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Primary Care Pearls

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Reena Gupta, Kate Dubé, Thomas Bodenheimer
Primary care residency programs and their associated primary care clinics face challenges in their goal to simultaneously provide a good education for tomorrow's doctors and excellent care for today's patients. A team from the Center for Excellence in Primary Care at the University of California, San Francisco, conducted site visits to 23 family medicine, internal medicine, and pediatric residency teaching clinics. The authors found that a number of programs have transformed themselves with respect to engaged leadership, resident scheduling, continuity of care for patients and residents, team-based care, and resident engagement in practice improvement...
April 2016: Academic Medicine: Journal of the Association of American Medical Colleges
(no author information available yet)
No abstract text is available yet for this article.
January 2016: Diabetes Care
K John McConnell
No abstract text is available yet for this article.
March 1, 2016: JAMA: the Journal of the American Medical Association
L M Arnold, K B Gebke, E H S Choy
AIMS: Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation...
February 2016: International Journal of Clinical Practice
W Michael Hooten, Steven P Cohen
Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis...
December 2015: Mayo Clinic Proceedings
Mark W Friedberg, Meredith B Rosenthal, Rachel M Werner, Kevin G Volpp, Eric C Schneider
IMPORTANCE: Published evaluations of medical home interventions have found limited effects on quality and utilization of care. OBJECTIVE: To measure associations between participation in the Northeastern Pennsylvania Chronic Care Initiative and changes in quality and utilization of care. DESIGN, SETTING, AND PARTICIPANTS: The northeast region of the Pennsylvania Chronic Care Initiative began in October 2009, included 2 commercial health plans and 27 volunteering small primary care practice sites, and was designed to run for 36 months...
August 2015: JAMA Internal Medicine
James C Watson, P James B Dyck
Peripheral neuropathy is one of the most prevalent neurologic conditions encountered by physicians of all specialties. Physicians are faced with 3 distinct challenges in caring for patients with peripheral neuropathy: (1) how to efficiently and effectively screen (in less than 2 minutes) an asymptomatic patient for peripheral neuropathy when they have a disorder in which peripheral neuropathy is highly prevalent (eg, diabetes mellitus), (2) how to clinically stratify patients presenting with symptoms of neuropathy to determine who would benefit from specialty consultation and what testing is appropriate for those who do not need consultation, and (3) how to treat the symptoms of painful peripheral neuropathy...
July 2015: Mayo Clinic Proceedings
Christopher Burton, Amanda J Cochran, Isobel M Cameron
BACKGROUND: Many patients in primary care stop antidepressant treatment after only one prescription, so do not benefit from treatment. Some patients who stop initial antidepressant treatment go on to restart it, but neither the incidence of restarting nor the probability that patients who restart treatment subsequently complete an adequate course of treatment is known. OBJECTIVE: To examine subsequent antidepressant use in patients who discontinued treatment after only one antidepressant prescription...
October 2015: Family Practice
Alex J Sinclair, Aaron Sturrock, Brendan Davies, Manjit Matharu
Headache is one of the most common conditions presenting to the neurology clinic, yet a significant proportion of these patients are unsatisfied by their clinic experience. Headache can be extremely disabling; effective treatment is not only essential for patients but is rewarding for the physician. In this first of two parts review of headache, we provide an overview of headache management, emerging therapeutic strategies and an accessible interpretation of clinical guidelines to assist the busy neurologist...
December 2015: Practical Neurology
Phillip A Low, Victoria A Tomalia
Orthostatic hypotension (OH) occurs when mechanisms for the regulation of orthostatic BP control fails. Such regulation depends on the baroreflexes, normal blood volume, and defenses against excessive venous pooling. OH is common in the elderly and is associated with an increase in mortality rate. There are many causes of OH. Aging coupled with diseases such as diabetes and Parkinson's disease results in a prevalence of 10-30% in the elderly. These conditions cause baroreflex failure with resulting combination of OH, supine hypertension, and loss of diurnal variation of BP...
July 2015: Journal of Clinical Neurology
Michelle Howard, Sharef Danho
No abstract text is available yet for this article.
February 2015: Family Practice
Darshak M Sanghavi, Patrick H Conway
No abstract text is available yet for this article.
July 14, 2015: JAMA: the Journal of the American Medical Association
Robert L Phillips
No abstract text is available yet for this article.
May 2015: Annals of Family Medicine
Alex Harding, Joe Rosenthal, Marwa Al-Seaidy, Denis Pereira Gray, Robert K McKinley
BACKGROUND: Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning AIM: This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision...
June 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Vinod S Hegade, Stuart F W Kendrick, Jahangir Rehman, David E J Jones
No abstract text is available yet for this article.
June 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Ashok Reddy, Craig E Pollack, David A Asch, Anne Canamucio, Rachel M Werner
IMPORTANCE: Primary care provider (PCP) turnover is common and can disrupt patient continuity of care. Little is known about the effect of PCP turnover on patient care experience and quality of care. OBJECTIVE: To measure the effect of PCP turnover on patient experiences of care and ambulatory care quality. DESIGN, SETTING, AND PARTICIPANTS: Observational, retrospective cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA)...
July 2015: JAMA Internal Medicine
Michael Tanner
No abstract text is available yet for this article.
May 19, 2015: Annals of Internal Medicine
(no author information available yet)
No abstract text is available yet for this article.
May 15, 2015: American Family Physician
Kristin Parker, Karen Dohr, Jon O Neher, Gary Kelsberg, Leilani St Anna
Statin therapy produces a small increase in the incidence of diabetes: one additional case per 255 patients taking statins over 4 years.
April 2015: Journal of Family Practice
Vari M Drennan, Mary Halter, Louise Joly, Heather Gage, Robert L Grant, Jonathan Gabe, Sally Brearley, Wilfred Carneiro, Simon de Lusignan
BACKGROUND: Physician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice. AIM: This study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs. DESIGN AND SETTING: An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England. METHOD: PA consultations were compared with those of GPs...
May 2015: British Journal of General Practice: the Journal of the Royal College of General Practitioners
2015-05-21 23:27:54
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