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MedWorm: Primary Care



MedWorm.com provides a medical RSS filtering service. Over 7000 RSS medical sources are combined and output via different filters. This feed contains the latest news and research in Primary Care



Last Build Date: Mon, 28 Mar 2016 00:43:46 +0100

 



RheumNow: Statin-Induced Autoimmune Myopathy

Sun, 27 Mar 2016 20:35:04 +0100

(MedPage Today) -- A guide to this rare syndrome (Source: MedPage Today Primary Care)

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Blended learning in CME: the perception of GP trainers.

Sat, 26 Mar 2016 20:02:02 +0100

CONCLUSION: GP trainers were positive about blended learning: they found e-learning a useful way to gain knowledge and the meetings a pleasant way of transferring the knowledge into practice. Although some preconditions should be taken into consideration during its development and implementation, they would participate in similarly designed learning in the future. PMID: 27012724 [PubMed - as supplied by publisher] (Source: Education for Primary Care)



Benlysta Found Steroid-Sparing in Lupus (CME/CE)

Sat, 26 Mar 2016 18:00:00 +0100

(MedPage Today) -- Modest effects in prednisone dose reduction seen in post-hoc analyses (Source: MedPage Today Primary Care)



Hypertension Management in Primary Care.

Sat, 26 Mar 2016 14:24:02 +0100

CONCLUSION: After the short follow-up of 5 months, the intervention had no impact on BP control but improved the use of practice strategies. PMID: 27010951 [PubMed - in process] (Source: Deutsches Arzteblatt International)



A Randomized Trial of Human Papillomavirus Self-Sampling as an Intervention to Promote Cervical Cancer Screening Among Women With HIV

Sat, 26 Mar 2016 08:13:15 +0100

Conclusions: The intervention did not improve cytology test attendance, although education about HPV and cervical cancer risk as part of study procedures was associated with testing for 35% of this group of women whose previous cytology occurred an average of 3.6 years before the baseline appointment. Self-sampling for HPV testing was feasible. (Source: Journal of Lower Genital Tract Disease)



2016 Country Doctor of the Year Built Rural Care Network2016 Country Doctor of the Year Built Rural Care Network

Sat, 26 Mar 2016 05:14:12 +0100

Jasmine Sulaiman, MD, the sole physician serving four community health centers in rural Texas, represents a 'new breed' of country physician. Medscape Medical News (Source: Medscape Medical News Headlines)



The 5 Best Remedies For Sinus Problems

Sat, 26 Mar 2016 01:42:43 +0100

SPECIAL FROM Here’s an appetizing tidbit: Your sinus produces one to two liters of mucus every day—that’s the size of two large soda bottles. Under normal conditions, most of the mucus dribbles undetected down your throat. Yes, it’s gross but also very important: Mucus filters out bacteria, viruses, and fungi in the air that we breathe, and moistens the nasal passages and sinuses, allowing us to breathe easier and lessen risk of infections.  Sometimes, due to allergens, environmental pollution, nasal obstruction or inflammation, the system goes haywire, filling you with congestion. According to American Family Physician, “sinusitis is one of the most common conditions treated by primary care physicians. Each year in the United States, sinusitis affects o...



Challenges of vaccination in older people. Can we circumvent immunosenescence?

Fri, 25 Mar 2016 23:00:00 +0100

(Source: Maturitas)



An Unusual Cecal Mass in an Otherwise Healthy Young Woman

Fri, 25 Mar 2016 23:00:00 +0100

Question: A 25-year-old woman presented to her primary care physician for mild right upper quadrant pain. Apart from the patient being an avid kickboxer, no noteworthy abdominal trauma was recalled. Because of an inconclusive ultrasound examination, showing no gallstones, together with elevated liver enzymes an abdominal magnetic resonance imaging study was ordered. A 7 × 4.5 × 4-cm mass in contact to the cecum was seen. (Source: Gastroenterology)



Adrenergic signaling in heart failure and cardiovascular aging

Fri, 25 Mar 2016 23:00:00 +0100

(Source: Maturitas)



Accessibility and use of primary healthcare for immigrants living in the Niagara Region

Fri, 25 Mar 2016 23:00:00 +0100

Publication date: May 2016 Source:Social Science & Medicine, Volume 156 Author(s): Irene D. Lum, Rebecca H. Swartz, Matthew Y.W. Kwan Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for eme...



