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Barreto TW. Management of Postpartum Hypertensive Disorders of Pregnancy. Am Fam Physician 2024; 109:Online. [PMID: 38393804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- Tyler W Barreto
- Family Health Associates, Family Care Network, Bellingham, Washington
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Barreto TW, Taylor MK, Goldstein JT, Eden AR. Retaining the perinatal care workforce: Lessons learned from experienced physicians who no longer attend deliveries. Health Serv Res 2024; 59:e14224. [PMID: 37653276 PMCID: PMC10771905 DOI: 10.1111/1475-6773.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE To inform policy supporting the retention of family physicians (FPs) in the perinatal care workforce by identifying physician characteristics that are associated with retention. DATA SOURCES AND STUDY SETTING We surveyed FPs who had been in practice for at least 11 years and reported attending deliveries as part of their practice. STUDY DESIGN We compared the characteristics of FPs who continue to provide perinatal care to those who have ceased and explored their reasons for no longer attending deliveries. DATA COLLECTION/EXTRACTION METHODS We estimated a probit regression with the dependent variable: whether the physician currently delivers babies. Open-ended survey responses were analyzed and close-coded using a conceptual content analysis approach. PRINCIPLE FINDINGS Of the FPs who received a survey, 1505 (37%) responded. Those who continue attending deliveries were more likely to receive a stipend or be paid per hour/shift in addition to their salary versus those paid a salary (percentage point difference = 13), and less likely to work part-time versus full-time (percentage point difference = -20). Those who ceased attending deliveries cite lifestyle (n = 208), call structure (n = 113), and delivery volume (n = 89) among the reasons for doing so. CONCLUSIONS Evidence-based policies aimed at preventing attrition from the perinatal care workforce, which might include targeting compensation models and work-life balance.
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Affiliation(s)
- Tyler W. Barreto
- Family Health AssociatesFamily Care NetworkBellinghamWashingtonUSA
| | | | | | - Aimee R. Eden
- American Board of Family MedicineLexingtonKentuckyUSA
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Young RA, Wilkinson E, Barreto TW, Newton RL, Turebylu A, Bullock D. A cross-sectional study of the practice types of US adult primary care physician specialists. Fam Pract 2022; 39:799-804. [PMID: 35064671 DOI: 10.1093/fampra/cmab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many physicians listed as primary care in databases such as the American Medical Association (AMA) Masterfile do not provide traditional ambulatory primary care. OBJECTIVE To compare physicians listed in the AMA Masterfile as primary care physician (PCPs) specialists for adult patients with their actual practice type. METHODS We conducted a cross-sectional study of the AMA Masterfile report for PCPs who care for adults (listed as family medicine, internal medicine, medicine-paediatrics, and geriatrics) in the summer and fall of 2018 (spring of 2019 for Hartford, CT) in the primary counties of 8 metropolitan areas across the United States. We searched multiple websites to determine the actual practice type of each physician in the study counties. We correlated the 2 datasets: the AMA Masterfile list vs the results of our searches. RESULTS Family physicians were more likely to function as traditional ambulatory PCPs than internists [1,738/2,101 (82.7%) vs 1,241/2,025 (60.9%), P < 0.001], and less likely to be hospitalists [83/2,101 (4.0%) vs 631/2,025 (31.0%), P < 0.001]. Other practice types included urgent care [105 (5.0%) family physicians, 16 (0.8%) internists] and emergency medicine [49 (2.3%) family physicians, 20 (1.0%) internists]. The AMA Masterfile identified 4,892 practicing PCPs for adult patients in the study counties, of which 3,084 (63.0%) matched by location and ambulatory PCP practice type [3,695 (75.5%) for ambulatory PCP practice type only]. CONCLUSIONS We provide an updated estimate using a unique methodology to estimate how to correct the AMA Masterfile for PCPs who actually provide traditional ambulatory primary care to adult patients.
