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Andrei V, Argirò A, Mazzoni C, Rossi G, Pieroni M, Bolognese L, Allinovi M, Scaletti C, Perfetto F, Cappelli F. Screening for cardiac amyloidosis in patients with tenosynovial red flags: A collaboration between family medicine and cardiology. Int J Cardiol 2024; 407:132114. [PMID: 38697400 DOI: 10.1016/j.ijcard.2024.132114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Amyloid deposition in tenosynovial structures precedes cardiac involvement up to 20 years. Therefore, a cardiological screening in patients with a history of tenosynovial manifestations of cardiac amyloidosis (CA) could lead to an increased number of early diagnoses. METHODS Patients with tenosynovial manifestations of CA (carpal tunnel syndrome, atraumatic biceps tendon rupture, lumbar spinal stenosis) have been identified by general practitioners and evaluated in a Referral Center for CA. Patients with a high suspicion of CA underwent the CA diagnostic pathway. RESULTS Among 50 General Practitioners (GP) contacted, 10 (20%) agreed to participate in the study for a total of 5615 patients ≥60 years. One hundred forty-five patients met the inclusion criteria, 2 of them already had a diagnosis of CA, and 57 agreed to undergo a cardiological evaluation (electrocardiography, echocardiography, NTproBNP assay). The median age was 73 [67-80] years and 31 (54%) were women. Eight patients were suggested to start the CA diagnostic pathway, five of them underwent a complete diagnostic evaluation for CA, three refused to complete the diagnostic exams and no new diagnoses were made. CONCLUSION A screening program for CA in patients with tenosynovial manifestations identified by general practitioners is feasible, but may not yield a high rate of new diagnosis. In this study, we identified two patients who already had a diagnosis of CA, and among patients at high risk for CA, 37% refused to complete the diagnostic pathway. Increased awareness of CA among patients might increase participation and diagnostic yield in screening studies. Further validation of this protocol is needed to evaluate its diagnostic performance.
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Affiliation(s)
- Valentina Andrei
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy; Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Alessia Argirò
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Carlotta Mazzoni
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Gabriele Rossi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | | | - Marco Allinovi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Cristina Scaletti
- Tuscany Region Rare Disease Network, Tuscany Region, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
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Porterfield L, Jan QH, Jones F, Cao T, Davis L, Guillot-Wright S, Walcher CM. Family Medicine Team Perspectives on Screening for Health-Related Social Needs. J Am Board Fam Med 2024; 37:180-186. [PMID: 38272534 DOI: 10.3122/jabfm.2023.230167r3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Social drivers of health (SDH) strongly influence health outcomes and disparities. Although systemic level change is vital to address the disparities driven by SDH, it is also crucial that health care organizations develop the ability to care for patients in a manner that accounts for social factors and their influence on patient health. Although primary care is a natural fit for health-related social needs (HRSN) screening and intervention, significant barriers can impede primary care's effectiveness in this area. METHODS We conducted 3 focus groups with family medicine clinicians, clinical staff, and social care workers in an academic medical center using a semistructured discussion guide to explore current practices, perceived benefits, barriers, and potential opportunities and approaches for integrating routine HRSN screening in primary care. RESULTS 3 primary themes emerged from the focus groups. They included 1) the barriers to routine screening in primary care, including time, workload, emotional burden, patient factors, and team members' fear of inadequacy of resources or their own ability; 2) the importance and benefit of HRSN screening, including the opportunity to improve patient care through increased care team awareness of the patient's context, interventions to address HRSN, and improved relationships between the care team and the patient; and 3) recommendations for implementing routine screening in primary care, including opportunities to optimize workflow and technology, the importance of an electronic medical record (EMR)-integrated resource database, and the centrality of teamwork. DISCUSSION Family medicine health care teams embrace the importance of HRSN screening and the potential for positive impact. However, there are vital barriers and considerations to address for HRSN screening to be effectively integrated into primary care visits.
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Affiliation(s)
- Laura Porterfield
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ).
| | - Quratulanne H Jan
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
| | - Forrest Jones
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
| | - Tran Cao
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
| | - Lacy Davis
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
| | - Shannon Guillot-Wright
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
| | - Christen M Walcher
- From the Department of Family Medicine, Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX (LP); Department of Family Medicine, University of Texas Medical Branch, Galveston, TX (QHJ, TC, LD, SGW, CMW); School of Medicine, University of Texas Medical Branch, Galveston, TX (FJ)
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Cohidon C, Senn N. [Organization and practice in family medicine. What's new in the 2024 literature?]. Rev Med Suisse 2024; 20:932-939. [PMID: 38717000 DOI: 10.53738/revmed.2024.19.873.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
This is a selection of some important studies recently published and dealing with several key organization and functioning features of family medicine. This year, the articles focus on organizational responses to emergencies in family medicine. In this field, the use of primary care professionals other than physicians is an interesting solution. One article examines direct access to a physiotherapist, with very positive results, while a second explores the wide-ranging skills of advanced practice nurses in the emergency field. In some countries, such as Belgium, the use of teleconsultation in primary care is also being considered to avoid inappropriate use of hospital emergencies. Finally, more macroscopic organizational aspects of the healthcare system and the role of primary care in health emergencies will be considered in the last article.
