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Primary care internal medicine

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https://www.readbyqxmd.com/read/29231960/prospective-validation-of-a-screening-tool-to-identify-older-adults-in-need-of-a-driving-evaluation
#1
Marian E Betz, Jason S Haukoos, Robert Schwartz, Carolyn DiGuiseppi, Deepika Kandasamy, Brenda Beaty, Elizabeth Juarez-Colunga, David B Carr
OBJECTIVES: To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. DESIGN: Prospective observational study. SETTING: Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. PARTICIPANTS: Cognitively intact drivers aged 65 and older (N = 315). MEASUREMENTS: Participants completed baseline questionnaire (including CRASH tool) and assessments and BTW test (evaluator blinded to questionnaire results) and participated in 1-month telephone follow-up...
December 12, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29226222/learning-processes-and-learning-problems-in-german-postgraduate-medical-education
#2
Hendrik van den Bussche, Lea Krause-Solberg, Martin Scherer, Stine Ziegler
Objective: In order to evaluate the quality of postgraduate medical education in Germany, we examined how the learning of theoretical and practical competencies is conceptualized and how the learning process takes place in real terms. The training conditions, as perceived by medical residents, are compared with the learning objectives, as stated by the Federal Chamber of Physicians in its regulation on postgraduate education. The analysis is based on the data of the "KarMed" study (abbreviation of "career progression and career breaks among physicians during postgraduate education"), a multicentre cohort study of medical school graduates from seven universities who arre followed until they receive their licenses as specialist physicians...
2017: GMS Journal for Medical Education
https://www.readbyqxmd.com/read/29209996/understanding-ownership-of-patient-care-a%C3%A2-dual-site-qualitative-study-of-faculty-and-residents-from-medicine-and-psychiatry
#3
Deborah S Cowley, Jesse D Markman, Jennifer A Best, Erica L Greenberg, Michael J Grodesky, Suzanne B Murray, Kelli A Corning, Mitchell R Levy, William E Greenberg
INTRODUCTION: With changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents. METHODS: The authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes...
December 5, 2017: Perspectives on Medical Education
https://www.readbyqxmd.com/read/29209722/association-between-treatment-by-locum-tenens-internal-medicine-physicians-and-30-day-mortality-among-hospitalized-medicare-beneficiaries
#4
Daniel M Blumenthal, Andrew R Olenski, Yusuke Tsugawa, Anupam B Jena
Importance: Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. Objective: To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. Design, Setting, and Participants: A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians...
December 5, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29209663/electronic-medical-record-alert-improves-hcv-testing-for-baby-boomers-in-primary-care-setting-adults-born-during-1945-1965
#5
Eyad Al-Hihi, Caylin Shankweiler, David Stricklen, Cheryl Gibson, Winston Dunn
Method: This project aims to implement the HCV birth cohort screening guidelines over a 9-month period in the primary care setting at the University of Kansas Health System General Internal Medicine Division. The project team measured the number of patients in the baby boomer population who received a one-time screen for HCV. An electronic medical record (EMR) intervention was implemented to identify baby boomers who did not have an HCV screening or diagnosis. Additionally, education was provided to all primary care providers in the clinic to increase awareness of the HCV birth cohort screening...
2017: BMJ Open Quality
https://www.readbyqxmd.com/read/29202320/screening-itself-for-disseminated-intravascular-coagulation-may-reduce-mortality-in-sepsis-a-nationwide-multicenter-registry-in-japan
#6
Yutaka Umemura, Kazuma Yamakawa, Mineji Hayakawa, Toshimitsu Hamasaki, Satoshi Fujimi
OBJECTIVES: Screening of patients with sepsis for disseminated intravascular coagulation (DIC) has been recommended in several guidelines. However, DIC screening is still not widely accepted as an essential component of sepsis management, partly because of a lack of evidence that DIC screening has an effect on mortality. We investigated whether DIC screening was associated with a survival benefit in patients with sepsis. DESIGN: Post hoc analysis of a nationwide multicenter retrospective cohort study...
