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https://www.readbyqxmd.com/read/28441678/the-addiction-recovery-clinic-a-novel-primary-care-based-approach-to-teaching-addiction-medicine
#1
Stephen R Holt, Nora Segar, Dana A Cavallo, Jeanette M Tetrault
PROBLEM: Substance use is highly prevalent in the United States, but little time in the curriculum is devoted to training internal medicine residents in addiction medicine. APPROACH: In 2014, the authors developed and launched the Addiction Recovery Clinic (ARC) to address this educational gap while also providing outpatient clinical services to patients with substance use disorders. The ARC is embedded within the residency primary care practice and is staffed by three to four internal medicine residents, two board-certified addiction medicine specialists, one chief resident, and one psychologist...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28424823/-coma-in-the-emergency-room
#2
M Braun, C J Ploner, T Lindner, M Möckel, W U Schmidt
Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO...
April 19, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28424063/clinical-and-cost-effectiveness-analysis-of-early-detection-of-patients-at-nutrition-risk-during-their-hospital-stay-through-the-new-screening-method-cipa-a-study-protocol
#3
José Pablo Suárez-Llanos, Néstor Benítez-Brito, Laura Vallejo-Torres, Irina Delgado-Brito, Adriá Rosat-Rodrigo, Carolina Hernández-Carballo, Yolanda Ramallo-Fariña, Francisca Pereyra-García-Castro, Juan Carlos-Romero, Nieves Felipe-Pérez, Jennifer García-Niebla, Eduardo Mauricio Calderón-Ledezma, Teresa de Jesús González-Melián, Ignacio Llorente-Gómez de Segura, Manuel Ángel Barrera-Gómez
BACKGROUND: Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system...
April 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28423837/a-terminology-in-general-practice-family-medicine-to-represent-non-clinical-aspects-for-various-usages-the-q-codes
#4
Marc Jamoulle, Julien Grosjean, Melissa Resnick, Ashwin Ittoo, Arthur Treuherz, Robert Vander Stichele, Elena Cardillo, Stéfan J Darmoni, Frank S Shamenek, Marc Vanmeerbeek
The hereby proposed terminology called "Q-Codes" can be defined as an extension of the International Classification of Primary Care (ICPC-2). It deals with non-clinical concepts that are relevant in General Practice/Family Medicine (GP/FM). This terminology is a good way to put an emphasis on underestimated topics such as Teaching, Patient issues or Ethics. It aims at indexing GP/FM documents such as congress abstracts and theses to get a more comprehensive view about the GP/FM domain. The 182 identified Q-Codes have been very precisely defined by a college of experts (physicians and terminologists) from twelve countries...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28406489/consensus-recommendation-for-a-diagnostic-guideline-for-acid-sphingomyelinase-deficiency
#5
Margaret M McGovern, Carlo Dionisi-Vici, Roberto Giugliani, Paul Hwu, Olivier Lidove, Zoltan Lukacs, Karl Eugen Mengel, Pramod K Mistry, Edward H Schuchman, Melissa P Wasserstein
Disclaimer:This diagnostic guideline is intended as an educational resource and represents the opinions of the authors, and is not representative of recommendations or policy of the American College of Medical Genetics and Genomics (ACMG). The information should be considered a consensus based on expert opinion, as more comprehensive levels of evidence were not available in the literature in all cases. BACKGROUND: Acid sphingomyelinase deficiency (ASMD) is a rare, progressive, and often fatal lysosomal storage disease...
April 13, 2017: Genetics in Medicine: Official Journal of the American College of Medical Genetics
https://www.readbyqxmd.com/read/28403911/predomos-study-impact-of-a-social-intervention-program-for-socially-isolated-elderly-cancer-patients-study-protocol-for-a-randomized-controlled-trial
#6
Elodie Crétel-Durand, Emilie Nouguerède, Hervé Le Caer, Frédérique Rousseau, Frédérique Retornaz, Olivier Guillem, Anne-Laure Couderc, Laurent Greillier, Emmanuelle Norguet, Maud Cécile, Rabia Boulahssass, Francoise Le Caer, Sandrine Tournier, Chantal Butaud, Pierre Guillet, Sophie Nahon, Laure Poudens, Sylvie Kirscher, Sandrine Loubière, Nadine Diaz, Jean Dhorne, Pascal Auquier, Karine Baumstarck
BACKGROUND: Cancer incidence and social isolation increase along with advanced age, and social isolation potentiates the relative risk of death by cancer. Once spotted, social isolation can be averted with the intervention of a multidisciplinary team. Techniques of automation and remote assistance have already demonstrated their positive impact on falls prevention and quality of life (QoL), though little is known about their impact on socially isolated elderly patients supported for cancer...