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Affiliation(s)
- Christine Cohidon
- PD, Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, Université de Lausanne, 1011 Lausanne
| | - Nicolas Senn
- Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, Université de Lausanne, 1011 Lausanne
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Senn N, Martin S, Bideau M, Haller DM. Les temps de l’urgence en médecine de famille. Rev Med Suisse 2024; 20:907. [PMID: 38716995 DOI: 10.53738/revmed.2024.19.873.907] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Nicolas Senn
- Département de médecine de famille, Unisanté, 1011 Lausanne
| | | | - Martine Bideau
- Institut universitaire de médecine de famille et de l'enfance, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Dagmar M Haller
- Institut universitaire de médecine de famille et de l'enfance, Faculté de médecine, Université de Genève, 1211 Genève 4
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Pimlott N. Restoring the particular to family medicine. Can Fam Physician 2024; 70:294. [PMID: 38744518 DOI: 10.46747/cfp.7005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
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Philippe E, Nielsen Fan J. Diary of a Family Physician. Am Fam Physician 2024; 109:371. [PMID: 38648839] [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: 04/25/2024]
Affiliation(s)
| | - Jennifer Nielsen Fan
- Baylor Scott and White Memorial Hospital and McLane Children's Hospital, Temple, Texas
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Bowman MA, Seehusen DA, Britz J, Ledford CJW. Research to Improve Clinical Care in Family Medicine: Big Data, Telehealth, Artificial Intelligence, and More. J Am Board Fam Med 2024; 37:161-164. [PMID: 38740469 DOI: 10.3122/jabfm.2024.240050r0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?
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Meci A, Du Breuil F, Vilcu A, Pitel T, Guerrisi C, Robard Q, Turbelin C, Hanslik T, Rossignol L, Souty C, Blanchon T. The Sentiworld project: global mapping of sentinel surveillance networks in general practice. BMC Prim Care 2022; 23:173. [PMID: 35836123 PMCID: PMC9281158 DOI: 10.1186/s12875-022-01776-x] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Sentinel networks composed of general practitioners (GPs) represent a powerful tool for epidemiologic surveillance and ad-hoc studies. Globalization necesitates greater international cooperation among sentinel networks. The aim of this study was to inventory GP sentinel networks involved in epidemiological surveillance on a global scale. METHODS GP sentinel surveillance networks were inventoried globally between July 2016 and December 2019. Each identified network was required to fill out an electronic descriptive survey for inclusion. RESULTS A total of 148 networks were identified as potential surveillance networks in general practice and were contacted. Among them, 48 were included in the study. Geographically, 33 networks (68.8%) were located in Europe and 38 (79.2%) had national coverage. The number of GPs registered in these networks represented between 0.1 and 100% of the total number of GPs in the network's country or region, with a median of 2.5%. All networks were involved in continuous epidemiologic surveillance and 47 (97.9%) monitored influenza-like illness. Data collection methods were paper-based forms (n = 26, 55.3%), electronic forms on a dedicated website (n = 18, 38.3%), electronic forms on a dedicated software program (n = 14, 29.8%), and direct extraction from electronic medical records (n = 14, 29.8%). Along with this study, a website has been created to share all data collected. CONCLUSIONS This study represents the first global geographic mapping of GP sentinel surveillance networks. By sharing this information, collaboration between networks will be easier, which can strengthen the quality of international epidemiologic surveillance. In the face of crises like that of COVID-19, this is more imperative than ever before.
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Affiliation(s)
- Andrew Meci
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France.
| | - Florence Du Breuil
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Ana Vilcu
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Thibaud Pitel
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Caroline Guerrisi
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Quentin Robard
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Clément Turbelin
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Thomas Hanslik
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR Simone Veil - Santé, F78180, Montigny-le-Bretonneux, France
- Assistance Publique - Hôpitaux de Paris, APHP, Hôpital Ambroise Paré, Service de Médecine Interne, F92100, Boulogne-Billancourt, France
| | - Louise Rossignol
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
- Université de Paris, Faculté de Médecine, Département de médecine générale, Université Paris Diderot, F75018, Paris, France
| | - Cécile Souty
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
| | - Thierry Blanchon
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMRS 1136, Sorbonne Université, F75012, Paris, France
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Dai M, Chung Y, Peterson LE, Petterson S, Phillips RL. Family Practices in Transforming Clinical Practice Initiative Showed No Changes in Medicare Costs or Utilization. Med Care 2022; 60:50-55. [PMID: 34739412 DOI: 10.1097/mlr.0000000000001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019. OBJECTIVE The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative. STUDY DESIGN A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample. SUBJECTS A total of 761 PTN practices and 3451 non-PTN practices. MEASURES To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics. RESULTS The differences in Medicare Part A and B costs (-1.71%, P=0.25), annual rates of hospitalization (-0.59%, P=0.12) and emergency department visit (-0.29%, P=0.46) were not significantly lower among PTN practices (N=761) than among propensity score-matched non-PTN practices (N=3541). CONCLUSIONS TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.
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Affiliation(s)
| | - Yoonkyung Chung
- Robert Graham Center of American Academy of Family Physicians, Washington, DC
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY
| | - Stephen Petterson
- Robert Graham Center of American Academy of Family Physicians, Washington, DC
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, KY
- Center for Professionalism and Value in Health Care, Washington, DC
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Chavez A, Sievers K. Diary of a Family Physician. Am Fam Physician 2021; 104:421. [PMID: 34652103] [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: 06/13/2023]
Affiliation(s)
| | - Karlynn Sievers
- St. Mary's Family Medicine Residency Program, Grand Junction, CO, USA
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Stewart-Patterson C, Bourgeois R, Martin DW. The Importance of Keeping Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (Long COVID) Engaged in Work. Am Fam Physician 2021; 103:710. [PMID: 34128623] [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: 06/12/2023]
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Marra J, Law AMY, Conlon E. Clinical Considerations in Caring for Transgender Athletes. Am Fam Physician 2021; 103:518-520. [PMID: 33929173] [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: 06/12/2023]
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Mott T, Echeverri D, Fondren L, Hunter A. Confidently rule out CAP in the outpatient setting. J Fam Pract 2021; 70:140-142. [PMID: 34314338 DOI: 10.12788/jfp.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients.
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Affiliation(s)
- Timothy Mott
- South Baldwin Regional Medical Center Family Medicine Residency, Foley, AL
| | - David Echeverri
- South Baldwin Regional Medical Center Family Medicine Residency, Foley, AL
| | - Luke Fondren
- South Baldwin Regional Medical Center Family Medicine Residency, Foley, AL
| | - Ashley Hunter
- South Baldwin Regional Medical Center Family Medicine Residency, Foley, AL
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Antenucci C, Schreiber S, Clegg K, Runnels P. Integrating primary care into a community mental health center. J Fam Pract 2021; 70:137-139. [PMID: 34314337 DOI: 10.12788/jfp.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Our initiation of a reverse-integration practice model revealed numerous advantages and rewards, as well as many challenges, for which we found solutions.