Medicine 3.0 Panelists Dissect Patient-Generated DataMedicine 3.0 Panelists Dissect Patient-Generated Data

Fri, 25 Mar 2016 22:33:20 +0100

The discussion centered on how patients can use mobile monitoring data to care for themselves and how that may affect the doctor-patient relationship. Medscape Medical News (Source: Medscape Medical News Headlines)

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Digital Mammograms Could Also Reveal Heart Disease Risk

Fri, 25 Mar 2016 21:46:48 +0100

This study demonstrates that accurate cardiovascular risk can be determined by evaluating the extent of calcification in blood vessels seen on digital mammograms, without the use of any additional radiation or risk. These exciting findings will allow women to be screened for the two most frequent life-threatening diseases at once - breast cancer and cardiovascular disease - (and allow) for determination of cardiovascular risk in a large population of women who might otherwise not get this potentially life-saving information.”   SOURCE: http://bit.ly/1MESUa8 JACC: Imaging, released March 24, 2016. -- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website....



What Can The Evolution Of Our Sleep Habits Teach Us?

Fri, 25 Mar 2016 21:20:52 +0100

When Amy Ozski started experiencing insomnia last August, it wasn't due to anything drastic. She recalls a heat wave in the Boston area where she lives, a bit more stress at work, and her schedule being thrown off for a few consecutive days. But the combination was enough to trigger a pattern: Ozski started having trouble falling asleep, and before long the problem snowballed into a chronic issue. Sometimes it would take her hours to fall asleep, or she'd wake up in the middle of the night and struggle to conk out again. Sleep -- and the lack of it -- took over her life. "It was all I thought about during the day," she says. "I was miserable." Ozski tried everything she could think of to fix the problem, from transcendental meditation to acupuncture, but to no avail. Finally, she sought he...



Sertraline improves Cryptococcus clearance in HIV meningitis

Fri, 25 Mar 2016 16:59:22 +0100

An open-label pilot study has found adjunct treatment with the SSRI antidepressant sertraline is associated with accelerated clearance of Cryptococcus from the cerebrospinal fluid in... (Source: Family Practice News)



Cannabinoids for seizures: Frankness, comfort, and follow-up are key to gathering data

Fri, 25 Mar 2016 16:34:14 +0100

Since Colorado is “ground zero” for medical marijuana use, the rest of the nation can learn from how pediatric neurologists there are taking care of children with seizures who use cannabinoids.



The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice.

Fri, 25 Mar 2016 16:29:02 +0100

Authors: Möller HJ, Bandelow B, Volz HP, Barnikol UB, Seifritz E, Kasper S Abstract According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition t...



Hidden Malpractice Dangers in Your EHRHidden Malpractice Dangers in Your EHR

Fri, 25 Mar 2016 15:39:34 +0100

Although EHRs can streamline record-keeping, some of the intrinsic features could lead to trouble if you're not careful. Medscape Business of Medicine (Source: Medscape Today Headlines)



Disclosing Down Syndrome: Must You Give an Upside?Disclosing Down Syndrome: Must You Give an Upside?

Fri, 25 Mar 2016 14:28:35 +0100

With the high rates of abortion after a positive screen for Down syndrome, should mothers be forced to listen to an upbeat message about the baby's future life? Medscape Business of Medicine (Source: Medscape Today Headlines)

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Reducing Healthcare Waste: Don't Expect Patients To Take The Lead

Fri, 25 Mar 2016 13:53:00 +0100

Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as Dual Energy X-ray Absorption. The scan would send two X-ray beams through her bones, one high energy and the other low. The difference in how much energy passes through her bones would somehow (the wonders of physics!) allow her doctors to calculate the thickness of her skeleton. (Source: Forbes.com Healthcare News)



A Scheduling Mystery

Fri, 25 Mar 2016 12:35:03 +0100

(MedPage Today) -- With a 30% no-show rate, why can't patients get same-day appointments? (Source: MedPage Today Primary Care)



Human factors and ergonomics for primary care.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Bowie P, Jeffcott S Abstract In the second paper of this series, we provide a brief overview of the scientific discipline of human factors and ergonomics (HFE). Traditionally the HFE focus in healthcare has been in acute hospital settings which are perceived to exhibit characteristics more similar to other high-risk industries already applying related principles and methods. This paper argues that primary care is an area which could benefit extensively from an HFE approach, specifically in improving the performance and well-being of people and organisations. To this end, we define the purpose of HFE, outline its three specialist sub-domains (physical, cognitive and organisational HFE) and provide examples of guiding HFE principles and practices. Additionally, we describe H...



Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: an evaluation of a combined face-to-face workshop and online educational intervention.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Magin PJ, Morgan S, Tapley A, Davis JS, McArthur L, Henderson KM, Mulquiney KJ, Dallas A, Davey AR, Scott J, van Driel ML Abstract Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-in...