November 26, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29197533/cervical-cancer-screening-uptake-among-hiv-positive-women-in-ontario-canada-a-population-based-retrospective-cohort-study
#7
Ann N Burchell, Claire E Kendall, Stephanie Y Cheng, Aisha Lofters, Michelle Cotterchio, Ahmed M Bayoumi, Richard H Glazier, Tony Antoniou, Janet Raboud, Mark H Yudin, Mona Loutfy
Cervical cancer caused by oncogenic types of the human papillomavirus (HPV) is of concern among HIV-positive women due to impairment of immune responses required to control HPV infection. Our objectives were to describe patterns of cervical cancer screening using Pap cytology testing among HIV-positive women in Ontario, Canada from 2008 to 2013 and to identify factors associated with adequate screening. We conducted a retrospective, population-based cohort study among screen-eligible HIV-positive women using provincial administrative health data...
November 29, 2017: Preventive Medicine
https://www.readbyqxmd.com/read/29197309/objective-structured-clinical-examination-based-teaching-of-the-musculoskeletal-examination
#8
Trishul Siddharthan, Sarita Soares, Hilary H Wang, Stephen R Holt
OBJECTIVES: Musculoskeletal complaints are the most common presenting illnesses in primary care settings, yet physicians often are underprepared to manage such complaints. We sought to create and evaluate an objective structured clinical examination (OSCE)-based musculoskeletal workshop designed to simultaneously educate medical students and internal medicine residents, enlisting volunteer medical students as standardized patients (SPs). METHODS: The setting for the study was the Yale Primary Care Residency Program...
December 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/29196046/prehospital-antibiotics-in-the-ambulance-for-sepsis-a-multicentre-open-label-randomised-trial
#9
Nadia Alam, Erick Oskam, Patricia M Stassen, Pieternel van Exter, Peter M van de Ven, Harm R Haak, Frits Holleman, Arthur van Zanten, Hien van Leeuwen-Nguyen, Victor Bon, Bart A M Duineveld, Rishi S Nannan Panday, Mark H H Kramer, Prabath W B Nanayakkara
BACKGROUND: Emergency medical services (EMS) personnel have already made substantial contributions to improving care for patients with time-dependent illnesses, such as trauma and myocardial infarction. Patients with sepsis could also benefit from timely prehospital care. METHODS: After training EMS personnel in recognising sepsis, we did a randomised controlled open-label trial in ten large regional ambulance services serving 34 secondary and tertiary care hospitals in the Netherlands...
November 28, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29195577/perspectives-on-managing-solitary-pulmonary-nodules-a-survey-of-primary-care-physicians
#10
Geena Wu, Martin Consunji, Rebecca A Nelson, Kenny Yeung, Canlan Sun, Jae Y Kim, Dan J Raz
Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians...
2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29190402/resident-and-residency-characteristics-associated-with-self-reported-preparedness-for-population-health-management
#11
Erica K Schuster, Lars E Peterson
BACKGROUND AND OBJECTIVES: Population health management (PHM) is an important function of primary care with potential to improve outcomes and decrease costs, but is also among the most difficult strategies to implement in both practices and residency training. Our objective was to determine resident and residency program characteristics associated with graduates' reported preparation to perform PHM. METHODS: We used data from the American Board of Family Medicine (ABFM) Certification Examination registration questionnaire in 2014 and 2015 and ABFM administrative data...
November 2017: Family Medicine
https://www.readbyqxmd.com/read/29183026/late-effects-and-long-term-follow-up-after-cancer-in-childhood
#12
Thorsten Langer, Desiree Grabow, Diana Steinmann, Bernhard Wörmann, Gabriele Calaminus
Today, 80% of children and adolescents with cancer survive their disease. From the results of aftercare research arises the question: Are the survivors also healthy? Many late effects depend on the type of cancer and its treatment. Patients with brain tumors and with malignant sarcomas are very often affected by secondary diseases. Data from the USA report that around 2/3 of all patients still living 30 years after their cancer treatment in childhood suffer from late complications. Equivalent figures for Germany were previously unavailable...
2017: Oncology Research and Treatment
https://www.readbyqxmd.com/read/29180563/strategies-for-increasing-the-role-of-family-medicine-in-mexican-health-care-reform
#13
José Manuel Ramírez Aranda, Chris van Weel, Felicity Goodyear-Smith
There is little or no role for primary care and family medicine in current health reforms in Mexico. However, robust evidence shows that primary care helps prevent morbidity and mortality and increases health equity. Mexico has participated in several international meetings sponsored by the World Organization of National Colleges, Academies and Academic Associations and the North American Primary Care Research Group that are aimed at increased understanding of national health systems and the need to strengthen primary care for improved health outcomes...