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Affiliation(s)
- Christina Antenucci
- MetroHealth, Cleveland, OH (Dr. Antenucci); University Hospitals, Cleveland (Mr. Schreiber and Drs. Clegg and Runnels)
| | - Steven Schreiber
- MetroHealth, Cleveland, OH (Dr. Antenucci); University Hospitals, Cleveland (Mr. Schreiber and Drs. Clegg and Runnels)
| | - Kathleen Clegg
- MetroHealth, Cleveland, OH (Dr. Antenucci); University Hospitals, Cleveland (Mr. Schreiber and Drs. Clegg and Runnels)
| | - Patrick Runnels
- MetroHealth, Cleveland, OH (Dr. Antenucci); University Hospitals, Cleveland (Mr. Schreiber and Drs. Clegg and Runnels)
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Eichorn W, Jevert-Eichorn S. Helping your obese patient achieve a healthier weight. J Fam Pract 2021; 70:131-136. [PMID: 34314336 DOI: 10.12788/jfp.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
These tips will help identify underlying causes of obesity, address comorbid conditions, and provide patients with the tools they need to successfully lose weight.
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Affiliation(s)
- Wesley Eichorn
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Susan Jevert-Eichorn
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
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Agarwal P, Mukerji G, Laur C, Chandra S, Pimlott N, Heisey R, Stovel R, Goulbourne E, Bhatia RS, Bhattacharyya O, Martin D. Adoption, feasibility and safety of a family medicine-led remote monitoring program for patients with COVID-19: a descriptive study. CMAJ Open 2021; 9:E324-E330. [PMID: 33795222 PMCID: PMC8034257 DOI: 10.9778/cmajo.20200174] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine-led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community. METHODS COVIDCare@Home is a multifaceted, interprofessional team-based remote monitoring program developed at an ambulatory academic centre, the Women's College Hospital in Toronto. A descriptive analysis of the first cohort of patients admitted from Apr. 8 to May 11, 2020, was conducted. Lessons from the implementation of the program are described, focusing on measure of adoption (number of visits per patient total, with a physician or with a nurse; length of follow-up), feasibility (received an oximeter or thermometer; consultation with general internal medicine, social work or mental health, pharmacy or acute ambulatory care unit) and safety (hospitalizations, mortality and emergency department visits). RESULTS The COVIDCare@Home program cared for a first cohort of 97 patients (median age 41 yr, 67% female) with 415 recorded virtual visits. Patients had a median time from positive testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to first appointment of 3 (interquartile range [IQR] 2-4) days, with a median virtual follow-up time of 8 (IQR 5-10) days. A total of 4 (4%) had an emergency department visit, with no patients requiring hospitalization and no deaths; 16 (16%) of patients required support with mental and social health needs. INTERPRETATION A family medicine-led, team-based remote monitoring program can safely manage the care of outpatients diagnosed with COVID-19. Virtual care approaches, particularly those that support patients with more complex health and social needs, may be an important part of ongoing health system efforts to manage subsequent waves of COVID-19 and other diseases.
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont.
| | - Geetha Mukerji
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Nick Pimlott
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Ruth Heisey
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Rebecca Stovel
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Elaine Goulbourne
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
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17
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Morris C, Stasko T, Collins L. Guarding against nonmelanoma skin cancer in solid organ transplant recipients. J Fam Pract 2021; 70:121-130. [PMID: 34314335 DOI: 10.12788/jfp.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Periodic skin examination and ongoing counseling are central in your posttransplantation care of these patients at high risk of skin malignancy.
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Affiliation(s)
- Chance Morris
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Lindsey Collins
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
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18
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Hayes J, Fox K. Urine drug screening: A guide to monitoring Tx with controlled substances. J Fam Pract 2021; 70:112-120. [PMID: 34314334 DOI: 10.12788/jfp.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Avoid error by ordering the appropriate test at a risk-based frequency. Be alert to sources of false-positives and adulteration. Be careful not to overreact to unexpected results.
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Affiliation(s)
- John Hayes
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee (Dr. Hayes); Waukesha Family Medicine Residency at ProHealth Care, WI (Dr. Fox)
| | - Kristen Fox
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee (Dr. Hayes); Waukesha Family Medicine Residency at ProHealth Care, WI (Dr. Fox)
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19
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Neuman M, Mahdavi R, Khodaee M. 37-year-old man • cough • increasing shortness of breath • pleuritic chest pain • Dx? J Fam Pract 2021; 70:143-149. [PMID: 34314339 DOI: 10.12788/jfp.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
► Cough ► Increasing shortness of breath ► Pleuritic chest pain.
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Affiliation(s)
- Melissa Neuman
- Department of Family Medicine, University of Colorado School of Medicine, Denver (Drs. Neuman and Khodaee); Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Dr. Mahdavi)
| | - Ramyar Mahdavi
- Department of Family Medicine, University of Colorado School of Medicine, Denver (Drs. Neuman and Khodaee); Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Dr. Mahdavi)
| | - Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver (Drs. Neuman and Khodaee); Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Dr. Mahdavi)
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20
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Stacey SK, McEleney M. Topical Corticosteroids: Choice and Application. Am Fam Physician 2021; 103:337-343. [PMID: 33719380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as psoriasis and atopic dermatitis. Topical corticosteroids are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions. The risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals. When prescribing topical corticosteroids for use in children, lower potencies and shorter durations should be used. Topical corticosteroids can work safely and effectively in patients who are pregnant or lactating. They are available in formulations such as ointments, creams, lotions, gels, foams, oils, solutions, and shampoos. The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated. Correct patient application is critical to successful use. Patients may be taught application using the fingertip unit method. One fingertip unit is the amount of medication dispensed from the tip of the index finger to the crease of the distal interphalangeal joint and covers approximately 2% body surface area on an adult. Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids. There is no specified time limit for low-potency topical corticosteroid use.