Overcoming challenges in primary care education: family physician education in Newfoundland and Labrador.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: O'Keefe D, Eaton B, Rourke L, MacLean C PMID: 27005842 [PubMed - in process] (Source: Education for Primary Care)



Reducing general practice trainees' antibiotic prescribing for respiratory tract infections: an evaluation of a combined face-to-face workshop and online educational intervention.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Magin PJ, Morgan S, Tapley A, Davis JS, McArthur L, Henderson KM, Mulquiney KJ, Dallas A, Davey AR, Scott J, van Driel ML Abstract Over-prescription of antibiotics for non-pneumonia respiratory tract infections (RTIs) is a major concern in general practice. Australian general practice registrars (trainees) have inappropriately high rates of prescription of antibiotics for RTIs. The 'apprenticeship' educational model and the trainee-trainer relationship are drivers of this inappropriate prescribing. We aimed to reduce registrars' non-pneumonia RTI antibiotic prescribing via an educational intervention (a 90-min face-to-face workshop supported by online modules), complemented by delivery of the same intervention, separately, to their trainers. We conducted a pre- and post-in...



'It gave me a new lease of life … ': GPs' views and experiences of supervising foundation doctors in general practice.

Fri, 25 Mar 2016 08:07:04 +0100

CONCLUSION: Supervisors are positive about working with F2s, who lift morale in the team and challenge GPs in their own practice and learning. This boosts job and personal satisfaction. Nonetheless, consideration should be given to managing teaching workload and team support for supervision. PMID: 27005838 [PubMed - in process] (Source: Education for Primary Care)



Undertake ethically sound medical education research.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Pugsley L Abstract There are key ethical principles that need to be considered before the start of any research study. The research should be designed, reviewed and conducted in ways that ensure the integrity and the quality of the work. Researchers and research participants need to be fully informed as to the purpose, methods and possible uses of the study. Participation needs to be voluntary with a right to withdraw at any stage clearly stated. Anonymity and confidentiality must be respected and maintained, within the usual caveats of potential for danger or harm. Ethical approval must be obtained from an appropriate professional body or group. This is an essential step which should not be overlooked as it affords objective scrutiny to each piece of research and also pub...



Overcoming challenges in primary care education: family physician education in Newfoundland and Labrador.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: O'Keefe D, Eaton B, Rourke L, MacLean C PMID: 27005842 [PubMed - in process] (Source: Education for Primary Care)



Undertake ethically sound medical education research.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Pugsley L Abstract There are key ethical principles that need to be considered before the start of any research study. The research should be designed, reviewed and conducted in ways that ensure the integrity and the quality of the work. Researchers and research participants need to be fully informed as to the purpose, methods and possible uses of the study. Participation needs to be voluntary with a right to withdraw at any stage clearly stated. Anonymity and confidentiality must be respected and maintained, within the usual caveats of potential for danger or harm. Ethical approval must be obtained from an appropriate professional body or group. This is an essential step which should not be overlooked as it affords objective scrutiny to each piece of research and also pub...



Impact of revalidation on appraisal in primary care: an initial evaluation of the experience of Welsh GPs.

Fri, 25 Mar 2016 08:07:04 +0100

CONCLUSION: The study participants reported that revalidation had impacted on appraisal, bringing increased time and costs alongside some increased individual reflection and Quality Improvement (QI) activity. The impact was felt more by appraisers than appraisees. Overall, of those GPs revalidated in 2013, 62% reported it was a positive experience. PMID: 27005839 [PubMed - in process] (Source: Education for Primary Care)



Developing communication skills with GP trainees: the REAM approach.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Elliott R, Scallan S PMID: 27005840 [PubMed - in process] (Source: Education for Primary Care)

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Impact of revalidation on appraisal in primary care: an initial evaluation of the experience of Welsh GPs.

Fri, 25 Mar 2016 08:07:04 +0100

CONCLUSION: The study participants reported that revalidation had impacted on appraisal, bringing increased time and costs alongside some increased individual reflection and Quality Improvement (QI) activity. The impact was felt more by appraisers than appraisees. Overall, of those GPs revalidated in 2013, 62% reported it was a positive experience. PMID: 27005839 [PubMed - in process] (Source: Education for Primary Care)



Developing communication skills with GP trainees: the REAM approach.

Fri, 25 Mar 2016 08:07:04 +0100

Authors: Elliott R, Scallan S PMID: 27005840 [PubMed - in process] (Source: Education for Primary Care)



Ticagrelor Not Better Than Aspirin for Preventing CV Events (FREE)

Thu, 24 Mar 2016 23:00:00 +0100

By Amy Orciari Herman Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS The antiplatelet ticagrelor (Brilinta) is no better than aspirin for preventing cardiovascular events … (Source: Physician's First Watch current issue)



"It Runs in My Family…": the Association of Perceived Family History with Body Dissatisfaction and Weight Bias Internalization among Overweight Women.

Thu, 24 Mar 2016 23:00:00 +0100

"It Runs in My Family…": the Association of Perceived Family History with Body Dissatisfaction and Weight Bias Internalization among Overweight Women. Women Health. 2016 Mar 25; Authors: Eisenberg MH, Street RL, Persky S Abstract Aspects of poor body acceptance (BA), such as internalized weight bias and dissatisfaction with one's shape and size, are the strongest predictors of disordered eating and are associated with reduced engagement in healthy behaviors. Perceiving oneself as having a family history of overweight (PFH) could boost BA by increasing attributions for inherited, biological causes of weight. A community sample of 289 women who were overweight from the Washington, DC metropolitan area who were dissatisfied with their current weight (68% Black; 32% Whit...



