Management Of Common Medical Conditions Research Articles

Management of Common Medical Conditions in End-Stage Kidney Disease by the General Practitioner

Management of Common Medical Conditions in End-Stage Kidney Disease by the General Practitioner

Management of Common Medical Conditions by Office-Based Psychiatrists.

This study examined the extent of psychiatrists' involvement in general medical management activities for their patients. With data from the 2006-2013 U.S. National Ambulatory Medical Survey-an annual cross-sectional survey of visits in a random week to office-based physicians-general medical management activities in 11,046 visits to psychiatrists, 66,267 to general medical physicians (general and family physicians and internists), and 158,933 to other physicians were compared. General medical management activities included recordings of hypertension, hyperlipidemia, diabetes, or obesity; prescriptions of medications for hypertension, hyperlipidemia, or diabetes; blood pressure or weight measurements; ordering glucose, glycohemoglobin (HbA1c), lipids, or cholesterol laboratory tests; and education or counseling for weight, exercise, diet and nutrition, or tobacco use. Any of the target general medical management activities were provided in 37.0% of visits to psychiatrists, compared with 98.0% of visits to general medical physicians and 78.4% to other physicians. Differences between psychiatrists and all other physician groups were smaller for health education and counseling. For each general medical management activity, many of the psychiatrists did not engage in the activity in any of their sampled visits. The most consistent predictors of general medical management activities in each psychiatrist visit were the extent of these activities in other visits to the same psychiatrist and having recorded other types of general medical management activities in the same visit. Efforts to expand psychiatric practice to general medical management activities require better understanding of barriers to such expansion, better characterization of conditions under which such expansion is feasible, and continuing medication education.

Reforming the 4th-Year Curriculum as a Springboard to Graduate Medical Training: One School's Experiences and Lessons Learned

ABSTRACTProblem: Concerns regarding the quality of training in the 4th year of medical school and preparation of graduates to enter residency education persist and are borne out in the literature. Intervention: We reviewed the published literature regarding Year 4 concerns as well as institutional efforts to improve the 4th-year curriculum from several schools. Based on input from key stakeholders, we established 4 goals for our Year 4 curriculum reform: (a) standardize the curricular structure, (b) allow flexibility and individualization, (c) improve the preparation for residency, and (d) improve student satisfaction. After the reform, we evaluated the outcomes using results from the Association of American Medical Colleges Questionnaire, student focus groups, and program director surveys. Context: This article describes the context, process, and outcomes of the reform of the Year 4 curriculum at Stony Brook University School of Medicine. Outcome: We were able to achieve all four stated goals for the reform. The significant components of the change included a flexible adaptable curriculum based on individual needs and preferences, standardized learning objectives across the year, standardized competency-based evaluations regardless of discipline, reinforcement of clinical skills, and training for the transition to the workplace as an intern. The reform resulted in increased student satisfaction, increased elective time, and increased preparedness for residency training as perceived by the graduates. The Program Director survey showed significant changes in ability to perform a medical history and exam, management of common medical conditions and emergencies, clinical reasoning and problem-solving skills, working and communication with the healthcare team, and overall professionalism in meeting obligations inherent in the practice of medicine. Lessons Learned: Lessons learned from our 4th-year reform process are discussed. Listening to the needs of the stakeholders was an important step in ensuring buy-in, having an institutional champion with an organizational perspective on the overall institutional mission was helpful in building the guiding coalition for change, building highly interactive collaborative interdisciplinary teams to work together addressed departmental silos and tunnel vision early on, and planning a curriculum is exciting but planning the details of the implementation can be quite tedious.

APA's Education Council Issues Report on Need for Integrated Care Training

APA's Education Council Issues Report on Need for Integrated Care Training

Common Ultramarathon Injuries and Illnesses

Participation in ultramarathons has become increasingly popular especially among nonelite athletes. Ultramarathons have a wide spectrum of race characteristics from the variety of distances to environmental factors. Ultramarathons continue to attract a relatively small number of participants who on average are more experienced than marathon runners. There are limited epidemiologic studies on common ultramarathon injuries and illnesses. Musculoskeletal and dermatologic problems are very common among ultramarathoners. Each ultramarathon is unique, and medical directors should try to establish an injury surveillance system in order to be better prepared for possible medical conditions. The focus of this article is on the evaluation and management of common medical conditions encountered during ultramarathons.

Aligning Patient Preferences and Patient Care at the End of Life

Aligning Patient Preferences and Patient Care at the End of Life

Determining the professional attributes of a hospitalist: experience in one Australian metropolitan hospital

Data were prospectively recorded on 1294 consecutive patients admitted to a General Medical Unit at the Gold Coast Hospital to review the caseload and pre-requisite professional skills of a general physician working as a full-time hospitalist. Based on this review, the general physician hospitalist must possess expertise in the management of common medical conditions and comorbidities, uncommon medical conditions, elderly patients, the seriously ill, the terminally ill, psychiatric patients, surgical patients and patients with dermatologic, ophthalmic and gynaecological problems. The hospitalist must also be proficient in medical education and organization governance. The demonstration of such skills ensures the 'hospitalist' model is efficient and effective for hospital-based care.

Emerging Credentialing Practices, Malpractice Liability Policies, and Guidelines Governing Complementary and Alternative Medical Practices and Dietary Supplement Recommendations

Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.

Treating the mind and body in schizophrenia: risks and prevention.

Patients with schizophrenia have increased mortality due to higher rates of suicide. However, natural causes of death, such as cardiovascular disease, also contribute greatly to excess mortality. Significant sources of cardiovascular risk in this patient population include high smoking prevalence, inactive lifestyles, poor dietary habits, and the metabolic effects of atypical antipsychotics. These sources of risk interact with underrecognition of common medical conditions by mental health providers, limited access to primary care services, and undertreatment of health conditions in the general medical setting. For many patient with severe mental illness, the mental health setting represents the sole source of medical care, making the psychiatrist the de facto primary care provider for these individuals. With the recent focus on medical consequences of antipsychotic treatment, psychiatrist have an obligation to minimize these adverse effects by choosing antipsychotics with lower risk for metabolic side effects, and becoming familiar with the screening and management of common medical conditions.

Evaluation of the impact of pharmacist-led therapeutic tutorials on third-year medical students' knowledge and understanding of drugs used in clinical practice

Three cohorts of third-year medical students on clinical placements were compared (n = 48). One cohort (study group, n = 18) attended a series of therapeutic tutorials led by the pharmacist. The other two cohorts (control group A and control group B) did not. The tutorials focused on using problem-based cases to review the therapeutic management of common medical conditions. The performance of the three cohorts was assessed using a written therapeutics test consisting of multiple-choice questions and problem-based cases. The study group also completed a questionnaire, which sought to obtain their opinions on the tutorials. The study group performed significantly better than control group A and control group B in both the multiple-choice questions and problem-based cases (p < 0.05, Student's t-test). The responses to the questionnaires indicated that all students welcomed the opportunity for structured teaching of therapeutics during their clinical placements. The students identified the need for more teaching of therapeutics in the undergraduate medical curriculum. All the students agreed that the pharmacist was an appropriate person to lead the tutorials.

Medical Considerations in Ambulatory Surgery

In addition to improving technique, a plastic surgeon who chooses to operate in an office surgical setting must become proficient in preoperative evaluation, management of common medical conditions, and recognition of iatrogenic pharmacologic complications. Attention to these factors should provide a sound basis for successful outcome for patients.