November 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29180552/neighborhood-socioeconomic-status-and-receipt-of-opioid-medication-for-new-back-pain-diagnosis
#14
Sarah Gebauer, Joanne Salas, Jeffrey F Scherrer
BACKGROUND: Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations. OBJECTIVE: Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics. METHODS: This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry...
November 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29178350/assessment-of-prescribing-practices-at-the-primary-healthcare-facilities-in-botswana-with-an-emphasis-on-antibiotics-findings-and-implications
#15
Yohana Mashalla, Vincent Setlhare, Amos Massele, Enoch Sepako, Celda Tiroyakgosi, Joyce Kgatlwane, Mpo Chuma, Brian Godman
BACKGROUND AND AIMS: Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. METHODS: Retrospective data from patients' records between January and December 2013 in 19 clinics were collected in a cross-sectional study...
November 27, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29164037/guidelines-for-the-management-of-degenerative-cervical-myelopathy-and-acute-spinal-cord-injury-development-process-and-methodology
#16
Lindsay A Tetreault, Andrea C Skelly, Joseph R Dettori, Jefferson R Wilson, Allan R Martin, Michael G Fehlings
The Institute of Medicine defines clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Guidelines help clinicians implement best evidence into practice and encourage informed shared decision making with patients. Guidelines are intended to enhance the quality of patient care by discouraging ineffective and potentially harmful interventions and standardizing practice...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29163729/prevalence-comorbidity-and-investigation-of-anemia-in-the-primary-care-office
#17
Shivani Jatin Gandhi, Iris Hagans, Karim Nathan, Krystal Hunter, Satyajeet Roy
Background: Anemia has a myriad of causes and its prevalence is growing. Anemia is associated with increased all-cause hospitalization and mortality in community-dwelling individuals above age 65 years. Our aim was to determine the prevalence and severity of anemia in adult patients in our primary care office and to determine the relationship between anemia and medical comorbidities. Methods: Electronic medical records of 499 adult patients in our suburban internal medicine office were reviewed who had had at least one hemoglobin value and did not undergo moderate to high-risk surgery in the preceding 30 days...
December 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29153354/the-choosing-wisely-initiative-a-critical-analysis-with-a-special-focus-on-primary-care
#18
Karl Horvath, Andrea Siebenhofer
The Choosing Wisely initiative (CWI), a campaign led by the American Board of Internal Medicine (ABIM) Foundation, promotes doctor-patient communication and reducing waste in healthcare. At present, many of the top 5 lists from the Choosing Wisely Initiative appear to be primarily eminence-based and influenced by self-interest. The implementation of recommendations from these lists may mean taking a step backwards to the time before evidence-based medicine. On the other hand, despite all the challenges that the Choosing Wisely initiatives are currently facing, it is difficult to deny that they also hold great potential in terms of making healthcare systems more efficient and beneficial to patients...
November 15, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29117934/uses-of-mobile-device-digital-photography-of-dermatologic-conditions-in-primary-care
#19
Jennifer L Pecina, Kirk D Wyatt, Nneka I Comfere, Matthew E Bernard, Frederick North
BACKGROUND: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)-based mobile devices. OBJECTIVE: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. METHODS: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant)...
November 8, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29116901/use-of-ics-in-copd-from-blockbuster-medicine-to-precision-medicine
#20
Marco Contoli, Angelo G Corsico, Pierachille Santus, Fabiano Di Marco, Fulvio Braido, Paola Rogliani, Luigi Calzetta, Nicola Scichilone
Chronic obstructive pulmonary disease (COPD) is a major cause of mortality worldwide, whose burden is expected to increase in the next decades, because of numerous risk factors, including the aging of the population. COPD is both preventable and treatable by an effective management including risk factor reduction, prevention, assessment, and treatment of acute exacerbations and co-morbidities. The available agents approved for COPD treatment are long-acting or ultra-long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) bronchodilators, as well as inhaled corticosteroids (ICS) in combination with LABAs...
November 8, 2017: COPD
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