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Affiliation(s)
- Stephen K Stacey
- Mayo Clinic Family Medicine Residency Program, La Crosse, WI, USA
| | - Mark McEleney
- Mayo Clinic Family Medicine Residency Program, La Crosse, WI, USA
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21
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Coles S, Vosooney A. Evidence Lacking to Support Universal Unhealthy Drug Use Screening. Am Fam Physician 2021; 103:72-73. [PMID: 33448770] [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: 06/12/2023]
Affiliation(s)
- Sarah Coles
- University of Arizona College of Medicine, Phoenix, AZ, USA
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22
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Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and Collaborative Management. Am Fam Physician 2021; 103:97-106. [PMID: 33448766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dysphagia is common but may be underreported. Specific symptoms, rather than their perceived location, should guide the initial evaluation and imaging. Obstructive symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia. Symptoms should be thoroughly evaluated because of the risk of aspiration. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most commonly caused by gastroesophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent; esophageal biopsies should be performed to make the diagnosis. Esophageal motility disorders such as achalasia are relatively rare and may be overdiagnosed. Opioid-induced esophageal dysfunction is becoming more common. Esophagogastroduodenoscopy is recommended for the initial evaluation of esophageal dysphagia, with barium esophagography as an adjunct. Esophageal cancer and other serious conditions have a low prevalence, and testing in low-risk patients may be deferred while a four-week trial of acid-suppressing therapy is undertaken. Many frail older adults with progressive neurologic disease have significant but unrecognized dysphagia, which significantly increases their risk of aspiration pneumonia and malnourishment. In these patients, the diagnosis of dysphagia should prompt a discussion about goals of care before potentially harmful interventions are considered. Speech-language pathologists and other specialists, in collaboration with family physicians, can provide structured assessments and make appropriate recommendations for safe swallowing, palliative care, or rehabilitation.
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23
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Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. Am Fam Physician 2021; 103:81-89. [PMID: 33448767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.
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24
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Kane SF, Abadie KV, Willson A. Degenerative Cervical Myelopathy: Recognition and Management. Am Fam Physician 2020; 102:740-750. [PMID: 33320508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Degenerative cervical myelopathy encompasses a collection of pathologic conditions that result in progressive spinal cord dysfunction secondary to cord compression. Patients are typically male (3: 1 male-to-female ratio), and the average age of presentation is 64 years. The exact incidence is unclear because of differences in terminology and because radiographic findings can be present in asymptomatic individuals. Common examination findings include neck pain or stiffness, a wide-based ataxic gait, ascending paresthesia in the upper or lower extremities, lower extremity weakness, decreased hand dexterity, hyperreflexia, clonus, Babinski sign, and bowel or bladder dysfunction in severe disease. Definitive diagnosis requires correlation of physical examination findings with imaging findings. Magnetic resonance imaging of the cervical spine with and without contrast media is the preferred imaging modality. Cervical spine computed tomography, computed tomography myelography, and plain radiography are helpful in certain situations. Treatment depends on the presence and severity of symptoms. Surgery is recommended for patients with moderate to severe symptoms or rapidly progressive disease. Conservative treatments with monitoring for progression may be considered in patients with mild to moderate disease. The evidence for the effectiveness of conservative treatments is scarce and of low quality, and outcomes can vary with individual patients. Primary care physicians play a vital role in recognizing the typical presentation of degenerative cervical myelopathy, coordinating treatment as indicated, and managing comorbidities.
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Affiliation(s)
- Shawn F Kane
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Katarina V Abadie
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Adam Willson
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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25
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Castelli G, Desai KM, Cantone RE. Peripheral Neuropathy: Evaluation and Differential Diagnosis. Am Fam Physician 2020; 102:732-739. [PMID: 33320513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing. Early peripheral neuropathy may present as sensory alterations that are often progressive, including sensory loss, numbness, pain, or burning sensations in a "stocking and glove" distribution of the extremities. Later stages may involve proximal numbness, distal weakness, or atrophy. Physical examination should include a comprehensive neurologic and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation for potential underlying etiologies should initially focus on treatable causes. Initial laboratory evaluation includes a complete blood count; a comprehensive metabolic profile; fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., electrodiagnostic studies, specific antibody assays, nerve biopsy) should be considered. Treatment of peripheral neuropathy focuses on managing the underlying etiology. Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain.
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Affiliation(s)
- Gregory Castelli
- University of Pittsburgh Medical Center St. Margaret, Pittsburgh, PA, USA
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26
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Ladkany D, Davis JE. Penile Swelling. Am Fam Physician 2020; 102:751-752. [PMID: 33320512] [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: 06/12/2023]
Affiliation(s)
- Diana Ladkany
- Georgetown University and MedStar Health, Washington, DC, USA
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27
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Galima SV, Vogel SR, Kowalski AW. Seasonal Affective Disorder: Common Questions and Answers. Am Fam Physician 2020; 102:668-672. [PMID: 33252911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Seasonal affective disorder is a mood disorder that is a subtype or qualifier of major depressive disorder or bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders. It is characterized by depressive symptoms that occur at a specific time of year (typically fall or winter) with full remission at other times of year (typically spring or summer). Possible risk factors include family history, female sex, living at a more northern latitude, and young adulthood (18 to 30 years of age). With the temporal nature of the mood episodes, diagnosis requires full remission when the specified season ends and two consecutive years of episodes in the same season. First-line therapy for seasonal affective disorder includes light therapy, antidepressants, and cognitive behavior therapy, alone or in combination. Commercial devices are available for administering light therapy or dawn simulation. The light intensity and duration of treatment depend on the device and the patient's initial response, but 2,500 to 10,000 lux for 30 to 60 minutes at the same time every day is typically effective. Lifestyle interventions, such as increasing exercise and exposure to natural light, are also recommended. If seasonal affective disorder recurs, long-term treatment or preventive intervention is typically indicated, and bupropion appears to have the strongest evidence supporting long-term use. Continuing light therapy or other antidepressants is likely beneficial, although evidence is inconclusive. Evidence is also inconclusive for psychotherapy and vitamin D supplementation.
