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Primary care medicine

Kurt D Christensen, Jason L Vassy, Kathryn A Phillips, Carrie L Blout, Danielle R Azzariti, Christine Y Lu, Jill O Robinson, Kaitlyn Lee, Michael P Douglas, Jennifer M Yeh, Kalotina Machini, Natasha K Stout, Heidi L Rehm, Amy L McGuire, Robert C Green, Dmitry Dukhovny
PurposeGreat uncertainty exists about the costs associated with whole-genome sequencing (WGS).MethodsOne hundred cardiology patients with cardiomyopathy diagnoses and 100 ostensibly healthy primary care patients were randomized to receive a family-history report alone or with a WGS report. Cardiology patients also reviewed prior genetic test results. WGS costs were estimated by tracking resource use and staff time. Downstream costs were estimated by identifying services in administrative data, medical records, and patient surveys for 6 months...
March 22, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
(no author information available yet)
In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with a global overview of the role of PRM in healthcare systems in Europe. Several documents and reports by WHO and the UN call for the worldwide strengthening of rehabilitation as a key health strategy of the 21st century. Therefore, further implementation of PRM in healthcare systems is crucial. Many aspects need to be considered when implementing PRM in a health system. Since PRM should be provided along the whole continuum of care, a specific phase model has been developed...
April 2018: European Journal of Physical and Rehabilitation Medicine
(no author information available yet)
In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the history of the PRM medical specialty. The specialty evolved in different European countries, and sometimes also into the single countries, from different medical streams that finally joined. These included among others: balneology, gymnastic, use of physical agents (water, heat, cold, massage, joint manipulations, physical exercise, etc.). Another important role has been played by the increasing number of people experiencing or likely to experience disability due to improvement of medicine and consequent survivals from wars, accidents and/or big infective epidemics (like polio); these evolutions happened in strict relationship with other specialties like cardiology, neurology, orthopaedics, pneumology, rheumatology, traumatology, creating a knowledge transversal to all of them...
April 2018: European Journal of Physical and Rehabilitation Medicine
(no author information available yet)
In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the core concepts at the base of the PRM specialty. These are the essential constituents that make PRM a primary medical specialty, different from all the other medical specialties, and PRM physician the primary medical specialist among the rehabilitation professionals. The core concepts that will be discussed in this Section include: - PRM is a person/functioning oriented specialty, and this makes the specialty different from the organ/disease oriented, or treatment/age specific medical specialties...
April 2018: European Journal of Physical and Rehabilitation Medicine
Marc Miravitlles, Jesús Molina, José Antonio Quintano, Anna Campuzano, Joselín Pérez, Carlos Roncero
Background: COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of COPD in order to guide therapy; therefore, it is important to understand the factors determining CAT scores. Methods: This is a post hoc analysis of a cross-sectional, observational study conducted in respiratory medicine departments and primary care centers in Spain with the aim of identifying the factors determining CAT scores, focusing particularly on the cognitive status measured by the Mini-Mental State Examination (MMSE) and levels of depression measured by the short Beck Depression Inventory (BDI)...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Talita Sousa Queiroz, Tania Cristina Morais Santa Barbara Rehem, Marina Morato Stival, Silvana Schwerz Funghetto, Luciano Ramos de Lima, Breno Guilherme Cardoso, Walterlânia Silva Santos
OBJECTIVE: To understand the care of elderly men with their own health. METHOD: A qualitative study with the participation of ten elderly men, through responses to the semi-structured interview guided by the "Tell me about your experiences of care with your health", carried out in a basic health unit, during the period of October-December 2014. The speeches, after being transcribed were submitted to content analysis. RESULTS: The ten interviewees were retired and had an average age of 67...
2018: Revista Brasileira de Enfermagem
Allah Bukhsh, Muhammad Sarfraz Nawaz, Hafiz Sajjad Ahmed, Tahir Mehmood Khan
BACKGROUND: Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan...
March 2018: Medicine (Baltimore)
Rebecca Simon, Sharon W Lahiri
OBJECTIVE: To identify provider recommendations and barriers in obesity management in a multicenter academic health system with extensive weight-loss management resources. METHODS: A 26-question online survey was sent to attending physicians, trainees, and advanced practice providers in primary care specialties (internal medicine, family medicine, women's health) and endocrinology. RESULTS: The survey response rate was 26% (111/430). Of respondents, 50% were internal medicine, 24% family medicine, 16% women's health, and 9% endocrinology...
March 21, 2018: Endocrine Practice
Adolph J Yates
The Center for Disease Control and Prevention recently released their 2017 Guideline for the Prevention of Surgical Site Infection. One of their recommendations is the ordering of a single dose of preoperative prophylactic antibiotics with no subsequent postoperative dosing; this recommendation includes perioperative antibiotics for patients undergoing total joint arthroplasty. At this time, the American Association of Hip and Knee Surgeons (AAHKS) does not agree with this recommendation vis-a-vis total joint arthroplasty because it contradicts current international standards of care with limited evidence and study...
March 2018: Arthroplasty Today
Christopher J Smith, Russell J Buzalko, Nathan Anderson, Joel Michalski, Jordan Warchol, Stephen Ducey, Chad E Branecki
Introduction: Miscommunication during inter-unit handoffs between emergency and internal medicine physicians may jeopardize patient safety. Our goal was to evaluate the impact of a structured communication strategy on the quality of admission handoffs. Methods: We conducted a mixed-methods, pre-test/post-test study at a 560-bed academic health center with 60,000 emergency department (ED) patient visits per year. Admission-handoff best practices were integrated into a modified SBAR format, resulting in the Situation, Background, Assessment, Responsibilities & Risk, Discussion & Disposition, Read-back & Record (SBAR-DR) model...