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Affiliation(s)
- Richard A Young
- Department of Family Medicine, John Peter Smith Hospital Family Medicine Residency Program, Fort Worth, TX, United States
| | | | | | - Rebecca L Newton
- Department of Family Medicine, John Peter Smith Hospital Family Medicine Residency Program, Fort Worth, TX, United States
| | | | - Dana Bullock
- Department of Family Medicine, John Peter Smith Hospital Family Medicine Residency Program, Fort Worth, TX, United States
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Shih G, Stulberg D, Barreto TW, Andrilla CHA, Guzman S, Nothnagle M. Faculty and Resident Contraceptive Opt Outs and Training Site Restrictions: A CERA Study. Fam Med 2022; 54:123-128. [DOI: 10.22454/fammed.2022.410546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: Contraception is a core component of family medicine residency curriculum. Institutional environments can influence residents’ access to contraceptive training and thus their ability to meet the reproductive health needs of their patients.
Methods: Contraceptive training questions were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked how many faculty and residents opt out of providing contraceptive methods for moral or religious reasons, and whether training sites have institutional restrictions on contraception. We performed descriptive statistics and regression to identify program characteristics associated with having a resident or faculty opt out of providing contraceptive care.
Results: Of 626 program directors, 249 responded to the survey, and 237 answered the contraceptive questions. Percentages of program directors reporting any residents or faculty who opted out of contraceptive services are as follows: pill/patch/ring (residents 27%; faculty 17%), emergency contraception (residents 40%, faculty 33%), or intrauterine devices/implants (resident 29%; faculty 23%). Programs in the South (OR 2.78; 1.19-6.49) and those with Catholic affiliation (OR 2.35; 1.23-4.91) had higher adjusted odds of at least one opt-out faculty but were not associated with having opt-out residents. Eleven percent of programs had at least one training site with institutional restrictions on contraception.
Conclusions: To ensure that residents have access to adequate contraceptive training, residencies should proactively seek faculty and training environments that meet residents’ needs, and should make limitations on services clear to potential residents and patients.
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Affiliation(s)
- Grace Shih
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Debra Stulberg
- Department of Family Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | | | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Melissa Nothnagle
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, Salinas, CA
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Roskos SE, Barreto TW, Phillips JP, King VJ, Eidson-Ton WS, Eden AR. Maternity Care Tracks at US Family Medicine Residency Programs. Fam Med 2021; 53:857-863. [PMID: 34780652 DOI: 10.22454/fammed.2021.237852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The number of family physicians providing maternity care continues to decline, jeopardizing access to needed care for underserved populations. Accreditation changes in 2014 provided an opportunity to create family medicine residency maternity care tracks, providing comprehensive maternity care training only for interested residents. We examined the relationship between maternity care tracks and residents' educational experiences and postgraduate practice. METHODS We included questions on maternity care tracks in an omnibus survey of family medicine residency program directors (PDs). We divided respondent programs into three categories: "Track," "No Track Needed," and "No Track." We compared these program types by their characteristics, number of resident deliveries, and number of graduates practicing maternity care. RESULTS The survey response rate was 40%. Of the responding PDs, 79 (32%) represented Track programs, 55 (22%) No Track Needed programs, and 94 (38%) No Track programs. Residents in a track attended more deliveries than those not in a track (at Track programs) and those at No Track Needed and No Track programs. No Track Needed programs reported the highest proportion of graduates accepting positions providing inpatient maternity care in 2019 (21%), followed by Track programs (17%) and No Track programs (5%; P<.001). CONCLUSIONS Where universal robust maternity care education is not feasible, maternity care tracks are an excellent alternative to provide maternity care training and produce graduates who will practice maternity care. Programs that cannot offer adequate experience to achieve competence in inpatient maternity care may consider instituting a maternity care track.
