in-an-internal-medicine-faculty-resident-practice
#2
Alanna Stone, Maria Wamsley, Patricia O'Sullivan, Jason Satterfield, Derek D Satre, Katherine Julian
BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is a practical means to address substance misuse in primary care. Important barriers to implementing SBIRT include adequacy of training and provider confidence as well as logistical hurdles and time constraints. A faculty development initiative aimed at increasing SBIRT knowledge and treatment of substance use disorders (SUDs) should lead to increased use of SBIRT by faculty and the residents they teach. This study examined how a faculty development program to promote SBIRT influenced faculty practice and resident teaching...
November 29, 2016: Substance Abuse
https://www.readbyqxmd.com/read/27893952/acceptability-and-impact-of-a-required-palliative-care-rotation-with-prerotation-and-postrotation-observed-simulated-clinical-experience-during-internal-medicine-residency-training-on-primary-palliative-communication-skills
#3
Maxwell T Vergo, Sharona Sachs, Meredith A MacMartin, Kathryn B Kirkland, Amelia M Cullinan, Lisa A Stephens
BACKGROUND: Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. OBJECTIVE: To assess skills acquisition and acceptability for IM residents not selecting an elective. DESIGN: A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points...
November 28, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27870544/referrals-and-the-pcmh-how-well-do-we-know-our-neighborhood
#4
Andrew Schreiner, Patrick Mauldin, Jingwen Zhang, Justin Marsden, William Moran
OBJECTIVES: Characterize patterns of referral from a patient-centered medical home (PCMH) and observe the association of provider experience, patient chronic disease burden, and risk of utilization on referral placement. STUDY DESIGN: Descriptive analysis of referral patterns in an academic, internal medicine PCMH. METHODS: We examined referrals (eg, specialist visit, testing, ancillary services) placed between July and December of 2014 in an academic PCMH caring for a total of 12,000 patients...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27864601/predictors-of-primary-care-provider-adoption-of-ct-colonography-for-colorectal-cancer-screening
#5
Jennifer M Weiss, David H Kim, Maureen A Smith, Aaron Potvien, Jessica R Schumacher, Ronald E Gangnon, B Dustin Pooler, Patrick R Pfau, Perry J Pickhardt
PURPOSE: To examine factors influencing primary care provider (PCP) adoption of CT colonography (CTC) for colorectal cancer (CRC) screening. MATERIALS AND METHODS: We performed a retrospective cohort study linking electronic health record (EHR) data with PCP survey data. Patients were eligible for inclusion if they were not up-to-date with CRC screening and if they had CTC insurance coverage in the year prior to survey administration. PCPs were included if they had at least one eligible patient in their panel and completed the survey (final sample N = 95 PCPs; N = 6245 patients)...
November 19, 2016: Abdominal Radiology
https://www.readbyqxmd.com/read/27849351/the-role-of-internal-medicine-subspecialists-in-patient-care-management
#6
Jonathan L Vandergrift, Bradley M Gray, James D Reschovsky, Eric S Holmboe, Rebecca D Lipner
OBJECTIVES: To understand the clinical roles in which internal medicine (IM) subspecialists engage, especially those involving ongoing patient management. STUDY DESIGN: Measures of physician clinical roles were based on survey responses collected from 8020 mid-career IM subspecialists who registered for the American Board of Internal Medicine maintenance of certification program (86% registration/response rate) between 2009 and 2013. METHODS: Each subspecialist reported their percentage of clinical time in 5 clinical roles: primary, principal, longitudinal consultative, medical consultative, and procedural care...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27835945/external-validation-of-multidimensional-prognostic-indices-ado-bodex-and-dose-in-a-primary-care-international-cohort-proepoc-copd-cohort
#7
Maite Espantoso-Romero, Miguel Román Rodríguez, Ana Duarte-Pérez, Jaime Gonzálvez-Rey, Pedro A Callejas-Cabanillas, Durdica Kasuba Lazic, Berta Anta-Agudo, Pere Torán Monserrat, Rosa Magallon-Botaya, Biljana Gerasimovska Kitanovska, Heidrun Lingner, Radost S Assenova, Claudia Iftode, Francisco Gude-Sampedro, Ana Clavería
BACKGROUND: Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014)...