March 2018: Western Journal of Emergency Medicine
Andrew C Berry, Nicholas A Berry, Travis S Myers, Joseph Reznicek, Bruce B Berry
Background: Many healthcare professionals consider obese individuals to be unmotivated and to lack the willpower to follow through with weight-loss plans. This attitude may result in less effort put into diagnosing, documenting, and treating obesity. Our aim was to assess documentation patterns of obesity and hypertension overall, by primary care specialty, and in relation to provider body mass index (BMI). Methods: Twenty-two physicians from one outpatient community practice were included: 10 internal medicine and 12 family practice practitioners...
2018: Ochsner Journal
Zhipeng Zhu, Hongmei Zhou, Yunjian Ni, Cheng Wu, Caijun Zhang, Xiaoyan Ling
Purpose: Cardiac surgery patients always present with atrial fibrillation (AF) after admission to the intensive care unit, leading to high mortality and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication used for sedation in the intensive care unit; however, whether it can reduce AF needs to be analyzed. Materials and methods: Three primary databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched...
2018: Drug Design, Development and Therapy
Matthew W Zackoff, Camille Graham, Denise Warrick, Kathleen Pulda, Craig Gosdin, Blair Simpson, Jessica Marischen, Paul Bunch, Michael Vossmeyer, Grant M Mussman
OBJECTIVES: During hospital admission, communication between primary care physicians (PCPs) and hospital medicine (HM) physicians provides an opportunity for collaboration. Two-way communication facilitates collaboration by allowing the receiver to ask and respond to questions. At our institution, most HM-to-PCP communication occurred by telephone call after discharge. Our specific aim was to increase the percentage of patients for whom a telephone conversation occurred between HM and PCPs during hospital admission from 40% to >80%...
March 20, 2018: Hospital Pediatrics
Karine Danno, Gérard Duru, Jean Marie Vetel
BACKGROUND:  The increasing use of psychotropic drugs to treat anxiety and depressive disorders (ADDs) is concerning. According to the study, 'Etude Pharmacoépidémiologique de l'Impact de Santé Publique des modes de prise en charge pour 3 groupes de pathologies' (EPI3)-LASER, adult ADD patients who consult a general practitioner prescribing homeopathic medicines (GP-Ho) report less psychotropic drug use and are marginally more likely to experience clinical improvement than those receiving conventional care...
March 20, 2018: Homeopathy: the Journal of the Faculty of Homeopathy
Bobbi Jo H Yarborough, Felicia W Chi, Carla A Green, Agatha Hinman, Jennifer Mertens, Arne Beck, Michael Horberg, Constance Weisner, Cynthia I Campbell
OBJECTIVES: Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures. METHODS: This mixed-methods study linked patient and health system data from four Kaiser Permanente regions to HEDIS performance measure data for 44,320 commercially or Medicare-insured adults with HEDIS-eligible AOD diagnoses in 2012...
March 19, 2018: Journal of Addiction Medicine
Sanjay V Desai, David A Asch, Lisa M Bellini, Krisda H Chaiyachati, Manqing Liu, Alice L Sternberg, James Tonascia, Alyssa M Yeager, Jeremy M Asch, Joel T Katz, Mathias Basner, David W Bates, Karl Y Bilimoria, David F Dinges, Orit Even-Shoshan, David M Shade, Jeffrey H Silber, Dylan S Small, Kevin G Volpp, Judy A Shea
Background Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. Methods We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores...
March 20, 2018: New England Journal of Medicine
Miran Brvar, Ming Yin Chan, Andrew H Dawson, Richard R Ribchester, Michael Eddleston
INTRODUCTION: Treatment of acute organophosphorus or carbamate insecticide self-poisoning is often ineffective, with tens of thousands of deaths occurring every year. Researchers have recommended the addition of magnesium sulfate or calcium channel blocking drugs to standard care to reduce acetylcholine release at cholinergic synapses. OBJECTIVE: We aimed to review systematically the evidence from preclinical studies in animals exposed to organophosphorus or carbamate insecticides concerning the efficacy of magnesium sulfate and calcium channel blocking drugs as therapy compared with placebo in reducing mortality or clinical features of poisoning...
March 20, 2018: Clinical Toxicology
Paul P Walker, Pasquale P Pompilio, Paolo Zanaboni, Trine S Bergmo, Kaiu Prikk, Andrei Malinovschi, Josep M Montserrat, Jo Middlemass, Silvana Šonc, Giulia Munaro, Dorjan Marušič, Ruth Sepper, Roberto Rosso, A Niroshan Siriwardena, Christer Janson, Ramon Farre, Peter M A Calverley, Raffaele L Dellaca'
RATIONALE: Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation. OBJECTIVES: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities. METHODS: This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49...
March 20, 2018: American Journal of Respiratory and Critical Care Medicine
José M Méndez Ribas
The Medicine for adolescents is a true specialty mostly exercised by doctors trained in pediatrics, family clinicians and gynecologists properly trained in their care and with the vocation for that. Based on my experience as a Founding Member and Director for more than 20 years of the Adolescence Program of the Hospital de Clínicas (University of Buenos Aires), I presented a methodology of attention with the objective of showing a comprehensive approach of the adolescents with an emphasis on general health promotion and prevention of diseases, and on reproductive health in particular...
April 1, 2018: Archivos Argentinos de Pediatría
Martin Mielke
Clinically relevant infections are the primary indication for the use of antimicrobial agents in human medicine. Consequently, the prevention of infections is the fundament of all measures to rationally reduce the use of antibiotics. A prevented infection must not be treated. For the prevention of several community-acquired infections, vaccines are available. In addition, several infections may be prevented on the basis of knowledge and responsible behavior. However, the prevention of nosocomial infections depends mainly on the responsibility of third parties in the context of medical procedures...
March 19, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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