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Affiliation(s)
- Steven E Roskos
- Michigan State University College of Human Medicine, Department of Family Medicine and Sparrow/MSU Family Medicine Residency Program, East Lansing, MI
| | - Tyler W Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA
| | - Julie P Phillips
- Michigan State University College of Human Medicine and Sparrow Hospital-Michigan State University Family Medicine Residency Program, Lansing, MI
| | - Valerie J King
- Oregon Health and Science University, Department of Family Medicine, Portland, OR
| | | | - Aimee R Eden
- American Board of Family Medicine, Lexington, KY
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Hall JWW, Holman H, Barreto TW, Bornemann P, Vaughan A, Bennett KJ, Chamberlain J, Micks T, Maurer DM, Bergus GR. Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study. Fam Med 2021; 52:505-511. [PMID: 32640473 DOI: 10.22454/fammed.2020.223648] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. METHODS Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. RESULTS POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Only 27% of programs use six of the eight surveyed POCUS modalities more than once per year. The top three barriers to including POCUS in residency training in 2019 have not changed since 2014, and are (1) a lack of trained faculty, (2) limited access to equipment, and (3) discomfort with interpreting images without radiologist review. CONCLUSIONS Training in POCUS has increased in family medicine residencies over the last 5 years, although practical use of this technology in the clinical setting may be lagging behind. Further research should explore how POCUS can improve outcomes and reduce costs in the primary care setting to better inform training for this technology.
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Affiliation(s)
- Jeffrey W W Hall
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine
| | - Harland Holman
- Spectrum Health/Michigan State University College of Human Medicine
| | - Tyler W Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA
| | - Paul Bornemann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine
| | - Andrew Vaughan
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine
| | - Kevin J Bennett
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine
| | - Jeffrey Chamberlain
- Mercy Health Department of Family Medicine, Michigan State University College of Human Medicine
| | - Taft Micks
- Brandon Regional Health Centre, Department of Emergency Medicine, University of Manitoba, Manitoba, Canada
| | | | - George R Bergus
- Departments of Family Medicine and Physician Assistant Studies, University of Iowa Carver College of Medicine
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Affiliation(s)
- Tyler W Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA
| | - Aimee Eden
- American Board of Family Medicine, Lexington, KY
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Abstract
BACKGROUND AND OBJECTIVES According to a previous study, obstetric deliveries may be protective against burnout for family physicians. Analyses of interviews conducted during a larger qualitative study about the experiences of early-career family physicians who intended to include obstetric deliveries in their practice revealed that many interviewees discussed burnout. This study aimed to understand the relationship between practicing obstetrics and burnout based on an analysis of these emerging data on burnout. METHODS We conducted semistructured interviews with physicians who graduated from family medicine residency programs in the United States between 2013 and 2016. We applied an immersion-crystallization approach to analyze transcribed interviews. RESULTS Fifty-six early-career family physicians participated in interviews. Burnout was an emerging theme. Physicians described how practicing obstetrics can protect from burnout (eg, brings joy to practice, diversity in practice), how it can contribute to burnout (eg, time demands, increased stress), how it can do both simultaneously and the importance of professional agency (ie, the capacity to make own free choices), and other sources of burnout (eg, administrative tasks, complex patients). CONCLUSIONS This study identifies a family medicine-obstetric paradox wherein obstetrics can simultaneously protect from and contribute to burnout for family physicians. Professional agency may partially explain this paradox.
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Affiliation(s)
- Tyler W Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA
| | - Aimee Eden
- American Board of Family Medicine, Lexington, KY
| | - Audrey Brock
- American Board of Family Medicine, Lexington, KY
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Barreto TW, Estacio A, Winkler P. The Overlap Between Rural Hospital Needs and Medical Student Goals in Texas. PRiMER 2020; 4:18. [PMID: 33111045 PMCID: PMC7581194 DOI: 10.22454/primer.2020.808983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The rural health workforce in the United States is difficult to maintain and harder to increase. This may contribute to worse health outcomes in rural areas and threaten the sustainability of rural hospitals. Previous studies have attempted to identify medical student characteristics and strategies to help grow this workforce. In this study, we aimed to understand the needs of medical students and hospital administrators to identify potential strategies to improve the rural health workforce. METHODS We conducted medical student and hospital administrator focus groups. We analyzed focus group data separately to identify themes, and reviewed these themes for overlap between groups and potential actionable areas. We calculated Cohen κ statistics. RESULTS We identified 26 themes in the medical student focus groups, and 14 themes in the hospital administrator focus group. Of these themes, three were identical between groups (scope of practice, loan repayment and financial concerns, and exposure to rural health in training), and two were similar between the groups (family and leadership). CONCLUSION The identification of two themes that are similar but not identical between medical students and hospital administrators may serve as part of future strategies to improving rural physician recruitment. Future studies should determine if a shift in language or focus in these areas specifically help to improve the rural health workforce.