Using tablets in medical consultations: Single loop and double loop learning processes

Thu, 24 Mar 2016 23:00:00 +0100

Conclusions This study indicates the importance of tablet use in ensuring information giving and patient learning. It further highlights the potential for tablets to promote single-loop learning in the medical encounter by better preparing patients for the physician's information giving. Tablets also enable double-loop learning, which leads to greater patient satisfaction. (Source: Computers in Human Behavior)

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Vancomycin-resistant enterococci carriage in an acute Irish hospital

Thu, 24 Mar 2016 23:00:00 +0100

Conclusion This high prevalence goes some way towards providing an explanation for the current high rates of VRE bacteraemia in Ireland, as well as highlighting the benefits of screening and enhanced infection control practices by all hospitals to control the high rates of VRE observed. (Source: Journal of Hospital Infection)



Women at Risk: Gender Inequality and Maternal Health.

Thu, 24 Mar 2016 23:00:00 +0100

Authors: Banda PC, Odimegwu CO, Ntoimo LF, Muchiri E Abstract Gender inequality has been documented as a key driver of negative health outcomes, especially among women. However, studies have not clearly examined the role of gender inequality in maternal health in an African setting. Therefore, this study examined the role of gender inequality, indicated by lack of female autonomy, in exposing women to maternal health risk. Data were obtained from the 2007 Zambia Demographic and Health Survey on a weighted sample of 3,906 married or partnered women aged 15-49 years. Multivariable analyses revealed that low autonomy in household decision power was associated with maternal health risk (Odds Ratio (OR) = 1.52, p < .001). Autonomy interacted with household wealth showed that res...



Partner Violence Victimization and Unintended Pregnancy in Latina and Asian American Women: Analysis Using Structural Equation Modeling.

Thu, 24 Mar 2016 23:00:00 +0100

Authors: Cha S, Masho SW, Heh V Abstract Intimate partner violence (IPV) is a pervasive public health problem in the U.S., affecting nearly one in every three women over their lifetimes. Using structural equation modeling, we evaluated the association between IPV and unintended pregnancy, mediated by condom use and perceived spousal/partner support among Latina and Asian women. Data came from the 2002-2003 National Latino and Asian American Study (NLAAS). The analysis was restricted to married or cohabiting female respondents aged 18+ years (n = 1,595). Dependent variables included: unintended pregnancy, condom use, and perceived partner support. Independent variables included: physical abuse or threats by current partner, and primary decision-maker. Weighted Least Squares was us...



FDA Issues Draft Guidance to Increase Availability of Abuse-Deterrent, Generic Opioids (FREE)

Thu, 24 Mar 2016 23:00:00 +0100

By the Editors The FDA on Thursday issued draft guidelines to support drug makers in developing … (Source: Physician's First Watch current issue)



Breast Arterial Calcifications Found on Mammograms Predictive of Coronary Artery Calcium (FREE)

Thu, 24 Mar 2016 23:00:00 +0100

By Kelly Young Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS Digital mammography might be able to help identify women at risk for cardiovascular disease, according to a retrospective study published in JACC: Cardiology Imaging that will be presented at the American College of Cardiology's upcoming annual meeting.At one medical center, … (Source: Physician's First Watch current issue)

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Your NEJM Group Today: ABIM Tutorial, Hyperbaric Oxygen & Diabetic Ulcers, New Hampshire Internist Opportunity (FREE)

Thu, 24 Mar 2016 23:00:00 +0100

By the Editors NEJM Group offers so many valuable resources for practicing clinicians. Here's what we chose for you today: … (Source: Physician's First Watch current issue)



Environmental and Personal Correlates of Physical Activity and Sedentary Behaviors in African American Women: an Ecological Momentary Assessment Study.

Thu, 24 Mar 2016 23:00:00 +0100

This study examined within-person associations of environmental factors (weather, built and social environmental barriers) and personal factors (daily hassles, affect) with moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) in African American women aged 25-64 years living in metropolitan Chicago (n = 97). In 2012-13, for 7 days, women wore an accelerometer and were signaled five times per day to complete a survey covering environmental and personal factors on a study-provided smartphone. Day-level measures of each were derived, and mixed regression models were used to test associations. Poor weather was associated with a 27.3% reduction in daily MVPA. Associations between built and social environmental barriers and daily MVPA or SB were generally not statistical...