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28
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O'Gurek DT, Lin KW, Bird MD. Management of Acute Pain from Musculoskeletal Injuries: Guidance for Family Physicians. Am Fam Physician 2020; 102:649-650. [PMID: 33252900] [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: 06/12/2023]
Affiliation(s)
- David T O'Gurek
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kenneth W Lin
- Georgetown University Medical Center, Washington, DC, USA
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29
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Halli-Tierney AD, Luker J, Carroll DG. Parkinson Disease. Am Fam Physician 2020; 102:679-691. [PMID: 33252908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parkinson disease is a progressive neurodegenerative disorder with significant morbidity and mortality. Most patients consult with their primary care physician about Parkinson disease symptoms before seeking care from a specialist. The diagnosis of Parkinson disease is clinical, and key disease features are bradykinesia, rigidity, and tremor. The main diagnostic signs of Parkinson disease are motor symptoms; however, Parkinson disease is also associated with nonmotor symptoms, including autonomic dysfunction, depression, and hallucinations, which can make the initial diagnosis of Parkinson disease difficult. Disease progression is variable and clinical signs cannot be used to predict progression accurately. Therapies, including levodopa, have not demonstrated the ability to slow disease progression. Motor symptoms are managed with carbidopa/levodopa, monoamine oxidase-B inhibitors, and nonergot dopamine agonists. Prolonged use and higher doses of levodopa result in dyskinesias and motor symptom fluctuations over time. Deep brain stimulation surgery is performed for patients who do not achieve adequate control with levodopa therapy. Deep brain stimulation is most effective for significant motor fluctuations, dyskinesias, and tremors. Nonmotor symptom therapies target patient-specific conditions during the disease course. Interdisciplinary team care can alleviate multiple symptoms of Parkinson disease.
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Affiliation(s)
| | | | - Dana G Carroll
- Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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30
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Windak A, Frese T, Hummers E, Klemenc Ketis Z, Tsukagoshi S, Vilaseca J, Vinker S, Ungan M. Academic general practice/family medicine in times of COVID-19 - Perspective of WONCA Europe. Eur J Gen Pract 2020; 26:182-188. [PMID: 33337939 PMCID: PMC7751383 DOI: 10.1080/13814788.2020.1855136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.
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Affiliation(s)
- Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Thomas Frese
- Institute of General Practice & Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva Hummers
- Department of General Practice, Georg-August-Universitat Gottingen, Gottingen, Germany
| | - Zalika Klemenc Ketis
- Community Health Centre Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Josep Vilaseca
- Consorci d'Atenció Primàrìa Barcelona Esquerra, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Turkey
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31
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Elliott C, Witherspoon PW, Werner KD. Home visits: A practical approach. J Fam Pract 2020; 69:507-513. [PMID: 33348345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This service, which significantly improves outcomes for many patients, is beneficial in this time of COVID-19.
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Affiliation(s)
- Curt Elliott
- University of South Carolina Department of Family and Preventive Medicine, Columbia, USA.
| | | | - Kristina D Werner
- Virginia Tech Carilion Family Medicine Residency Program, Roanoke, USA
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32
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Davis A, Weidner A, Moretz J, Holland N, Bortz B, Martinez-Guijosa A. THE COVID-19 PANDEMIC AND SILVER LININGS FOR PATIENT-CENTERED CARE. Ann Fam Med 2020; 18:570-571. [PMID: 33168694 PMCID: PMC7708276 DOI: 10.1370/afm.2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Cates JR, Diehl SJ, Fuemmeler BF, North SW, Chung RJ, Hill JF, Coyne-Beasley T. Toward Optimal Communication About HPV Vaccination for Preteens and Their Parents: Evaluation of an Online Training for Pediatric and Family Medicine Health Care Providers. J Public Health Manag Pract 2020; 26:159-167. [PMID: 31348153 PMCID: PMC6980988 DOI: 10.1097/phh.0000000000001022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Health care provider recommendation is a key determinant of human papillomavirus (HPV) vaccination. We developed an online training program for providers that addressed vaccine guidelines, hesitancy to strongly recommend the vaccine, and reluctance to discuss HPV infection as a sexually transmitted infection. DESIGN Single-group evaluation with 3 waves. Providers completed a 29-item electronic survey with closed and open-ended response options after course completion. SETTING Pediatric and family medicine practices in North Carolina. PARTICIPANTS Prescribing clinicians (MD, DO, family nurse practitioner, physician assistant) who serve preteens aged 11 to 12 years. In wave 3, we expanded our communities to include nursing and medical staff. INTERVENTION An asynchronous online course to promote preteen HPV vaccination. Topics included HPV epidemiology, vaccine recommendations from the Advisory Committee on Immunization Practices (ACIP), preteen-provider-parent communication, topics about hesitancy to seek vaccination, subjects related to sexual health, and practice-level strategies to increase vaccination rates. The course, approved for 12 CME and CNE credits, was live for 4 weeks and available on-demand for 3 additional months. MAIN OUTCOME MEASURES Provider-reported change in vaccine communication, perceptions of course content in improving practice, and satisfaction with materials. RESULTS A total of 113 providers from 25 practices enrolled in the course and 69 (61%) completed an evaluation. Providers spent an average of 6.3 hours on the course and rated the CDC (Centers for Disease Control and Prevention)-ACIP Web site and multiple resources on hesitancy and communication about sexually transmitted infection vaccines most highly of all materials across the 3 waves. Almost all (96%) agreed the course will improve their practice. About half of all participants said they were either "much more likely" (28%) or "more likely" (19%) to recommend the vaccine after course participation. CONCLUSIONS An online format offers a highly adaptable and acceptable educational tool that promotes interpersonal communication and practice-related changes known to improve providers' vaccine uptake by their patients.