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Affiliation(s)
- Tyler W Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, WA
| | - Alvin Estacio
- South Central Area Health Education Center, San Antonio, TX
| | - Paula Winkler
- South Central Area Health Education Center, San Antonio, TX
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Louis JS, Eden AR, Morgan ZJ, Barreto TW, Peterson LE, Phillips RL. Maternity Care and Buprenorphine Prescribing in New Family Physicians. Ann Fam Med 2020; 18:156-158. [PMID: 32152020 PMCID: PMC7062488 DOI: 10.1370/afm.2504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/25/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022] Open
Abstract
The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work.
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Affiliation(s)
- Joshua St Louis
- Greater Lawrence Family Health Center, Lawrence, Massachusetts
| | - Aimee R Eden
- American Board of Family Medicine, Lexington, Kentucky
| | | | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Barrera SC, Cancino RS, Barreto TW. The impact of continuity of care on antibiotic prescribing in acute otitis media. Int J Pediatr Otorhinolaryngol 2019; 126:109616. [PMID: 31376791 DOI: 10.1016/j.ijporl.2019.109616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND The rate of antibiotic prescribing for acute otitis media (AOM) remains high despite efforts to decrease inappropriate use. Studies have aimed to understand the prescribing patterns of providers to increase antibiotic stewardship. Watch and wait (WAW) prescriptions are effective at decreasing the number of antibiotic prescriptions being filled by patients. Additionally, poor continuity of care has been associated with higher cost and lower quality health care. OBJECTIVE To understand the antibiotic prescribing habits for AOM in a largely Hispanic population. METHODS A retrospective review was performed from 2016 to 2018 of all patients under 25 years old with a diagnosis of AOM seen at multiple outpatient primary care clinics of a single institution. Charts were reviewed for factors including race, ethnicity, gender, insurance status, presence of fever, primary care physician visit, and treatment choice. Data were collected and analyzed using STATA software with t-tests, ANOVA, and Pearson chi squared analysis. RESULTS Antibiotics were prescribed 95.6% of the time with 3.8% being WAW prescriptions. There was no significant difference in antibiotic prescribing by race (p = 0.66), ethnicity (p = 0.38), gender (p = 0.34) or insurance status (p = 0.24). There was a difference between physicians, nurse practitioners, and physician's assistants and antibiotic prescribing rate (p < 0.01). Additionally, seen by their primary care provider were less likely to be prescribed antibiotics (85.8% vs 94.4%, p = 0.01). CONCLUSION While a patient's race, ethnicity, gender, and insurance status did not influence the prescribing rate of physicians, continuity of care may play an important role in decreasing inappropriate antibiotic prescribing.