On Review, NFL Concussion Research Ruled a Fumble (FREE)

Thu, 24 Mar 2016 23:00:00 +0100

By Joe Elia Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS The National Football League's internal research that played down the game's concussion risks "was far more flawed than previously known," according to a New … (Source: Physician's First Watch current issue)



New York e-Prescribing Law Goes Into Effect This SundayNew York e-Prescribing Law Goes Into Effect This Sunday

Thu, 24 Mar 2016 22:19:54 +0100

Easter Sunday will see the rollout of the law that requires all New York physicians to prescribe electronically and register their e-prescribing devices with the state. Medscape Medical News (Source: Medscape Medical News Headlines)



Dr. William Waugh (1851-1936): promoter of change in nineteenth century medical education and practice.

Thu, 24 Mar 2016 21:51:02 +0100

Authors: McKellar S Abstract SUMMARY: Dr. William E. Waugh (1851-1936) witnessed and actively participated in many changes in medical education and practice during his 6 decades in medicine. Trained as a surgeon and general practitioner, Waugh practised medicine in London, Ont., during the late nineteenth and early twentieth centuries. Early in his career, he embraced the new field of microbiology; refused outdated practices, such as bleeding; and dared to form a medical school despite strong criticism. Waugh was one of the founders of the Western University medical school, and he served various teaching and administrative roles in addition to maintaining a successful practice. He reminded students of the role of the physician's senses, which he cautioned were in danger of being ec...

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Heart attack patients getting younger, fatter, and less healthy

Thu, 24 Mar 2016 21:00:00 +0100

Despite advances in the prevention and early detection of cardiovascular disease, heart attack patients are getting younger, fatter, and less health conscious. A look at 10 years’ worth of patient... (Source: Family Practice News)



Brain imaging suggests link between stress and cardiovascular events

Thu, 24 Mar 2016 21:00:00 +0100

Stress seems to be a strong driver of cardiovascular events, including heart attack, stroke, and even death. For the first time, brain imaging has confirmed a link that has long been suspected:... (Source: Family Practice News)



Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy.

Thu, 24 Mar 2016 20:17:01 +0100

This report details the initial steps in the development of such an instrument. An interdisciplinary team of clinician-scientists performed four discrete steps in this study: (1) conceptualization of the purpose and function of the instrument, (2) assembly of an item pool, (3) expert rating on which items were most important to include in the instrument, and (4) modification of expert-selected items based on a reading level check and cognitive interviews with patients. A diverse panel of 47 subject matter experts was presented with 69 items to rate on a 1-9 scale in terms of importance for inclusion in the instrument. The panel highly rated 37 items: 8 related to harm, 4 related to efficacy, and 25 related to misuse. These 37 items were then tested for patient comprehension and modified as...



Does comorbid chronic pain affect posttraumatic stress disorder diagnosis and treatment? Outcomes of posttraumatic stress disorder screening in Department of Veterans Affairs primary care.

Thu, 24 Mar 2016 20:17:01 +0100

Authors: Outcalt SD, Hoen HM, Yu Z, Franks TM, Krebs EE Abstract Because posttraumatic stress disorder (PTSD) is both prevalent and underrecognized, routine primary care-based screening for PTSD has been implemented across the Veterans Health Administration. PTSD is frequently complicated by the presence of comorbid chronic pain, and patients with both conditions have increased symptom severity and poorer prognosis. Our objective was to determine whether the presence of pain affects diagnosis and treatment of PTSD among Department of Veterans Affairs (VA) patients who have a positive PTSD screening test. This retrospective cohort study used clinical and administrative data from six Midwestern VA medical centers. We identified 4,244 VA primary care patients with a positive PTSD scre...



Stepped care model of pain management and quality of pain care in long-term opioid therapy.

Thu, 24 Mar 2016 20:17:01 +0100

This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days) were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education). General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain ...

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Retail Clinics Contribute to an Increase in Health Care Spending

Thu, 24 Mar 2016 19:45:00 +0100

Retail clinics, often touted as offering health care savings, actually contribute to an increase in health care spending, according to a study published in Health Affairs. (Source: AAFP News)



FDA Releases Draft Plan for Abuse-Deterrent Opioid Generics

Thu, 24 Mar 2016 18:35:03 +0100

(MedPage Today) -- Move is second in a week on opioids (Source: MedPage Today Primary Care)



OncoBreak: Cancer in the Floor; Cancerous Products; Cancer Diagnosis Disaster

Thu, 24 Mar 2016 18:00:00 +0100

(MedPage Today) -- News, features, commentary about cancer-related issues (Source: MedPage Today Primary Care)



Diabetes Prevention Programs to Get Medicare Support

Thu, 24 Mar 2016 17:33:12 +0100

(MedPage Today) -- Proven model to be expanded, says HHS (Source: MedPage Today Primary Care)



Dual-Site HPV Infections Rare, But Risky for New Partners (CME/CE)

Thu, 24 Mar 2016 17:02:57 +0100

(MedPage Today) -- Women under 20 at highest risk for dual or concordant HPV infections (Source: MedPage Today Primary Care)