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Affiliation(s)
- Joan R Cates
- School of Media and Journalism (Dr Cates) and Frank Porter Graham Child Development Institute (Ms Diehl), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia (Dr Fuemmeler); Blue Ridge Medical Center, Spruce Pine, North Carolina (Dr North); Duke Health, Durham, North Carolina (Dr Chung); Duke Cancer Network, Network Services in Duke University Health System, Durham, North Carolina (Dr Hill); and Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of Alabama, Birmingham, Alabama (Dr Coyne-Beasley)
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Martin S, David S, Dvorak C, Jaunin N. [Not Available]. Rev Med Suisse 2020; 16:1953. [PMID: 33058585] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sébastien Martin
- Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Stéphane David
- Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Charles Dvorak
- Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Nicole Jaunin
- Département de médecine de famille, Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
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Barry A, Fahey T. Clinical Diagnosis of Acute Bacterial Rhinosinusitis. Am Fam Physician 2020; 101:758-759. [PMID: 32538592] [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: 06/11/2023]
Affiliation(s)
- Alan Barry
- Health Research Board, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom Fahey
- Health Research Board, Royal College of Surgeons in Ireland, Dublin, Ireland
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36
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Tracer H, Caton Gilstrap L. Screening for Cognitive Impairment in Older Adults. Am Fam Physician 2020; 101:753-754. [PMID: 32538603] [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: 06/11/2023]
Affiliation(s)
- Howard Tracer
- U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, USA
| | - Laura Caton Gilstrap
- Preventive Medicine and Biostatistics Residency, Uniformed Services University of the Health Sciences, USA
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Bernard C, Tan A, Slaven M, Elston D, Heyland DK, Howard M. Exploring patient-reported barriers to advance care planning in family practice. BMC Fam Pract 2020; 21:94. [PMID: 32450812 PMCID: PMC7249389 DOI: 10.1186/s12875-020-01167-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 05/14/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although patient-centred care has become increasingly important across all medical specialties, when it comes to end of life care, research has shown that treatments ordered are not often concordant with people's expressed preferences. Patient and family engagement in Advance Care Planning (ACP) in the primary care setting could improve the concordance between patients' wishes and the healthcare received when patients cannot speak for themselves. The aim of this study was to better understand the barriers faced by older patients regarding talking to their family members and family physicians about ACP. METHODS In this multi-site cross-sectional study, three free text questions regarding reasons patients found it difficult to discuss ACP with their families or their family physicians were part of a self-administered questionnaire about patients' knowledge of and engagement in ACP. The questionnaire, which included closed ended questions followed by three probing open ended questions, was distributed in 20 family practices across 3 provinces in Canada. The free text responses were analyzed using thematic analysis and form the basis of this paper. RESULTS One hundred two participants provided an analyzable response to the survey when asked why they haven't talked to someone about ACP. Two hundred fifty-four answered the question about talking to their physician and 340 answered the question about talking to family members. Eight distinct themes emerged from the free text response analysis: 1. They were too young for ACP; 2. The topic is too emotional; 3. The Medical Doctor (MD) should be responsible for bringing up ACP 4. A fear of negatively impacting the patient-physician relationship; 5. Not enough time in appointments; 6. Concern about family dynamics; 7. It's not a priority; and 8. A lack of knowledge about ACP. CONCLUSIONS Patients in our sample described many barriers to ACP discussions, including concerns about the effect these discussions may have on relationships with both family members and family physicians, and issues relating to patients' knowledge and interpretation of the importance, responsibility for, or relevance of ACP itself. Family physicians may be uniquely placed to leverage the longitudinal, person- centred relationship they have with patients to mitigate some of these barriers.
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Affiliation(s)
- Carrie Bernard
- Department of Family Medicine, McMaster University, DBHSC 100 Main Street West, 5th floor, Hamilton, Ontario L8P 1H6 Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada
| | - Amy Tan
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marissa Slaven
- Department of Family Medicine, McMaster University, DBHSC 100 Main Street West, 5th floor, Hamilton, Ontario L8P 1H6 Canada
- Division of Palliative Care, McMaster University, Hamilton, Ontario Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, DBHSC 100 Main Street West, 5th floor, Hamilton, Ontario L8P 1H6 Canada
| | - Daren K. Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario Canada
- Department of Public Health, Queen’s University, Kingston, Ontario Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, DBHSC 100 Main Street West, 5th floor, Hamilton, Ontario L8P 1H6 Canada
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38
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Gastaldi G, Pautex S, Jelk-Morales L, Léocadie F, Sierro C, Sommer J. [Intensive treatment in family medicine : use of pumps and continuous glucose measurement systems]. Rev Med Suisse 2020; 16:1022-1025. [PMID: 32432418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
New technologic devices are presented: insulin pumps and continuous glucose monitoring (CGM) devices as well as morphine pumps to help general practitioners to deal different intensive situations. Insulin pumps and CGM devices are revolutionary for the management of diabetes. However, their use requires strong patient involvement, the opposite of automated diabetes management. Morphine pumps are a great help when patients in end-of-life stage cannot swallow oral morphine anymore. This article summarizes the main principles of use of these technological devices, common problems and situations at risk primary care practice.