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Affiliation(s)
- Shelby C Barrera
- UT Health San Antonio Long School of Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Ramon S Cancino
- UT Health San Antonio Long School of Medicine, Department of Family and Community Medicine, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Tyler W Barreto
- SeaMar Community Health Centers, 1920 100th St SE, Suite B, Everett, WA, 98208, USA
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Eden AR, Barreto TW, St. Louis J. Improving treatment of opioid use disorder in pregnancy: first define the workforce. Am J Obstet Gynecol 2019; 221:371-372. [PMID: 31279846 DOI: 10.1016/j.ajog.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
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Barreto TW, Svec JH. Chronic Neck Pain: Nonpharmacologic Treatment. Am Fam Physician 2019; 100:180-182. [PMID: 31361100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Jeff H Svec
- University of Texas Health, San Antonio, TX, USA
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Abstract
BACKGROUND AND OBJECTIVES The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in their practices. The objective of this study was to understand barriers to providing obstetrical care faced by recent family medicine residency graduates who intended to provide obstetrical care at graduation. METHODS Email surveys were sent to graduating family medicine residents who indicated intention to include obstetrics in their practice on the American Board of Family Medicine (ABFM) Certification Examination Registration Survey (2014-2016). We used descriptive and bivariate statistics to analyze the data. RESULTS Of our sample of 2,098 early career family physicians, 1,016 (48.4%) responded. Seven hundred (68.9%) currently include obstetrics in their practices. Those currently including obstetrics were more likely to practice in a small rural or isolated (15.4% vs 5.2% and 4.6% vs 1.7%, P<0.001) community and report credentialing was easy (85.2% and 26.5%, respectively, P<0.001). Physicians not currently including obstetrics in their practice reported "found a job without OB" and "lifestyle concerns" as the most significant barriers. Respondents living in the Middle Atlantic and West South Central regions were least likely to provide obstetric deliveries, with fewer than 50% doing so. CONCLUSIONS Among recent graduates who intended to practice obstetrics, finding a job without obstetrics and lifestyle concerns were the most significant barriers to realizing the scope of practice they intended.
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Affiliation(s)
- Tyler W Barreto
- University of Texas Health Science Center at San Antonio Department of Family and Community Medicine
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Barreto TW, Lin KW. Clostridium difficile Infection: Prevention and Treatment. Am Fam Physician 2018; 97:196-199. [PMID: 29431975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Tyler W Barreto
- University of Texas Health San Antonio, San Antonio, TX, USA
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Barreto TW, Lin KW. Noninvasive Treatments for Low Back Pain. Am Fam Physician 2017; 96:324-327. [PMID: 28925652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Tyler W Barreto
- Robert Graham Center and Georgetown University, Washington, DC, USA
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Barreto TW, Kemmeter PR, Paletta MP, Davis AT. A comparison of a single center's experience with three staple line reinforcement techniques in 1,502 laparoscopic sleeve gastrectomy patients. Obes Surg 2015; 25:418-22. [PMID: 25214203 DOI: 10.1007/s11695-014-1432-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to compare outcomes of laparoscopic sleeve gastrectomy (LSG) patients based on three types of staple line reinforcement (SLR): seromuscular suturing (imbrication), absorbable polymer membrane (APM), and bovine pericardial strips (BPS). BACKGROUND LSG represented 67.3 % of bariatric procedures performed in Michigan in 2013, and its prevalence continues to rise. Multiple studies suggest that SLR can potentially reduce the incidence of complications. However, the current literature is limited secondary to a small sample size and is not conclusive on which type of reinforcement technique is best in reducing the risk of complications. METHODS The charts of 1,526 consecutive patients who underwent an LSG from January 2005 to January 2013, by four experienced surgeons, were reviewed. Data include patient demographics, reinforcement technique utilized, length of hospitalization, complications, hospital readmission rates, and mortality. RESULTS Of 1,502 patients who underwent an LSG and met inclusion/exclusion criteria, 373 (24.8 %) were reinforced using imbrication, 269 (17.9 %) with BPS, and 860 (57.3 %) with APM. Patient demographics and complication rates were similar between groups. A statistically significant difference occurred in length of stay, readmission, and reoperation rates (p < 0.01). Length of stay was shortest in the BPS group, but readmission and reoperation rates were statistically higher, and there was a trend towards increased leaks (p = 0.08). CONCLUSIONS A comparison of imbrication, BPS, and APM demonstrated significantly increased readmission and reoperation rates with a trend towards increased leak rates with the use of BPS in LSG patients. Hemorrhage was not statistically different between the three reinforcement techniques.
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Affiliation(s)
- Tyler W Barreto
- Grand Rapids Medical Education Partners Family Medicine Residency, 300 Lafayette SE, Suite 4000, Grand Rapids, MI, 49503, USA,
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