November 11, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27824420/-the-physical-examination-a-vanishing-art
#8
Ernst Tönnesmann, Diane Goltz, Thorsten Lewalter, Armin Welz
This report describes the case of a 63-year-old female patient who presented with progressive dyspnea to a specialized internal medicine practice. Prior consultations with her primary care physician and a cardiologist followed by hospitalizations in an acute care hospital and in a specialist clinic for cardiology had not yielded a conclusive diagnosis. During the physical examination, significant bilateral lower extremity edema, as well as pronounced jugular venous distention was noted while in a seated position...
October 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27815762/acceptability-of-naloxone-co-prescription-among-primary-care-providers-treating-patients-on-long-term-opioid-therapy-for-pain
#9
Emily Behar, Christopher Rowe, Glenn-Milo Santos, Diana Coffa, Caitlin Turner, Nina C Santos, Phillip O Coffin
BACKGROUND: Naloxone co-prescription is recommended for patients on long-term opioids for pain, yet there are few data on the practice. OBJECTIVE: To explore naloxone co-prescribing acceptability among primary care providers for patients on long-term opioids. DESIGN: We surveyed providers at six safety-net primary care clinics in San Francisco that had initiated naloxone co-prescribing. Providers were encouraged to offer naloxone to patients on long-term opioids or otherwise at risk of witnessing or experiencing an overdose...
November 4, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27809793/using-the-4-pillars%C3%A2-practice-transformation-program-to-increase-adult-influenza-vaccination-and-reduce-missed-opportunities-in-a-randomized-cluster-trial
#10
Chyongchiou J Lin, Mary Patricia Nowalk, Valory N Pavlik, Anthony E Brown, Song Zhang, Jonathan M Raviotta, Krissy K Moehling, Mary Hawk, Edmund M Ricci, Donald B Middleton, Suchita Patel, Jeannette E South-Paul, Richard K Zimmerman
BACKGROUND: An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine. METHODS: Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14)...
November 3, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27805951/the-development-and-evaluation-of-a-novel-instrument-assessing-residents-discharge-summaries
#11
Musab S Hommos, Ethan F Kuperman, Aparna Kamath, Clarence D Kreiter
PURPOSE: To develop and determine the reliability of a novel measurement instrument assessing the quality of residents' discharge summaries. METHOD: In 2014, the authors created a discharge summary evaluation instrument based on consensus recommendations from national regulatory bodies and input from primary care providers at their institution. After a brief pilot, they used the instrument to evaluate discharge summaries written by first-year internal medicine residents (n = 24) at a single U...
November 1, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/27798775/attitudes-toward-naloxone-prescribing-in-clinical-settings-a-qualitative-study-of-patients-prescribed-high-dose-opioids-for-chronic-non-cancer-pain
#12
Shane R Mueller, Stephen Koester, Jason M Glanz, Edward M Gardner, Ingrid A Binswanger
BACKGROUND: Over the last 2 decades, medical providers have increasingly prescribed pharmaceutical opioids for chronic non-cancer pain, while opioid overdose death rates have quadrupled. Naloxone, an opioid antagonist, can be prescribed to patients with chronic pain to reverse an opioid overdose, yet little is known about how patients perceive this emerging practice. OBJECTIVE: This study assessed the knowledge and attitudes toward naloxone prescribing among non-cancer patients prescribed opioids in primary care...
October 31, 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27777663/factors-associated-with-resident-continuity-in-ambulatory-training-practices
#13
Robert J Fortuna, Lynn Garfunkel, Michael D Mendoza, Megan Ditty, Julia West, Karen Nead, Brett W Robbins
BACKGROUND : Continuity of care is a critical element of residents' educational experience in primary care programs. OBJECTIVE : We examined how continuity in resident practices compares to nonteaching practices, identified factors associated with increased continuity, and explored the association between continuity and quality measures. METHODS : We analyzed 117 235 patient visits to 4 resident practices (26 resident teams in internal medicine, pediatrics, family medicine, and medicine-pediatrics) and 270 242 visits to nonteaching community practices between July 2013 and May 2014...