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Affiliation(s)
- Giacomo Gastaldi
- Service d'endocrinologie, diabétologie, nutrition et éducation thérapeutique du patient, HUG, 1211 Genève 14
| | | | | | - Fabrice Léocadie
- Institution maintien à domicile (imad), Avenue Cardinal-Mermillod 36, 1227 Carouge
| | | | - Johanna Sommer
- Unité des internistes généralistes et pédiatres, Faculté de médecine, Université de Genève, , 1206 Genève
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Cohidon C, Senn N. [Improving patient care in family medicine : what's new about healthcare organization in the 2019 literature?]. Rev Med Suisse 2020; 16:1039-1043. [PMID: 32432421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Interprofessional collaboration (IPC) in primary care is widely encouraged, however, while medical students have a favourable attitude towards IPC, this attitude is less favourable when they reach the post-graduate level. A review of the literature on the characteristics of interprofessional primary care teams shows that while the positive effects of IPC are relatively clear on the care processes, they are much less clear with respect to patient health outcomes. A third paper studies the annual rate of family medicine visits and shows no association with mortality or hospital admissions rates. A final article, from China, looks at the idea of changing patients' perceptions of expected waiting times in order to improve their satisfaction with the health care system. The results could be extrapolated to our Western systems!
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Affiliation(s)
- Christine Cohidon
- Département de médicine de famille, Centre universitaire de médecine générale et santé publique, Université de Lausanne, Rue du Bugnon 44, 1011 Lausanne
| | - Nicolas Senn
- Département de médicine de famille, Centre universitaire de médecine générale et santé publique, Université de Lausanne, Rue du Bugnon 44, 1011 Lausanne
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40
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Middleton JL. Why the Stress-Disease Connection Matters and How to Respond. Am Fam Physician 2020; 101:585-586. [PMID: 32412222] [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: 06/11/2023]
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41
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Mishori R, Otubu O. The Older Driver. Am Fam Physician 2020; 101:625-629. [PMID: 32412218] [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: 06/11/2023]
Affiliation(s)
- Ranit Mishori
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA
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42
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Affiliation(s)
- Carles Llor
- Centro de Salud Via Roma, Barcelona, España.
| | - Ana Moragas
- Universidad Rovira i Virgili. Centro de Salud Jaume I, Tarragona, España
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43
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Clebak KT, Mendez-Miller M, Croad J. Cutaneous Cryosurgery for Common Skin Conditions. Am Fam Physician 2020; 101:399-406. [PMID: 32227823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue. Cutaneous cryosurgery has become a commonly performed outpatient procedure because of the combination of its safety, effectiveness, low cost, ease of use, lack of need for injectable anesthetic, and good cosmetic results. Cryosurgery may be performed in the outpatient setting using dipstick, spray, or cryoprobe techniques to treat a variety of benign, premalignant, and malignant skin lesions with high cure rates. Benign lesions such as common and plantar warts, anogenital condylomas, molluscum contagiosum, and seborrheic keratoses can be treated with cryotherapy. Basal and squamous cell carcinomas with low-risk features may be treated with cryosurgery. Contraindications to cryosurgery include neoplasms with indefinite margins or when pathology is desired, basal cell or squamous cell carcinomas with high-risk features, and prior adverse local reaction or hypersensitivity to cryosurgery. Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain and less commonly include tendon rupture, scarring, alopecia, atrophy, and hypopigmentation.
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Affiliation(s)
- Karl T Clebak
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Jason Croad
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Walling A. Frequent Headaches: Evaluation and Management. Am Fam Physician 2020; 101:419-428. [PMID: 32227826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most frequent headaches are typically migraine or tension-type headaches and are often exacerbated by medication overuse. Repeated headaches can induce central sensitization and transformation to chronic headaches that are intractable, are difficult to treat, and cause significant morbidity and costs. A complete history is essential to identify the most likely headache type, indications of serious secondary headaches, and significant comorbidities. A headache diary can document headache frequency, symptoms, initiating and exacerbating conditions, and treatment response over time. Neurologic assessment and physical examination focused on the head and neck are indicated in all patients. Although rare, serious underlying conditions must be excluded by the patient history, screening tools such as SNNOOP10, neurologic and physical examinations, and targeted imaging and other assessments. Medication overuse headache should be suspected in patients with frequent headaches. Medication history should include nonprescription analgesics and substances, including opiates, that may be obtained from others. Patients who overuse opiates, barbiturates, or benzodiazepines require slow tapering and possibly inpatient treatment to prevent acute withdrawal. Patients who overuse other agents can usually withdraw more quickly. Evidence is mixed on the role of medications such as topiramate for patients with medication overuse headache. For the underlying headache, an individualized evidence-based management plan incorporating pharmacologic and nonpharmacologic strategies is necessary. Patients with frequent migraine, tension-type, and cluster headaches should be offered prophylactic therapy. A complete management plan includes addressing risk factors, headache triggers, and common comorbid conditions such as depression, anxiety, substance abuse, and chronic musculoskeletal pain syndromes that can impair treatment effectiveness. Regular scheduled follow-up is important to monitor progress.
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Affiliation(s)
- Anne Walling
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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45
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Freeman T, Stewart M. Making the case for the study of symptoms in family practice. Can Fam Physician 2020; 66:218-219. [PMID: 32165472 PMCID: PMC8302357] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Tom Freeman
- Professor Emeritus in the Department of Family Medicine in the Centre for Studies in Family Medicine of the Schulich School of Medicine and Dentistry at Western University in London, Ont
| | - Moira Stewart
- Distinguished University Professor Emeritus in the Centre for Studies in Family Medicine
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46
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Ramdin C, Keller S. Sequential third-year medical student quality assurance (QA) clerkship projects appear to introduce a culture of continuous quality improvement across New Jersey family medicine practices. BMJ Open Qual 2020; 9:bmjoq-2019-000822. [PMID: 32169862 PMCID: PMC7074804 DOI: 10.1136/bmjoq-2019-000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/14/2019] [Accepted: 12/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background In recent years, Rutgers New Jersey Medical School Department of Family Medicine has integrated a quality assurance (QA) project as a required component of their 5-week medical student clerkship. This project requires each student to conduct a QA study at an assigned family practice and discuss the results with their preceptor. The aim of this study was to determine if sequential medical student QA projects impact physician readiness to improve guideline adherence over time. Methods A retrospective analysis of student reports was conducted to determine if physician readiness to improve compliance improved post implementation of the QA project using James Prochaska’s Transtheoretical Model of Behavioral Change. Fisher’s exact test or the χ2 test were used as applicable to compare the change in results. Results In academic year 2015–2016, there were 11 (6%) instances where physicians were precontemplating on change, 43 (24%) instances where physicians were contemplating, 101 (57%) instances where physicians were preparing to make change, 18 (10%) instances where physicians were acting, and 4 (2%) of instances where a physician were maintaining previous changes. The following year, the numbers were: 15 (8%), 38 (21%), 82 (46%), 34 (19%) and 11 (6%), respectively. There were increases of physicians in stages of precontemplation (p=0.047), action (p=0.02) and maintenance (p=0.047), a decrease in physicians that were in the stage of preparation (p=0.05) and no significant change in the instances they were in a stage of contemplation (p=0.60). Conclusion Student QA projects appear to leverage physician readiness to improve guideline adherence. Future studies will determine if raising awareness through these clerkship projects results in practice behavioural change.