April 12, 2017: Trials
https://www.readbyqxmd.com/read/28397979/the-obstetric-consultant-on-the-labour-ward-beyond-infancy-to-early-adolescence
#7
William F Rayburn
Hospital medicine has emerged over the last two decades into a practice pattern for those with generalist training in internal medicine, family medicine, and pediatrics. Their hospital consultative practices are now generally acceptable in light of a changing health care financial landscape, primary care physicians leaving the hospital workplace, and a push to improve the efficiency and effectiveness of systems-based hospital care. Today, several specialties are more involved in hospital consultant programs such as obstetrics, emergency medicine, surgery, and psychiatry...
April 11, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28396090/executive-summary-of-imported-infectious-diseases-after-returning-from-foreign-travel-consensus-document-of-the-spanish-society-for-infectious-diseases-and-clinical-microbiology-seimc
#8
José Luis Pérez-Arellano, Miguel Górgolas-Hernández-Mora, Fernando Salvador, Cristina Carranza-Rodríguez, Germán Ramírez-Olivencia, Esteban Martín-Echeverría, Azucena Rodríguez-Guardado, Francesca Norman, Virginia Velasco-Tirado, Zuriñe Zubero-Sulibarría, Gerardo Rojo-Marcos, José Muñoz-Gutierrez, José Manuel Ramos-Rincón, M Paz Sánchez-Seco-Fariñas, María Velasco-Arribas, Moncef Belhassen-García, Mar Lago-Nuñez, Elías Cañas García-Otero, Rogelio López-Vélez
In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections...
April 7, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28387049/training-residents-in-depression-and-grief
#9
Angela Ghesquiere, Johanna Martinez, Cathy Jalali, Jo Anne Sirey, Susana Morales
BACKGROUND: About 20 per cent of Americans will experience depression in their lifetimes, and almost all will experience the death of a loved one. Both depression and grief have been associated with adverse health outcomes, including a decline in quality of life and excess mortality. Primary care physicians (PCPs) are the initial health care contact for most patients with depression and grief, yet often perceive that they lack the skills to adequately address these issues. Previous studies have investigated whether educational efforts improve PCP depression and grief knowledge or perceived skills, but few have focused on medical residents...
April 6, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28381243/internists-career-choice-towards-primary-care-a-cross-sectional-survey
#10
Nathalie Scherz, Stefan Markun, Vera Aemissegger, Thomas Rosemann, Ryan Tandjung
BACKGROUND: Swiss primary care (PC) is facing workforce shortage. Up to 2011 this workforce was supplied by two board certifications: general medicine and internal medicine. To strengthen them against subspecialties, they were unified into one: general internal medicine. However, since unification general practitioners' career options are no longer restrained by early commitment to PC. This may lead to a decrease of future primary care physicians (PCPs). METHODS: To gain insights in timing and factors influencing career choice of internists, we addressed a cross sectional survey to all board certified internists in the years 2000-2010 (n = 1462)...
April 5, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28379504/low-risk-of-producing-an-opioid-use-disorder-in-primary-care-by-prescribing-opioids-to-prescreened-patients-with-chronic-noncancer-pain
#11
Martin D Cheatle, Rollin M Gallagher, Charles P O'Brien
Objective. : To examine the risk of developing aberrant behaviors that might lead to a substance use disorder (addiction) when prescribing opioids for the relief of chronic noncancer pain in primary care settings. Design. : Longitudinal, prospective, descriptive design with repeated measures. Setting. : Private community-based internal medicine and family medicine clinics. Subjects. : Patients with chronic musculoskeletal pain...
March 31, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28378961/primary-care-appointment-availability-and-the-aca-insurance-expansions
#12
Molly Candon, Daniel Polsky, Brendan Saloner, Douglas Wissoker, Katherine Hempstead, Genevieve M Kenney, Karin Rhodes
In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern. Fortunately, our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times. Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees...
March 2017: LDI Issue Brief
https://www.readbyqxmd.com/read/28375881/institutional-substance-use-disorder-intervention-improves-general-internist-preparedness-attitudes-and-clinical-practice
#13
Sarah E Wakeman, Genevieve Pham Kanter, Karen Donelan
OBJECTIVE: To assess the impact of hospital substance use disorder (SUD) initiative, which, beginning in October 2014, implemented an inpatient addiction consult team, a postdischarge addiction clinic, recovery coaches, and SUD treatment within primary care on general internists' attitudes, clinical practice, and preparedness to care for SUD. METHODS: Pre and postintervention survey of general internal medicine physicians at Massachusetts General Hospital, in Boston, Massachusetts, in September 2014 (n = 290) and 2015 (n = 296) was conducted...