ACOG: Vaccines Should Be Part of Routine OB/GYN Practice

Thu, 24 Mar 2016 16:35:02 +0100

(MedPage Today) -- Recognizes specialty's role as primary care (Source: MedPage Today OB/GYN)

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Distress and alienation behind junior doctor strikes a 'serious concern', says GMC

Thu, 24 Mar 2016 16:29:52 +0100

The level of distress and alienation among junior doctors taking strike action is a 'matter of serious concern', the GMC chairman has warned. (Source: GP Online News)



Hackers Seek Ransom From Two More California HospitalsHackers Seek Ransom From Two More California Hospitals

Thu, 24 Mar 2016 16:15:07 +0100

Hackers demanded a ransom from two Southern California hospitals last week. Federal authorities are investigating the case. Kaiser Health News (Source: Medscape Medical News Headlines)



Two Birds With One Stone in Gout? (CME/CE)

Thu, 24 Mar 2016 16:00:00 +0100

(MedPage Today) -- Arhalofenate lowered uric acid and also prevented flares in a phase IIb trial (Source: MedPage Today Primary Care)



NICE scraps recommendations for paracetamol and acupuncture for low back pain

Thu, 24 Mar 2016 15:57:16 +0100

Exercise is the optimum way to manage low back pain, NICE experts have said in its latest draft guidance, which also downplays the use of paracetamol and retracts its endorsement of acupuncture. (Source: GP Online News)

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Some Ways of Telling Patients 'No' Are Nicer Than OthersSome Ways of Telling Patients 'No' Are Nicer Than Others

Thu, 24 Mar 2016 13:41:21 +0100

With patient surveys and patient-rating websites empowering patients to retaliate against doctors who refuse their requests, should you try to soften how you say 'no'? See what your colleagues think. Medscape Business of Medicine (Source: Medscape Today Headlines)



Would you know if your teen was depressed?

Thu, 24 Mar 2016 13:30:13 +0100

Parents of teenagers, here is another post that I hope will be helpful to you. Moms and dads of teens — and the doctors who care for these children — know how difficult it can be to identify depression in adolescents. When is your teen simply feeling down or irritable, and when is it something more? Doctors are receiving better and better training in diagnosing teenage depression, but perhaps the greatest challenge is finding time to make sure it happens. During a typical well-child visit, parents are usually busy trying to address the concerns they have about their child, while at the same time trying to understand what vaccines they need and making sure school forms are filled out. Pediatricians are busy trying to address physical and emotional concerns and anticipate problems that m...



The value of reasons for encounter in early detection of colorectal cancer.

Thu, 24 Mar 2016 13:17:02 +0100

Conclusion Data capture and organization in ICPC permits study of the predictive value of RFE for CRC in primary care.[Box: see text]. PMID: 27003276 [PubMed - as supplied by publisher] (Source: European Journal of General Practice)



Early-Career Docs No Less Likely to Prescribe Antibiotics Early-Career Docs No Less Likely to Prescribe Antibiotics

Thu, 24 Mar 2016 13:16:18 +0100

Medscape Medical News (Source: Medscape Allergy Headlines)

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'Militant' junior doctors holding country to ransom, says health minister

Thu, 24 Mar 2016 12:50:41 +0100

A government health minister has accused 'increasingly militant' junior doctors of holding the country to ransom after the BMA announced plans for an all-out strike next month. (Source: GP Online News)



GPs slash antibiotics dispensed in primary care by 5% in 2015

Thu, 24 Mar 2016 10:59:35 +0100

GP practices have helped to slash the number of antibiotics dispensed in primary care by 5% in 2015, official data show. (Source: GP Online News)



Video: NHS must do more to support GP mental health

Thu, 24 Mar 2016 10:39:19 +0100

NHS support for GPs and other doctors facing mental health problems must improve to reflect growing pressure on the profession, a charity has warned. (Source: GP Online News)



Clinical management following self-harm in a UK-wide primary care cohort - Carr MJ, Ashcroft DM, Kontopantelis E, While D, Awenat Y, Cooper J, Chew-Graham C, Kapur N, Webb RT.

Thu, 24 Mar 2016 02:14:47 +0100

BACKGROUND: Little is known about the clinical management of patients in primary care following self-harm. METHODS: A descriptive cohort study using data from 684 UK general practices that contributed to the Clinical Practice Research Datalink (CPR... (Source: SafetyLit)

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The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial

Thu, 24 Mar 2016 00:00:00 +0100

The National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40–... (Source: BMC Family Practice)



Systematic review of interventions to improve the psychological well-being of general practitioners

Thu, 24 Mar 2016 00:00:00 +0100

The health of doctors who work in primary care is threatened by workforce and workload issues. There is a need to find and appraise ways in which to protect their mental health, including how to achieve the br... (Source: BMC Family Practice)



Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?