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Affiliation(s)
- Christine Ramdin
- Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Steven Keller
- Family Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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47
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Bragg S, Ramsetty A, Bunt C. Refining your approach to hypothyroidism treatment. J Fam Pract 2020; 69:84-89. [PMID: 32182289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Thyroid hormone supplementation can be complicated by a number of factors. These tips can help to ensure that you provide the best treatment possible.
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Affiliation(s)
- Scott Bragg
- Clinical Pharmacy and Outcome Sciences, Medical University of South Carolina College of Pharmacy and Department of Family Medicine, Medical University of South Carolina College of Medicine, Charleston, USA
| | - Anita Ramsetty
- Department of Family Medicine, Medical University of South Carolina College of Medicine, Charleston, USA
| | - Christopher Bunt
- Department of Family Medicine, Medical University of South Carolina College of Medicine, Charleston, USA.
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Boeckxstaens P, Meskens A, Van der Poorten A, Verpoort AC, Sturgiss EA. Exploring the therapeutic alliance in Belgian family medicine and its association with doctor-patient characteristics: a cross-sectional survey study. BMJ Open 2020; 10:e033710. [PMID: 32029490 PMCID: PMC7045179 DOI: 10.1136/bmjopen-2019-033710] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient-doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance. DESIGN Cross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient-doctor relationship. SETTING Belgian primary care. PARTICIPANTS Every third patient (both practice and house call visits) was invited to participate. 170 patient-doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24-63 years) and 170 patients (35.9% men, age range 18-92 years). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations). RESULTS The median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year. CONCLUSIONS Consultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | - Annelou Meskens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | | | | | - Elizabeth Ann Sturgiss
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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Ruggeri CE. Closing the Gap: A Resident-Led Quality Improvement Project to Improve Colorectal Cancer Screening in Primary Care Community Clinics. J Grad Med Educ 2020; 12:104-108. [PMID: 32089801 PMCID: PMC7012507 DOI: 10.4300/jgme-d-19-00144.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/19/2019] [Accepted: 10/28/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the prevalence and mortality associated with colorectal cancer (CRC), 67.4% of US adults aged 50 to 75 years received recommended screening tests in 2016. OBJECTIVE We created a quality improvement project in resident-run outpatient clinics to increase CRC screening rates to ≥ 50% from 2016 to 2018, with emphasis on vulnerable patient populations. METHODS We applied a comprehensive, multidisciplinary approach involving internal medicine and family medicine residents and staff from various hospital network departments, selecting 4 clinics to participate whose screening rates were below our network's average of 41%. Our intervention consisted of a needs assessment, resident-led educational sessions for clinicians, staff, and patients, use of fecal immunochemical tests as a first screening option, and application of care gap analysts at each clinic to answer patients' screening questions and to follow up regarding their screening status. RESULTS We obtained approximately 100 patient surveys from each clinic, a 100% staff completion rate (68 of 68), and a 90% clinician completion rate (85 of 94). Staff and clinician surveys revealed concerns about reducing patient screening fears, inconsistent documentation of screening outcomes, and need for education about CRC prevention, early detection, and screening recommendations. Patient surveys revealed educational deficits and concerns about perceived screening obstacles (eg, transportation and insurance). While CRC screening rates increased across all participating clinics, one clinic experienced an increase from 23% to 48%. CONCLUSIONS Our multitargeted approach in primary care residency practices yielded increased CRC screening rates in vulnerable patient populations.
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50
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Klein DA, Paradise SL, Landis CA. Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. Am Fam Physician 2020; 101:147-158. [PMID: 32003959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Healthy development is likely to occur when an adolescent's risk factors are limited and when protective factors are fostered. Healthy development is further encouraged when youth feel valued, empowered, and form healthy social connections. Threats to the well-being of adolescents typically result from experimentation and psychosocial stressors. SSHADESS (strengths, school, home, activities, drugs, emotions/eating, sexuality, safety) is a mnemonic to facilitate collection of psychosocial history of critical life dimensions emphasizing strengths within a youth's life experience instead of solely focusing on risks, which in isolation can provoke feelings of shame. Because adolescents are more likely to access health care and share sensitive information when confidentiality is assured, clinicians should regularly offer confidential screening and counseling. When limited for time, a brief psychosocial screen may include current stressors, availability of a confidant, and school or work experience as a proxy for well-being. Clinicians should provide education to prevent initiation of tobacco use. Long-acting reversible contraceptives are safe and effective in adolescents and should be offered as first-line options to prevent pregnancy. Sexually active females 24 years or younger should be screened for gonorrhea and chlamydia annually. Adolescents 12 years or older should be screened for major depressive disorder when systems are available to ensure accurate diagnosis, treatment, and follow-up. Adolescents with body mass index at the 95th percentile or higher should be referred for comprehensive behavioral interventions. Seatbelt use and avoidance of distracted or impaired driving should be discussed. Clinicians should discuss digital literacy and appropriate online boundary setting and display of personal information.
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Affiliation(s)
- David A Klein
- 11th Medical Group, Joint Base Anacostia-Bolling, Washington, DC, USA
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