October 2016: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/27774716/the-perceived-value-of-clinical-pharmacy-service-provision-by-pharmacists-and-physicians-an-initial-assessment-of-family-medicine-and-internal-medicine-providers
#14
Jon P Wietholter, Charles D Ponte, Dustin M Long
BACKGROUND: Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. OBJECTIVES: The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists...
October 24, 2016: International Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27773897/moving-toward-the-reduction-of-publication-reporting-biases-in-clinical-trials-using-a-new-international-standard
#15
Yuriko Doi
 Evidence-based medicine (EBM) is fundamental to ensuring high-quality medical care. It requires systematic reviews and meta-analyses to synthesize diverse information available from individual clinical studies. However, the literature reviewed may represent an incomplete and selective set of research findings, which could lead to publication/reporting biases and distort the true picture of research as a whole. Prospective registry of all clinical trials in the world is mandatory to reduce the biases, which have been disclosed on the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization (WHO) since 2007...
2016: [Nihon Kōshū Eisei Zasshi] Japanese Journal of Public Health
https://www.readbyqxmd.com/read/27757231/emergency-department-crowding-in-singapore-insights-from-a-systems-thinking-approach
#16
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
https://www.readbyqxmd.com/read/27755655/using-the-4-pillars-practice-transformation-program-to-increase-pneumococcal-immunizations-for-older-adults-a-cluster-randomized-trial
#17
Richard K Zimmerman, Anthony E Brown, Valory N Pavlik, Krissy K Moehling, Jonathan M Raviotta, Chyongchiou J Lin, Song Zhang, Mary Hawk, Shakala Kyle, Suchita Patel, Faruque Ahmed, Mary Patricia Nowalk
OBJECTIVES: To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination. DESIGN: Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractions...
October 18, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27753823/sy-01-1-adaptation-of-major-guidelines-for-regional-applications
#18
Ernesto Schiffrin
Clinical practice guidelines, which are systematically developed statements aimed at helping people make clinical, policy-related and system-related decisions, frequently vary widely in quality. A strategy is needed to differentiate among guidelines and ensure that those of the highest quality are implemented. Hypertension Canada provides annually updated standardized recommendations and clinical practice guidelines to detect, treat and control hypertension. The annual, evidence-based recommendations are developed through intense discussion of the clinical implications via a systematic review of the literature followed by critical appraisals of all the new clinical research, taking into account the assessment criteria in the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument that evaluates the process of practice guideline development and the quality of reporting...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27741176/pregnancy-outcomes-in-women-with-a-history-of-previable-preterm-prelabor-rupture-of-membranes
#19
Martha A Monson, Karen J Gibbons, M Sean Esplin, Michael W Varner, Tracy A Manuck
OBJECTIVE: To characterize subsequent pregnancy outcomes among women with a history of previable, preterm prelabor rupture of membranes (PROM) and assess factors associated with recurrent preterm birth. METHODS: This was a retrospective cohort study of women cared for with a history of one or more singleton pregnancy complicated by preterm PROM at less than 24 weeks of gestation between 2002 and 2013 who were cared for in two tertiary care health systems by a single group of maternal-fetal medicine specialists...
November 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27733673/vaccination-practices-in-patients-with-inflammatory-bowel-disease-among-general-internal-medicine-physicians-in-the-usa
#20
Grigoriy E Gurvits, Gloria Lan, Amy Tan, Arlene Weissman
BACKGROUND: Increasing prevalence of inflammatory bowel disease (IBD) poses significant challenges to medical community. Preventive medicine, including vaccination against opportunistic infections, is important in decreasing morbidity and mortality in patients with IBD. We conduct first study to evaluate general awareness and adherence to immunisation guidelines by primary care physicians in the USA. METHODS: We administered an electronic questionnaire to the research panel of the American College of Physicians (ACP) assessing current vaccination practices, barriers to vaccination and provider responsibility for administering vaccinations and compared responses with the European Crohn's and Colitis Organization consensus guidelines and expert opinion from the USA...
October 12, 2016: Postgraduate Medical Journal
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