Thu, 24 Mar 2016 00:00:00 +0100

The rising volume of referrals to secondary care is a continuing concern in the NHS in England, with considerable resource implications. Referral management centres (RMCs) are one of a range of initiatives bro... (Source: BMC Family Practice)



RPS Scotland welcomes £6.6M funding for pharmacists working with GP practices

Thu, 24 Mar 2016 00:00:00 +0100

The Scotttish Government has advised that it has allocated its second allocation of funding for pharmacists working with GP practices from the Primary Care Fund. On 25 June 2015, the Scottish Government announced that over three years (Source: Royal Pharmaceutical Society News)

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RPS in Scotland welcomes funding for new model of primary care test pilot

Thu, 24 Mar 2016 00:00:00 +0100

NHS Lanarkshire has received Scottish Government funding to test a new model of primary care. The £4.5 million project will see test sites in East Kilbride and Coatbridge bring together a range of health professionals in GP surgeries - such as practice nurses, district nurses, mental health (Source: Royal Pharmaceutical Society News)



The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial

Thu, 24 Mar 2016 00:00:00 +0100

The National Health Service Health Check (NHS HC) is a population level public health programme. It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40–... (Source: BMC Family Practice)



Infection biomarkers in primary care patients with acute respiratory tract infections–comparison of Procalcitonin and C-reactive protein

Thu, 24 Mar 2016 00:00:00 +0100

There is a lack of studies comparing the utility of C-reactive protein (CRP) with Procalcitonin (PCT) for the management of patients with acute respiratory tract infections (ARI) in primary care. Our aim was t... (Source: BMC Pulmonary Medicine)



The physician as patient in palliative care: A retrospective case-note audit.

Wed, 23 Mar 2016 23:00:00 +0100

CONCLUSION: This study adds to the growing body of literature that identifies the potential difficulties associated with caring for medical practitioners. By understanding some of the complexity of this particular doctor-patient relationship, clinicians can approach the management of physician-patients facing the end of their lives with a more sound understanding of their particular care needs. PMID: 27013531 [PubMed - as supplied by publisher] (Source: Australian Family Physician)



New Psoriasis Drug Approved (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By the Editors The FDA has approved ixekizumab (Taltz) to treat moderate-to-severe … (Source: Physician's First Watch current issue)

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FDA Approves New Drug for Severe Asthma (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By Kristin J. Kelley Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM The FDA has approved reslizumab (Cinqair) as a maintenance treatment for severe … (Source: Physician's First Watch current issue)



WHO: Zika Circulating in 38 Countries, Linked to Guillain-Barré in 12 (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By Amy Orciari Herman Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM The Zika virus is currently circulating in 38 countries and territories, WHO Director-General Margaret Chan said in … (Source: Physician's First Watch current issue)






Gender inequalities in COPD decision-making in primary care

Wed, 23 Mar 2016 23:00:00 +0100

COPD is a frequent severe illness that increasingly affects females. Gender inequalities have been reported in COPD care. (Source: Respiratory Medicine CME)



Atopic dermatitis, asthma and allergic rhinitis in general practice and the open population: a systematic review.

Wed, 23 Mar 2016 23:00:00 +0100

CONCLUSION: There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. KEY POINTS Epidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations. On average, the prevalence of atopic disorders is higher in the open population. GPs should take into account the possible misclassific...

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Your NEJM Group Today: Flint's Water Crisis, Naltrexone-Bupropion's CV Risk Unknown, Maine Hospitalist Opportunity (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By the Editors NEJM Group offers so many valuable resources for practicing clinicians. Here's what we chose for you today: … (Source: Physician's First Watch current issue)



Incretin-Based Diabetes Drugs Not Tied to Heart Failure Hospitalizations (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By Kelly Young Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM Use of incretin-based drugs for type 2 diabetes — including dipeptidyl-peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 analogues — is not associated with increased risk for … (Source: Physician's First Watch current issue)



The Effect of Fish Oil Supplementation on Serum Phospholipid Fatty Acids Profile during Pregnancy: A Double Blind Randomized Controlled Trial.

Wed, 23 Mar 2016 23:00:00 +0100

The objective of this study was to evaluate the effect of fish oil supplementation in pregnancy on maternal serum FA profiles. Participants (n = 150 pregnant women aged 18-35 years in Tabriz, Iran) were randomly assigned to receive either 1000 mg fish oil supplements daily containing 120 mg docosahexanoic acid (DHA) and 180 mg eicosapentaenoic acid (EPA), or placebo from week 21 of pregnancy to delivery. The primary outcome measures were mean serum DHA and EPA proportion of total FAs at weeks 35-37 of pregnancy. Analyses were based on intention-to-treat. No significant differences were observed between the groups in consumption of fish and serum FAs levels at baseline. Fish oil supplementation significantly increased the mean DHA proportion of total FAs in the intervention compared t...