April 3, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28375415/improving-the-perception-of-outpatient-practice-a-second-continuity-experience-for-internal-medicine-residents
#14
Jennifer Jeremiah, Kelly McGarry, Joao Filipe Goncalves Monteiro
BACKGROUND: The challenges trainees experience in the traditional medical clinic are felt to be one deterrent to choosing a primary care career. OBJECTIVE: We examined whether participation in a second outpatient continuity experience (Second Site) affects trainee perception of primary care practice. METHODS: 241 current and former graduates of the Brown Alpert Medical School Internal Medicine training programs were surveyed about their experiences with Second Site...
April 3, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28369774/temporal-trends-in-healthcare-utilization-following-primary-melanoma-diagnosis-among-medicare-beneficiaries
#15
J P Lott, Q Wang, L J Titus, T Onega, H D Nelson, M A Weinstock, J G Elmore, A N A Tosteson
BACKGROUND: Despite increasing melanoma incidence in the United States, little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. OBJECTIVE: To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. METHODS: We conducted a before-after multiple time series study of Medicare beneficiaries ages ≥66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results-Medicare database...
March 30, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28365679/development-of-a-curriculum-and-training-program-in-woman-veterans-health-for-internal-medical-residents
#16
Manju Ceylony, Jahan Porhomayon, Leili Pourafkari, Nader D Nader
INTRODUCTION: Internal Medicine residents must develop competency as Primary Care Providers, but a gap exists in their curriculum and training with regards to women's reproductive health. With increasing need in VA due to new influx of women veterans it poses problems in recruitment of competent physicians trained in Women's health. METHODS: An intensive, one-month women's reproductive health curriculum with hands on experience for Internal Medicine residents was provided...
April 1, 2017: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
https://www.readbyqxmd.com/read/28364218/-memorandum-of-the-german-society-for-rheumatology-on-the-quality-of-treatment-in-rheumatology-update-2016
#17
A Zink, J Braun, E Gromnica-Ihle, D Krause, H J Lakomek, W Mau, U Müller-Ladner, J Rautenstrauch, C Specker, M Schneider
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases...
April 2017: Zeitschrift Für Rheumatologie
https://www.readbyqxmd.com/read/28350833/a-fast-and-frugal-algorithm-to-strengthen-diagnosis-and-treatment-decisions-for-catheter-associated-bacteriuria
#18
Aanand D Naik, Felicia Skelton, Amber B Amspoker, Russell A Glasgow, Barbara W Trautner
OBJECTIVES: Guidelines for managing catheter-associated urinary tract infection (CAUTI) and asymptomatic bacteria (ASB) are poorly translated into routine care due in part to cognitive diagnostic errors. This study determines if the accuracy for CAUTI and ASB diagnosis and treatment improves after implementation of a fast and frugal algorithm compared with traditional education methods. MATERIALS AND METHODS: A pre and post-intervention with contemporaneous comparison site involving inpatient and long term care wards at two regional Veterans Affairs Systems in United States...
2017: PloS One
https://www.readbyqxmd.com/read/28344140/high-value-cost-conscious-care-iterative-systems-based-interventions-to-reduce-unnecessary-lab-testing
#19
Brett W Sadowski, Alison B Lane, Shannon M Wood, Sara L Robinson, Chin Hee Kim
BACKGROUND: Inappropriate testing contributes to soaring health care costs within the United States and teaching hospitals are vulnerable to providing care largely for academic development. Via its 'Choosing Wisely' campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards at an academic facility. METHODS: We identified the computer-based order entry system as an appropriate target for sustainable intervention...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28340041/bleeding-complications-in-patients-undergoing-intrathecal-drug-delivery-system-implantation
#20
Nafisseh S Warner, Markus A Bendel, Matthew A Warner, Jacob J Strand, Halena M Gazelka, Bryan C Hoelzer, William D Mauck, Tim J Lamer, Daryl J Kor, Susan M Moeschler
Introduction.:  Intrathecal drug delivery systems (IDDSs) have dramatically improved analgesia and the functional status of cancer patients and those with chronic pain states. However, given the close proximity to the neuraxis and frequent concomitant use of antiplatelet or anticoagulant medications, this intervention is not without risk. The goal of this investigation was to determine the incidence of bleeding complications following IDDS placement. Methods.:  This is a retrospective review from 2005 through 2014 of adult patients undergoing IDDS implantation or revision at a tertiary care center...
March 3, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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