Atopic dermatitis, asthma and allergic rhinitis in general practice and the open population: a systematic review.

Wed, 23 Mar 2016 23:00:00 +0100

CONCLUSION: There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. KEY POINTS Epidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations. On average, the prevalence of atopic disorders is higher in the open population. GPs should take into account the possible misclassific...



GP services to receive £17m boost in Northern Ireland

Wed, 23 Mar 2016 23:00:00 +0100

£7m uplift to GP contract and £10m premises loan fundRelated items from OnMedicaNew funding plans will drive NHS integrationOut-of-hours pilots to test new models of careGP services reach point of ‘emergency’ warning£20m boost for GP pay and servicesNHS provides £15m for pharmacists in GP surgeries (Source: OnMedica Latest News)

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Campaign credited with fall in antibiotic prescribing

Wed, 23 Mar 2016 23:00:00 +0100

The number of prescriptions for antibiotics made by GPs and others in primary care fell by nearly 8% last year, following a national campaign to reduce avoidable prescribing. (Source: NHS Networks)



Putting doctors and patients on the same page

Wed, 23 Mar 2016 23:00:00 +0100

The Commonwealth Fund has published results of a trial by Harvard researchers in which 100 primary care doctors were asked to share their notes made during consultations with their patients. (Source: NHS Networks)



Antibiotic prescribing falls in general practice

Wed, 23 Mar 2016 23:00:00 +0100

7.9% fall in antibiotic prescribing in a year Related items from OnMedicaRCGP backs O’Neill’s call for investment in new antimicrobialsPoint-of-care diagnostics needed to curb antimicrobial resistanceBetter use of vaccines could help tackle antimicrobial resistance Tackling antimicrobial resistancePatient safety alert issued on antimicrobial resistance (Source: OnMedica Latest News)



Parents Who Sleep Poorly Overestimate Their Children's Sleep Problems (FREE)

Wed, 23 Mar 2016 23:00:00 +0100

By John Cowden, MD, MPH Dr. Cowden is an associate editor with NEJM Journal Watch Pediatrics and Adolescent Medicine, from which this summary was adapted. Full coverage is available at the link below.Parents who sleep poorly report more sleep problems … (Source: Physician's First Watch current issue)



Simplified vs comprehensive echocardiographic grading of left ventricular diastolic dysfunction in primary care

Wed, 23 Mar 2016 23:00:00 +0100

Echocardiographic determination of left ventricular (LV) diastolic dysfunction (DD) is associated with increased morbidity and mortality, irrespective of symptoms and ejection fraction [1]. In particular, a comprehensive approach for grading DD (cDD) integrating measurements of LV filling velocities at rest and during Valsalva maneuver, the assessment of pulmonary vein flow (PVF), and early diastolic mitral annulus velocities (e′) by Doppler tissue imaging has been proven prognostically relevant [2]. (Source: International Journal of Cardiology)

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Race, Insurance Status, and Nulliparous, Term, Singleton, Vertex Cesarean Indication: A Case Study of a New England Tertiary Hospital

Wed, 23 Mar 2016 23:00:00 +0100

The current U.S. cesarean section rate (32.2%) is recognized as too high in light of its negative health impacts on women and infants. Efforts are underway in several states and individual hospitals to lower the rate of cesarean section among low-risk women, defined as nulliparous (first birth), term (≥37 weeks gestation), singleton (one baby), vertex (head down presentation; NTSV). (Source: Womens Health Issues)



Stopping systemic menopausal hormone therapy: Why, when and how

Wed, 23 Mar 2016 23:00:00 +0100

(Source: Maturitas)



Hot flushes and reproductive hormone levels during the menopausal transition

Wed, 23 Mar 2016 23:00:00 +0100

(Source: Maturitas)



Over 90? TAVR May Still Be Worth it for Selected Patients

Wed, 23 Mar 2016 22:35:03 +0100

(MedPage Today) -- Outcomes on par with their younger counterparts at 1 year (Source: MedPage Today Primary Care)



Higher levels of function before hip fracture tied to greater fears of falling at 1 year

Wed, 23 Mar 2016 21:28:23 +0100

WASHINGTON – Fear of falling at 12 weeks was associated with poorer functional recovery up to 1 year after hip fracture, particularly if the person had a high level of function before the fracture, a... (Source: Family Practice News)



Drug Abuse Experts Stump for Opioid Addiction Tx Bill

Wed, 23 Mar 2016 21:08:55 +0100

(MedPage Today) -- Ninety percent of patients needing treatment don't get it (Source: MedPage Today Primary Care)



Why Can’t Hospitals Learn To 'Fly'?

Wed, 23 Mar 2016 21:05:33 +0100

(MedPage Today) -- Hospitals need to learn from the aviation industry, says David Nash, MD, MBA (Source: MedPage Today Primary Care)